Thorac Cardiovasc Surg 2020; 68(05): 417-424
DOI: 10.1055/s-0040-1708046
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Risk and Consequences of Postoperative Delirium in Cardiac Surgery

Yukiharu Sugimura
1  Department of Cardiac Surgery, University Hospital, Duesseldorf, Germany
,
Nihat Firat Sipahi
1  Department of Cardiac Surgery, University Hospital, Duesseldorf, Germany
,
Arash Mehdiani
1  Department of Cardiac Surgery, University Hospital, Duesseldorf, Germany
,
Georgi Petrov
1  Department of Cardiac Surgery, University Hospital, Duesseldorf, Germany
,
Mareike Awe
1  Department of Cardiac Surgery, University Hospital, Duesseldorf, Germany
,
Jan Philipp Minol
1  Department of Cardiac Surgery, University Hospital, Duesseldorf, Germany
,
1  Department of Cardiac Surgery, University Hospital, Duesseldorf, Germany
,
Bernhard Korbmacher
1  Department of Cardiac Surgery, University Hospital, Duesseldorf, Germany
,
Artur Lichtenberg
1  Department of Cardiac Surgery, University Hospital, Duesseldorf, Germany
,
Hannan Dalyanoglu
1  Department of Cardiac Surgery, University Hospital, Duesseldorf, Germany
› Author Affiliations
Funding None.
Further Information

Publication History

26 October 2019

16 January 2020

Publication Date:
29 March 2020 (online)

Abstract

Background Delirium is a common complication after cardiac surgery that leads to increased costs and worse outcomes. This retrospective study evaluated the potential risk factors and postoperative impact of delirium on cardiac surgery patients.

Methods One thousand two hundred six patients who underwent open-heart surgery within a single year were included. Uni- and multivariate analyses of a variety of pre, intra-, and postoperative parameters were performed according to differences between the delirium (D) and nondelirium (ND) groups.

Results The incidence of delirium was 11.6% (n = 140). The onset of delirium occurred at 3.35 ± 4.05 postoperative days with a duration of 5.97 ± 5.36 days. There were two important risk factors for postoperative delirium: higher age (D vs. ND, 73.1 ± 9.04 years vs. 69.0 ± 11.1 years, p < 0.001) and longer aortic cross-clamp time (D vs. ND, 69.8 ± 49.9 minutes vs. 61.6 ± 53.8 minutes, p < 0.05). We found that delirious patients developed significantly more frequent postoperative complications, such as myocardial infarction (MI) (D vs. ND, 1.43% [n = 3] vs. 0.28% [n = 2], p = 0.05), cerebrovascular accident (D vs. ND, 10.7% [n = 15] vs. 3.75% [n = 40], p < 0.001), respiratory complications (D vs. ND, 16.4% [n = 23] vs. 5.72% [n = 61], p < 0.001), and infections (D vs. ND, 36.4% [n = 51] vs. 16.0% [n = 170], p < 0.001). The hospital stay was longer in cases of postoperative delirium (D vs. ND, 23.2 ± 13.6 days vs. 17.4 ± 12.8 days, p < 0.001), and fewer patients were discharged home (D vs. ND, 56.0% [n = 65] vs. 66.8% [n = 571], p < 0.001).

Conclusions Because the propensity for delirium-related complications is high after cardiac surgery, a practical, preventative strategy should be developed for patients with perioperative risk factors, including higher age and a longer cross-clamp time.

Author Contributions

Conceptualization, U.B. and H.D.;methodology, U.B. and H.D.; software, Y.S. and M.C.A.; validation, U.B., B.K., H.D. and A.L.; formal analysis, Y.S. and M.C.A.; investigation, M.C.A.; data curation, Y.S. and M.C.A.; writing—original draft preparation, Y.S. and M.C.A.; writing—review and editing, N.F.S, A.M., G.P. and J.P.M; visualization, Y.S.; supervision, U.B., B.K., H.D. and A.L.; project administration, H.D.