Association of postoperative delirium with hypotension in critically ill patients after cardiac surgery: a prospective observational study.

BACKGROUND: Postoperative delirium (POD), an acute and variable disturbance in cognitive function, is an intricate and elusive phenomenon that occurs after cardiac surgery. Despite progress in surgical techniques and perioperative management, POD remains a formidable challenge, imposing a significant burden on patients, caregivers, and healthcare systems. METHODS: This prospective observational study involved 307 patients who underwent cardiac surgery. Data on the occurrence of delirium, clinical parameters, and postoperative characteristics were collected. A multivariate analysis was performed to assess the relationship between POH and POD. RESULTS: Sixty-one patients (21%) developed delirium, with an average onset of approximately 5 days postoperatively and a duration of approximately 6 days. On multivariate analysis, POH was significantly associated with POD, and the adjusted odds ratios indicated that patients with POH were more likely to develop delirium (OR, 5.61; p = 0.006). Advanced age (OR, 1.11; p = 0.002), emergency surgery (OR, 8.31; p = 0.001), and on-pump coronary artery bypass grafting were identified as risk factors of POD. Patients who developed delirium were typically older, more likely to be male, and had higher morbidity rates than those who did not. CONCLUSION: POH is significantly associated with delirium in critically ill patients after cardiac surgery. Surgical complexity and advanced age contribute to the risk of developing POD and poor postoperative outcomes.

Identification of early delirium and its outcomes after cardiopulmonary bypass among adult patients with cardiovascular disease: a prospective observational study.

Purpose: To identify the incidence and outcomes of postoperative delirium after cardiopulmonary bypass machine in adult cardiac surgery patients. Method: A prospective observational study was conducted in a single-center institution in the Republic of China. This study included 273 patients who underwent cardiac surgical procedures requiring cardiopulmonary bypass machine utilization. Results: This study used the Confusion Assessment Method to screen for delirium. Univariate analysis identified advanced age, emergency surgery and prolonged aortic cross-clamping time as significant predisposing factors for delirium, which occurred in 19.8% (n = 54) of cases and typically developed in average of 4.8 ± 3.28 days after the surgery. The analysis also identified that delirium was associated with increased complications and external referrals. A total of 142 patients (52.1%) were discharged to their homes, wherein the discharge rate in the delirium group was notably lower, with only 35.2% (n = 19) of patients, than in the delirium-free group with 56.2% (n = 123) of patients. Conclusion: Considering the increased probability of delirium-related complications following cardiac surgery, it is important to develop effective preventive strategies for patients with perioperative risk factors, such as advanced age, emergency surgery and prolonged cross-clamp time, by implementing practical measures to minimize the risk of delirium.