Original article
Adult cardiac
Consequences of Delirium After Cardiac Operations

https://doi.org/10.1016/j.athoracsur.2011.07.006Get rights and content

Background

Delirium is a transient mental syndrome characterized by disturbances in consciousness, cognition, and perception. The risk that delirium will develop is increased in patients who undergo cardiac operations, especially the elderly. Generally, delirium during hospital admission is independently associated with many negative consequences, such as higher mortality, increased length of hospital stay, nursing home placement after admission, and cognitive and functional decline.

Methods

This prospective follow-up study used the Short Form 36-Item questionnaire, the Cognitive Failure Questionnaire, and a purpose-designed questionnaire to assess 300 patients who underwent elective cardiac operations at 6 months after the procedure. Postoperative delirium developed in 52 patients (17%). Mortality and readmission were also assessed.

Results

Delirium after cardiac procedures is associated with increased mortality (13.5% vs 2.0% in patients without), more hospital readmissions (45.7% vs 26.5%), and reduced quality of life. It is also associated with reduced cognitive functioning, including failures in attention, memory, perception, and motor function, and with functional dysfunction such as independency in activities of daily living and mobility.

Conclusions

Postoperative delirium after cardiac operations is associated with many important consequences. These findings provide justification for intervention studies to evaluate whether delirium prevention, early recognition, or treatment strategies might improve postoperative functional and cognitive function.

Section snippets

Patients and Methods

The Ethics Committee of Medisch Spectrum Twente ruled that approval was not required because this was an observational study, without invasive procedures. Informed consent was obtained from participating patients in accordance with hospital policy.

Study Population

The study included 300 patients, and postoperative delirium developed in 52 (17%), as diagnosed with the DOS scale. The mean duration of delirium was 1 to 3 days in most patients, sometimes 4 to 7 days, and in 2 patients, 11 and 14 days. The duration of delirium in some patients could not be estimated because they were transferred to another hospital for further postoperative recovery. Almost all patients were treated with a low dose of haloperidol (1 to 3 mg/d), and some patients received a

Comment

Delirium occurring after cardiac operations is associated with increased mortality and a higher hospital readmission rate, lower quality of life, cognitive failure as measured with the CFQ, functional dysfunction such as dependency in ADL, and reduced mobility. Because we assumed age could be a confounder, we corrected the outcomes for age, and found that in the event of delirium, only the incidence of dependency in ADL was no longer significantly higher. In the other outcomes, the correction

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