Preoperative and operative predictors of delirium after cardiac surgery in elderly patients

Feb 21, 2012European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

Factors before and during heart surgery linked to delirium in older patients

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Abstract

Sixty-three patients (31%) developed a delirium after cardiac surgery.

A lower score on the Mini-Mental State Examination prior to surgery was observed in patients who developed delirium (27 vs. 28).
Higher creatinine levels before surgery were found in patients who experienced delirium (98 vs. 88 μmol/l).
Extracorporeal circulation time was significantly longer in delirious patients (145 vs. 113 min).
Delirium was associated with a higher mortality rate within the first 30 days post-surgery (14% vs. 0%).
Low MMSE score, high creatinine level, and increased ECC time may serve as independent predictors of delirium.

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OBJECTIVES: Delirium is a common complication in elderly patients after cardiac surgery and is associated with adverse outcomes including prolonged hospital stay and increased mortality. Therefore, prevention or early detection of delirium is indicated. Our objective was to identify preoperative and operative characteristics that could predict delirium after cardiac surgery in elderly patients.

METHODS: We conducted a prospective cohort study in which we analysed 201 patients of 70 years and older who underwent cardiac surgery, for developing a delirium. Patients were assessed daily using the Confusion Assessment Method-Intensive Care Unit.

RESULTS: Sixty-three patients (31%) developed a delirium after cardiac surgery. The Mini-Mental State Examination (MMSE) score prior to surgery was lower in the delirious patients when compared with the non-delirious patients (27 vs. 28, P = 0.026), creatinine level was higher (98 vs. 88 μmol/l, P = 0.003) and extracorporeal circulation (ECC) time was longer (145 vs. 113 min, P < 0.001). Mortality during the first 30 days after surgery in patients with delirium was significantly higher than that in the non-delirious patients (14 vs. 0%, P < 0.001).

CONCLUSIONS: Low MMSE score and high creatinine level prior to surgery as well as increased ECC time are important independent predictors of delirium. In addition, delirium is an important predictor of 30-day mortality. Patients with a substantial risk for delirium should be candidates for interventions to reduce postoperative delirium and to potentially improve overall surgical outcomes.

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Preoperative and operative predictors of delirium after cardiac surgery in elderly patients

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