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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2018

Open Access 01-12-2018 | Research article

Hypertension, mitral valve disease, atrial fibrillation and low education level predict delirium and worst outcome after cardiac surgery in older adults

Authors: Fátima R. Oliveira, Victor H. Oliveira, Ítalo M. Oliveira, José W. Lima, Daniela Calderaro, Danielle M. Gualandro, Bruno Caramelli

Published in: BMC Anesthesiology | Issue 1/2018

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Abstract

Background

Delirium is a common complication after cardiac surgery in older adult patients. However, risk factors and the influence of delirium on patient outcomes are not well established. We aimed to determine the incidence, predisposing and triggering factors of delirium following cardiac surgery.

Methods

One hundred seventy-three consecutive patients aged ≥60 years were studied. Patients’ characteristics and two cognitive function assessment tests were recorded preoperatively. Perioperative variables were blood transfusion, orotracheal intubation time (OIT), renal dysfunction, and hypoxemia. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit. The composite outcome consisted of death, infection, and perioperative myocardial infarction until hospital discharge or 30 days after surgery, and for up to 18 months.

Results

One hundred six patients (61.27%) were men and the age was 69.5 ± 5.8 years. EuroSCORE II index was 4.06 ± 3.86. Hypertension was present in 75.14%, diabetes in 39.88%, and 30.06% were illiterate. Delirium occurred in 59 patients (34.1%). Education level (OR 0.81, 0.71–0.92), hypertension (OR 2.73, 1.16–6.40), and mitral valve disease (OR 2.93, 1.32–6.50) were independent predisposing factors for delirium, and atrial fibrillation after surgery (OR 2.49, 1.20–5.20) represented the potential triggering factor. Delirium (OR 2.35, 1.20–4.58) and OIT ≥ 900 min (OR 2.50; 1.30–4.80) were independently associated with the composite outcome.

Conclusions

In older adult patients submitted to cardiac surgery, delirium is a frequent complication that is associated with worst outcome. Independent risk factors for delirium included education level, hypertension, mitral valve disease, and atrial fibrillation after cardiac surgery.
Literature
1.
Rudolph JL, Inouye SK, Jones RN, Yang FM, Fong TG, Levkoff SE, et al. Delirium: an independent predictor of functional decline after cardiac surgery. J Am Geriatr Soc. 2010;58:643–9.CrossRefPubMedPubMedCentral
2.
Sockalingam S, Parekh N, Bogoch II, Sun J, Mahtani R, Beach C, et al. Delirium in the postoperative cardiac patient: a review. J Card Surg. 2005;20(6):560–7.CrossRefPubMed
3.
Kazmierski J, Kowman M, Banach M, Fendler W, Okonski P, Banys A, et al. Incidence and predictors of delirium after cardiac surgery: results from the IPDACS study. J Psychosom Res. 2010;69(2):179–85.CrossRefPubMed
4.
Lin Y, Chen J, Wang Z. Meta-analysis of factors which influence delirium following cardiac surgery. J Card Surg. 2012;27:481–92.CrossRefPubMed
5.
Guenther U, Theuerkauf N, Frommann I, Brimmers K, Malik R, Stori S, et al. Predisposing and precipitating factors of delirium after cardiac surgery. A prospective observational cohort study. Ann Surg. 2013;257:1160–7.CrossRefPubMed
6.
7.
PHF B, SMD B, Campacci SR, Juliano Y. O mini-exame do estado mental em uma população geral: impacto da escolaridade. Arq Neuropsiquiatr. 1994;52:1–7.CrossRef
8.
Brucki SMD, Malheiros SMF, Okamoto IH, Bertolucci PHF. Dados normativos para o teste de fluência verbal categoria animais em nosso meio. Arq Neuropsiquiatr. 1997;55:56–61.CrossRefPubMed
9.
Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A method for detection of delirium. Ann Intern Med. 1990;113:941–8.CrossRefPubMed
10.
Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, et al. Delirium in mechanically ventilated patients. Validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286:2703–10.CrossRefPubMed
11.
Blazer DG, van Nieuwenhuizen AO. Evidence for the diagnostic criteria of delirium: an update. Curr Opin Psychiatry. 2012;25:239–43.CrossRefPubMed
12.
Bellomo R, Kellum JA, Ronco C. Defining and classifying acute renal failure: from advocacy to consensus and validation of the RIFLE criteria. Intensive Care Med. 2007;33:409–13.CrossRefPubMed
13.
14.
van Belle G. Statistical rules of thumb. 2nd ed. New Jersey: John Wiley and Sons; 2008.CrossRef
15.
Hosmer DW, Lemeshow S Jr, Sturdivant RX. Applied logistic regression. 3rd ed. New Jersey: John Wiley and Sons; 2013.CrossRef
16.
Arenson BG, MacDonald LA, Grocolt HP, Hiebert BM, Arora RC. Effect of intensive care unit environment on in-hospital delirium after cardiac surgery. J Thorac Cardiovasc Surg. 2013;146(1):172–8.CrossRefPubMed
17.
Jones RN, Yang FM, Zhang Y, Kiely DK, Marcantonio ER, Inouye SK. Does educational attainment contribute to risk for delirium? A potential role for cognitive reserve. J Gerontol A Biol Sci Med Sci. 2006;61:1307–11.CrossRefPubMed
18.
Stern Y, Gurland B, Tatemichi TK, Tang MX, Wilder D, Mayeux R. Influence of education and occupation on the incidence of Alzheimer’s disease. JAMA. 1994;271:1004–10.CrossRefPubMed
19.
Sprung J, Roberts RO, Weingarten TN, Cavalcante AN, Knopman DS, Petersen RC, et al. Postoperative delirium in elderly patients is associated with subsequente cognitive impairment. Br J Anaesth. 2017;119(2):316–23.CrossRefPubMed
20.
Sauër AC, Veldhuijzen DS, Ottens TH, Slooter AJC, Kalkman CJ, van Dijk D. Association between delirium and cognitive change after cardiac surgery. Br J Anaesth. 2017;119(2):308–15.CrossRefPubMed
21.
Norkienė I, Ringaitienė D, Kuzminskaitė V, Šipylaitė J. Incidence and risk factors of early delirium after cardiac surgery. Bio Med Res Int 2013;2013:323491.
22.
Koster S, Hensens AG, van der Palen J. The long-term cognitive and functional outcomes of postoperative delirium after cardiac surgery. Ann Thorac Surg. 2009;87:1469–74.CrossRefPubMed
23.
Saczynski JS, Marcantonio ER, Quach L, Fong TG, Gross A, Inouye SK, et al. Cognitive trajectories after postoperative delirium. N Engl J Med. 2012;367:30–9.CrossRefPubMedPubMedCentral
24.
Rudolph JL, Schreiber KA, Culley DJ, McGlinchey RE, Crosby G, Levitsky S, et al. Measurement of postoperative cognitive dysfunction after cardiac surgery: a systematic review. Acta Anaesthesiol Scand. 2010;54:663–77.CrossRefPubMedPubMedCentral
25.
Jodati A, Safaie N, Raoofi M, Ghorbani L, Ranjbar F, Noorazar G, et al. Prevalence and risk factors of postoperative delirium in patients undergoing open heart surgery in northwest of Iran. J Cardiovasc Thorac Res. 2013;5(3):97–9.PubMedPubMedCentral
26.
Joudi M, Fathi M, Harati H, Joudi M, Izanloo A, Rahdari A, et al. Evaluating the incidence of cognitive disorder following off-pump coronary artery bypasses surgery and its predisposing factors. Anesth Pain Med. 2014;4:e18545.PubMedPubMedCentral
27.
Zaal IJ, Devlin JW, Peelen LM, Slooter AJC. A systematic review of risk factors for delirium in the ICU. Crit Care Med. 2015;43:40–7.CrossRefPubMed
28.
Huai J, Ye X. A meta-analysis of critically ill patients reveals several potential risk factors for delirium. Gen Hosp Psychiatry. 2014;36:488–96.CrossRefPubMed
29.
Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41:263–306.CrossRefPubMed
30.
Rudolph JL, Babikian VL, Treanor P, Pochay VE, Wigginton JB, et al. Microemboli are not associated with deliriumafter coronary artery by-pass graft surgery. Perfusion. 2009;24(6):409–15.CrossRefPubMedPubMedCentral
31.
Schneider F, Onnasch JF, Falk V, Walther T, Autschbach R, Mohr FW. Cerebral microemboli during minimally invasive and conventional mitral valve operations. Ann Thorac Surg. 2000;70(3):1094–7.CrossRefPubMed
32.
Santos FS, Velasco IT, Fráguas R Jr. Riskfactors for delirium in the elderly after coronary artery bypass graft surgery. Int Psychogeriatr. 2004;16(2):175–93.CrossRefPubMed
33.
Andrejaitiene J, Sirvinskas E. Early post-cardiac surgery delirium risk factors. Perfusion. 2011;27(2):105–12.CrossRefPubMed
34.
35.
Shadvar K, Baastani F, Mahmoodpoor A, Bilehjani E. Evaluation of the prevalence and risk factors of delirium in cardiac surgery ICU. J Cardiovasc Thorac Res. 2013;5(4):157–61.PubMedPubMedCentral
36.
Bucerius J, Gummert JF, Borger MA, Walther T, Doll N, Falk V, et al. Predictors of delirium after cardiac surgery delirium: effect of beating-heart (off-pump) surgery. J Thorac Cardiovasc Surg. 2004;127(1):57–64.CrossRefPubMed
37.
Gottesman RF, Grega MA, Bailey MM, et al. Delirium after coronary artery bypass graft surgery and late mortality. Ann Neurol. 2010;67(3):338–44.PubMedPubMedCentral
38.
Lima DP, Ochiai ME, Lima AB, Curiati JAE, Farfel JM, Filho WJ. Delirium in hospitalized elderly patients and post-discharge mortality. Clinics. 2010;65:251–5.CrossRefPubMedPubMedCentral
39.
McCusker J, Cole M, Abrahamowicz M, Primeau F, Belzile E. Delirium predicts 12-month mortality. Arch Intern Med. 2002;162:457–63.CrossRefPubMed
40.
Rockwood K, Cosway S, Carver D, Jarrett P, Stadnyk K, Fisk J. The risk of dementia and death after delirium. Age Ageing. 1999;28(6):551.CrossRefPubMed
41.
42.
Metadata
Title
Hypertension, mitral valve disease, atrial fibrillation and low education level predict delirium and worst outcome after cardiac surgery in older adults
Authors
Fátima R. Oliveira
Victor H. Oliveira
Ítalo M. Oliveira
José W. Lima
Daniela Calderaro
Danielle M. Gualandro
Bruno Caramelli
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2018
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-018-0481-0

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