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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 11/2017

01-11-2017 | Reports of Original Investigations

Risk factors for delirium after cardiac surgery: a historical cohort study outlining the influence of cardiopulmonary bypass

Authors: Jason B. O’Neal, MD, Frederic T. Billings IV, MD, MSCI, Xulei Liu, MS, Matthew S. Shotwell, PhD, Yafen Liang, MD, Ashish S. Shah, MD, Jesse M. Ehrenfeld, MD, MPH, Jonathan P. Wanderer, MD, MPhil, Andrew D. Shaw, MB, FRCA, FFICM

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 11/2017

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Abstract

Purpose

Cardiopulmonary bypass (CPB) induces a significant inflammatory response that may increase the risk for delirium. We hypothesized that exposure to CPB during coronary artery bypass grafting (CABG) surgery would correlate with an increased risk of delirium.

Methods

We reviewed clinical data from two databases at our medical centre - the Cardiac Surgery Perioperative Outcomes Database and the Society of Thoracic Surgeons Database. Patients undergoing elective CABG surgery (on-pump and off-pump) from November 1, 2009 to September 30, 2015 were included in the study. Delirium was defined as any postoperative positive Confusion Assessment Method for the Intensive Care Unit exam during the intensive care unit stay. We performed logistic regression to isolate the association between CPB exposure and delirium adjusted for predetermined risk factors and potential confounders.

Results

During the study period, 2,280 patients underwent elective CABG surgery, with 384 patients (16.9%) exposed to CPB. Delirium was diagnosed in 451 patients (19.8%). Exposure to CPB showed a significant independent association with delirium. Patients exposed to CPB for 142 min (90th percentile of CPB duration) vs those exposed for 54 min (10th percentile) had an adjusted relative risk (RR) of delirium of 2.18 (95% confidence interval [CI], 1.39 to 3.07; P = 0.002) vs a RR of 1.51 (95% CI, 0.92 to 2.29; P = 0.10), respectively.

Conclusions

The use and duration of cardiopulmonary bypass were associated with an increased risk of delirium in patients undergoing CABG surgery.

Trial registration

www.​clinicaltrials.​gov, NCT02548975. Registered 4 September 2015.
Appendix
Available only for authorised users
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Metadata
Title
Risk factors for delirium after cardiac surgery: a historical cohort study outlining the influence of cardiopulmonary bypass
Authors
Jason B. O’Neal, MD
Frederic T. Billings IV, MD, MSCI
Xulei Liu, MS
Matthew S. Shotwell, PhD
Yafen Liang, MD
Ashish S. Shah, MD
Jesse M. Ehrenfeld, MD, MPH
Jonathan P. Wanderer, MD, MPhil
Andrew D. Shaw, MB, FRCA, FFICM
Publication date
01-11-2017
Publisher
Springer US
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 11/2017
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-017-0938-5

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