Modifiable and Nonmodifiable Risk Factors for Postoperative Delirium After Cardiac Surgery With Cardiopulmonary Bypass

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 24; no. 4; pp. 555 - 559
• Main Authors: Burkhart, Christoph S., MD, Dell-Kuster, Salome, MD, MSc, Gamberini, Melanie, MD, Moeckli, Ariane, Grapow, Martin, MD, Filipovic, Miodrag, MD, Seeberger, Manfred D., MD, Monsch, Andreas U., PhD, Strebel, Stephan P., MD, Steiner, Luzius A., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2010
• Subjects: Aged; Aged, 80 and over; Anesthesia & Perioperative Care; cardiac surgical procedures; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Cardiopulmonary Bypass - adverse effects; Cardiopulmonary Bypass - methods; Critical Care; delirium; Delirium - chemically induced; Delirium - etiology; Delirium - prevention & control; Female; fentanyl; Fentanyl - adverse effects; Humans; Male; mechanical ventilation; Postoperative Complications - chemically induced; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Prospective Studies; Respiration, Artificial - adverse effects; Risk Factors; Time Factors; risk factors; mechanical ventilation; cardiac surgical procedures; delirium; fentanyl
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2010.01.003

Objectives Postoperative delirium after cardiac surgery is associated with increased morbidity and mortality as well as prolonged stay in both the intensive care unit and the hospital. The authors sought to identify modifiable risk factors associated with the development of postoperative delirium in elderly patients after elective cardiac surgery in order to be able to design follow-up studies aimed at the prevention of delirium by optimizing perioperative management. Design A post hoc analysis of data from patients enrolled in a randomized controlled trial was performed. Setting A single university hospital. Participants One hundred thirteen patients aged 65 or older undergoing elective cardiac surgery with cardiopulmonary bypass. Interventions None. Measurements and Mains Results Screening for delirium was performed using the Confusion Assessment Method (CAM) on the first 6 postoperative days. A multivariable logistic regression model was developed to identify significant risk factors and to control for confounders. Delirium developed in 35 of 113 patients (30%). The multivariable model showed the maximum value of C-reactive protein measured postoperatively, the dose of fentanyl per kilogram of body weight administered intraoperatively, and the duration of mechanical ventilation to be independently associated with delirium. Conclusions In this post hoc analysis, larger doses of fentanyl administered intraoperatively and longer duration of mechanical ventilation were associated with postoperative delirium in the elderly after cardiac surgery. Prospective randomized trials should be performed to test the hypotheses that a reduced dose of fentanyl administered intraoperatively, the use of a different opioid, or weaning protocols aimed at early extubation prevent delirium in these patients.