Independent External Validation of a Preoperative Prediction Model for Delirium After Cardiac Surgery: A Prospective Observational Cohort Study

Dec 25, 2022Journal of cardiothoracic and vascular anesthesia

Testing a model that predicts delirium risk before heart surgery in a new patient group

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Abstract

Out of 348 patients undergoing cardiac surgery, 17.4% developed postoperative delirium.

Patients with a prediction model score of 0 had a 12.6% incidence of postoperative delirium.
Scores of 1, 2, and ≥3 corresponded to incidences of 22.8%, 25.8%, and 35%, respectively.
The predictive model included four preoperative risk factors related to cognitive function and prior medical history.
The model demonstrated a pooled area under the receiver operating characteristics curve of 0.60, indicating poor discriminative capacity.
Calibration of the model was assessed and found to be fair.

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OBJECTIVE: This investigation provided independent external validation of an existing preoperative risk prediction model.

DESIGN: A prospective observational cohort study of patients undergoing cardiac surgery covering the period between April 16, 2018 and January 18, 2022.

SETTING: Two academic hospitals in Switzerland.

PARTICIPANTS: Adult patients (≥60 years of age) who underwent elective cardiac surgery, including coronary artery bypass graft, mitral or aortic valve replacement or repair, and combined procedures.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: The primary outcome measure was the incidence of postoperative delirium (POD) in the intensive or intermediate care unit, diagnosed using the Intensive Care Delirium Screening Checklist. The prediction model contained 4 preoperative risk factors to which the following points were assigned: Mini-Mental State Examination (MMSE) score ≤23 received 2 points; MMSE 24-27, Geriatric Depression Scale (GDS) >4, prior stroke and/or transient ischemic attack (TIA), and abnormal serum albumin (≤3.5 or ≥4.5 g/dL) received 1 point each. The missing data were handled using multiple imputation. In total, 348 patients were included in the study. Sixty patients (17.4%) developed POD. For point levels in the prediction model of 0, 1, 2, and ≥3, the cumulative incidence of POD was 12.6%, 22.8%, 25.8%, and 35%, respectively. The validation resulted in a pooled area under the receiver operating characteristics curve of 0.60 (median CI, 0.525-0.679).

CONCLUSIONS: The evaluated predictive model for delirium after cardiac surgery in this patient cohort showed only poor discriminative capacity but fair calibration.

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Independent External Validation of a Preoperative Prediction Model for Delirium After Cardiac Surgery: A Prospective Observational Cohort Study

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