Predisposing and precipitating factors of delirium after cardiac surgery: a prospective observational cohort study.

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State: Public
Version: author
Serval ID
serval:BIB_540521397EA3
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Predisposing and precipitating factors of delirium after cardiac surgery: a prospective observational cohort study.
Journal
Annals of Surgery
Author(s)
Guenther U., Theuerkauf N., Frommann I., Brimmers K., Malik R., Stori S., Scheidemann M., Putensen C., Popp J.
ISSN
1528-1140 (Electronic)
ISSN-L
0003-4932
Publication state
Published
Issued date
2013
Peer-reviewed
Oui
Volume
257
Number
6
Pages
1160-1167
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov'tPublication Status: ppublish
Abstract
OBJECTIVE: To comprehensively assess pre-, intra-, and postoperative delirium risk factors as potential targets for intervention.
BACKGROUND: Delirium after cardiac surgery is associated with longer intensive care unit (ICU) stay, and poorer functional and cognitive outcomes. Reports on delirium risk factors so far did not cover the full range of patients' presurgical conditions, intraoperative factors, and postoperative course.
METHODS: After written informed consent, 221 consecutive patients ≥ 50 years scheduled for cardiac surgery were assessed for preoperative cognitive performance, and functional and physical status. Clinical and biochemical data were systematically recorded perioperatively.
RESULTS: Of the 215 patients remaining for analysis, 31% developed delirium in the intensive care unit. Using logistic regression models, older age [73.3 (71.2-75.4) vs 68.5 (67.0-70.0); P = 0.016], higher Charlson's comorbidity index [3.0 (1.5-4.0) vs 2.0 (1.0-3.0) points; P = 0.009], lower Mini-Mental State Examination (MMSE) score (MMSE, [27 (23-29) vs 28 (27-30) points; P = 0.021], length of cardiopulmonary bypass (CPB) [CPB; 133 (112-163) vs 119 (99-143) min; P = 0.004], and systemic inflammatory response syndrome in the intensive care unit [25 (36.2%) vs 13 (8.9%); P = 0.001] were independently associated with delirium. Combining age, MMSE score, Charlson's comorbidity index, and length of CPB in a regression equation allowed for a prediction of postoperative delirium with a sensitivity of 71.19% and a specificity of 76.26% (receiver operating analysis, area under the curve: 0.791; 95% confidence interval: 0.727-0.845).
CONCLUSIONS: Further research will evaluate if modification of these risk factors prevents delirium and improves outcomes.
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Web of science
Create date
04/07/2013 20:43
Last modification date
20/08/2019 15:09
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