Factors associated with delirium after cardiac surgery: A prospective cohort study.

Background: Delirium is a frequent complication after cardiac surgery and is associated with a higher incidence of morbidity and mortality and a prolonged hospital stay. However, knowledge of the variables involved in its occurrence is still limited; therefore, in this study, we evaluated the perioperative risk factors independently associated with this complication. Methods: This study was conducted in a referral tertiary care university hospital with a cardiovascular focus. A total of 311 consecutive adult patients undergoing any type of cardiac surgery were evaluated. The subjects were examined at regular intervals in the postoperative period using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) tool. Results: The incidence of postoperative delirium (PD) was 10%. Among the 18 pre-, intra- and postoperative variables evaluated, the logistic regression analysis showed that low education level, history of diabetes or stroke, type of surgery, prolonged extracorporeal circulation, or red blood cell transfusion in the intra- or postoperative period were independently associated with delirium after cardiac surgery. An increased body mass index was identified as a protective factor. Conclusions: The aforementioned risk factors are significantly and independently associated with the presentation of PD. Because some of these factors can be treated or avoided, the results of this study are highly relevant to reduce the risk of this complication and improve the care of patients undergoing cardiac surgery.

Postoperative atrial fibrillation: evaluation of its economic impact on the costs of cardiac surgery

Abstract Objective: The objective of this study was to calculate the direct costs of postoperative atrial fibrillation (POAF) in a high-complexity cardiovascular hospital. Methods: We performed a cost analysis with a pairwise-matched design. Twenty-two patients with POAF and 22 patients without this complication were included. Pair-matching was performed (1:1) based on the following criteria: identical type of surgery, similar EuroSCORE II values, and absence of any other postoperative complication. Results: The total hospital cost was significantly higher in the POAF group than in the non-POAF group (US$ 10,880 [± 2,688] vs. US$ 8,856 [± 1,782], respectively, for each patient; P=0.005). This difference was attributable to postoperative costs (US$ 3,103 [± 1,552] vs. US$ 1,238 [± 429]; P=0.0001) for patients with or without POAF, respectively. The median postoperative lengths of stay were 9 (range 5-17) and 5 (3-9) days for patients with and without POAF (P=0.032), respectively. Preoperatively, no differences were found in the EuroSCORE II values (median 1.7 vs. 1.6, respectively; P=0.91) or direct costs (US$ 1,127 vs. US$ 1,063, respectively; P=0.56) between POAF and non-POAF groups. Conclusion: POAF generates a high economic burden in the overall costs of cardiac surgery, and our results reveal the differential contribution of each of the evaluated factors. This information, which was previously unavailable in this setting, is essential for the development of more effective prevention strategies.

Postoperative Atrial Fibrillation: Evaluation of its Economic Impact on the Costs of Cardiac Surgery.

OBJECTIVE: The objective of this study was to calculate the direct costs of postoperative atrial fibrillation (POAF) in a high-complexity cardiovascular hospital. METHODS: We performed a cost analysis with a pairwise-matched design. Twenty-two patients with POAF and 22 patients without this complication were included. Pair-matching was performed (1:1) based on the following criteria: identical type of surgery, similar EuroSCORE II values, and absence of any other postoperative complication. RESULTS: The total hospital cost was significantly higher in the POAF group than in the non-POAF group (US$ 10,880 [± 2,688] vs. US$ 8,856 [± 1,782], respectively, for each patient; P=0.005). This difference was attributable to postoperative costs (US$ 3,103 [± 1,552] vs. US$ 1,238 [± 429]; P=0.0001) for patients with or without POAF, respectively. The median postoperative lengths of stay were 9 (range 5-17) and 5 (3-9) days for patients with and without POAF (P=0.032), respectively. Preoperatively, no differences were found in the EuroSCORE II values (median 1.7 vs. 1.6, respectively; P=0.91) or direct costs (US$ 1,127 vs. US$ 1,063, respectively; P=0.56) between POAF and non-POAF groups. CONCLUSION: POAF generates a high economic burden in the overall costs of cardiac surgery, and our results reveal the differential contribution of each of the evaluated factors. This information, which was previously unavailable in this setting, is essential for the development of more effective prevention strategies.

Hemoglobin and B-type natriuretic peptide preoperative values but not inflammatory markers, are associated with postoperative morbidity in cardiac surgery: a prospective cohort analytic study.

INTRODUCTION: Risk stratification in cardiac surgery significantly impacts outcome. This study seeks to define whether there is an independent association between the preoperative serum level of hemoglobin (Hb), leukocyte count (LEUCO), high sensitivity C-reactive protein (hsCRP), or B-type natriuretic peptide (BNP) and postoperative morbidity and mortality in cardiac surgery. METHODS: Prospective, analytic cohort study, with 554 adult patients undergoing cardiac surgery in a tertiary cardiovascular hospital and followed up for 12 months. The cohort was distributed according to preoperative values of Hb, LEUCO, hsCRP, and BNP in independent quintiles for each of these variables. RESULTS: After adjustment for all covariates, a significant association was found between elevated preoperative BNP and the occurrence of low postoperative cardiac output (OR 3.46, 95% CI 1.53-7.80, p = 0.003) or postoperative atrial fibrillation (OR 3.8, 95% CI 1.45-10.38). For the combined outcome (death/acute coronary syndrome/rehospitalization within 12 months), we observed an OR of 1.93 (95% CI 1.00-3.74). An interaction was found between BNP level and the presence or absence of diabetes mellitus. The OR for non-diabetics was 1.26 (95% CI 0.61-2.60) and for diabetics was 18.82 (95% CI 16.2-20.5). Preoperative Hb was also significantly and independently associated with the occurrence of postoperative low cardiac output (OR 0.33, 95% CI 0.13-0.81, p = 0.016). Both Hb and BNP were significantly associated with the lengths of intensive care unit and hospital stays and the number of transfused red blood cells (p < 0.002). Inflammatory markers, although associated with adverse outcomes, lost statistical significance when adjusted for covariates. CONCLUSIONS: High preoperative BNP or low Hb shows an association of independent risk with postoperative outcomes, and their measurement could help to stratify surgical risk. The ability to predict the onset of atrial fibrillation or postoperative low cardiac output has important clinical implications. Our results open the possibility of designing studies that incorporate BNP measurement as a routine part of preoperative evaluation, and this strategy could improve upon the standard evaluation in terms of reducing adverse postoperative events.

[Epidemiology of acute coronary syndrome and heart failure in Latin America]. / Epidemiología del síndrome coronario agudo y la insuficiencia cardiaca en Latinoamérica.

Cardiovascular disease is the principle cause of death in Latin America. Data from the World Health Organization indicate that the region is currently experiencing a large-scale epidemic of cardiovascular disease. This could be attributable to demographic and lifestyle changes inherent in the epidemiologic transition: one consequence of increased life-expectancy is longer exposure to cardiovascular risk factors, which results in a higher probability of adverse events. Latin America is one of the regions of the world with the highest burden of cardiovascular risk factors, particularly overweight, dyslipidemia and diabetes mellitus. These factors will have a significant impact on the incidence of coronary events and heart failure in the near future. In addition, infectious conditions, especially Chagas disease and rheumatic fever, affect large sections of the population in the region. Unless preventive measures are introduced in the next three to four decades, the number of deaths due to cardiovascular disease in the region will increase by more than 200%. Data currently available indicate that mortality in patients with acute coronary syndrome is greater in Latin America than in developed countries. Among the possible factors that could explain this finding are the underuse of therapies that have been shown to be effective and the more conservative and later use of surgical and percutaneous interventions. In Latin America, heart failure occurs in younger subjects than in the rest of the world and is most frequently related to ischemic heart disease. However, Chagas disease is close to hypertension as the second most common cause. There is an urgent need for well-designed epidemiologic studies to guide the implementation of preventive measures and appropriate treatment.

Epidemiología del síndrome coronario agudo y la insuficiencia cardiaca en Latinoamérica / Epidemiology of acute coronary syndrome and heart failure in latin america

La enfermedad cardiovascular es la principal causa de muerte en Latinoamérica. Datos de la Organización Mundial de la Salud indican que en la región está en curso una epidemia de enfermedad cardiovascular de grandes proporciones, lo que se puede atribuir a cambios demográficos y de hábitos de vida inherentes a la transición epidemiológica: el incremento en la expectativa de vida trae como consecuencia periodos de exposición a factores de riesgo más largos, lo que resulta en mayor probabilidad de eventos adversos. Latinoamérica es una de las regiones del mundo con más alta carga de factores de riesgo cardiovascular, especialmente sobrepeso, dislipemia y diabetes mellitus; estos factores tendrán un impacto significativo en la incidencia de eventos coronarios e insuficiencia cardiaca en un futuro cercano. Además, factores infecciosos, especialmente Chagas y fiebre reumática, afectan a enormes grupos de población en la región. A menos que se introduzcan medidas preventivas, en las próximas tres décadas el número de muertes en la región atribuidas a enfermedad cardiovascular se incrementará en más del 200%.Los datos disponibles indican que la mortalidad de los pacientes con síndrome coronario agudo en Latinoamérica es mayor que en los países desarrollados. Como causas potenciales para explicar este hallazgo, se mencionan la subutilización de medidas terapéuticas demostradamente eficaces y un uso más conservador y tardío de los procedimientos intervencionistas. La insuficiencia cardiaca en Latinoamérica se presenta en sujetos más jóvenes que en el resto del mundo y se relaciona más frecuentemente con cardiopatía isquémica; sin embargo, la etiología chagásica se aproxima a la hipertensiva como segunda causa. Se necesitan con urgencia estudios epidemiológicos adecuadamente diseñados que permitan guiarla implementación de medidas preventivas y tratamientos apropiados (AU)

Cardiovascular disease is the principle cause of death in Latin America. Data from the World Health Organization indicate that the region is currently experiencing a large-scale epidemic of cardiovascular disease. This could be attributable to demographic and lifestyle changes inherent in the epidemiologic transition: one consequence of increased life-expectancy is longer exposure to cardiovascular risk factors, which results in a higher probability of adverse events. Latin America is one of the regions of the world with the highest burden of cardiovascular risk factors, particularly overweight, dyslipidemia and diabetes mellitus. These factors will have a significant impact on the incidence of coronary events and heart failure in the near future. In addition, infectious conditions, especially Chagas disease and rheumatic fever, affect large sections of the population in the region. Unless preventive measures are introduced in the next three to four decades, the number of deaths due to cardiovascular disease in the region will increase by more than 200%.Data currently available indicate that mortality in patients with acute coronary syndrome is greater in Latin America than in developed countries. Among the possible factors that could explain this finding are the underuse of therapies that have been shown to be effective and the more conservative and later use of surgical and percutaneous interventions. In Latin America, heart failure occurs in younger subjects than in the rest of the world and is most frequently related to ischemic heart disease. However, Chagas disease is close to hypertension as the second most common cause. There is an urgent need for well-designed epidemiologic studies to guide the implementation of preventive measures and appropriate treatment (AU)