Risk factors for postoperative delirium in elderly patients undergoing heart valve surgery with cardiopulmonary bypass

• Published in: Journal of cardiothoracic surgery 2024-02, Vol.19 (1), p.106-106, Article 106
• Main Authors: Chen, Na, Mo, Yun-Chang, Xu, Min, Chen, Si-Si, Gao, Wei, Zheng, Qiong, Wang, Jue, Wang, Xiao-Chu, Wang, Jun-Lu
• Format: Article
• Language: English
• Subjects: Aged patients; Aorta; Bladder; Blood transfusion; Cardiac patients; Cardiopulmonary bypass; Cardiovascular disease; Cerebral oxygen saturation; Cognition; Cognitive ability; Coronary artery bypass; Delirium; Dexmedetomidine; Education; Elderly; Heart; Heart surgery; Heart valve surgery; Heart valves; Hospitals; Indicators; Infrared spectra; Infrared spectroscopy; Intubation; Mechanical ventilation; Medical colleges; Medical research; Medicine, Experimental; Mental disorders; Mortality; Near infrared radiation; Older people; Oximetry; Oxygen content; Oxygen saturation; Pain; Patients; Postoperative delirium; Regression analysis; Risk analysis; Risk factors; Sufentanil; Surgery; Surgical drains; Temperature; Transfusion; Veins & arteries; Ventilation; Ventilators; Wound drainage
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-024-02568-3

The aim of this study was to identify the risk factors for postoperative delirium (POD) in elderly patients undergoing heart valve surgery with cardiopulmonary bypass (CPB). Elderly patients undergoing elective heart valve surgery with CPB in The First Affiliated Hospital of Wenzhou Medical University between March 2022 and March 2023 were selected for this investigation. They were divided into a POD group and a non-POD group. Their baseline information was collected and recorded, and the patients were subjected to neurocognitive function assessment using the Mini-Mental State Examination and the Montreal Cognitive Assessment scales before surgery. We also recorded their intraoperative indicators such as duration of surgery, duration of CPB, duration of aortic cross-clamp, blood transfusion, and postoperative indicators such as duration of mechanical ventilation, postoperative 24-hour drainage volume, and pain score. Regional cerebral oxygen saturation was monitored intraoperatively by near-infrared spectroscopy based INVOS5100C Regional Oximeter. Patients were assessed for the occurrence of POD using Confusion Assessment Method for the Intensive Care Unit, and logistic regression analysis of risk factors for POD was performed. The study finally included 132 patients, with 47 patients in the POD group and 85 ones in the non-POD group. There were no significant differences in baseline information and preoperative indicators between the two groups. However, marked differences were identified in duration of surgery, duration of CPB, duration of aortic cross-clamp, duration of postoperative mechanical ventilation, postoperative length of stay in cardiac intensive care unit, postoperative length of hospital stay, intraoperative blood transfusion, postoperative pain score, and postoperative 24-hour drainage volume between the two groups (p  23.5 h (OR, 6.210 [95% CI, 1.619-23.815]; p = 0.008), and postoperative CCU stay > 3.5 d (OR, 3.927 [95% CI, 1.046-14.735]; p = 0.043) were independent risk factors of the occurrence of POD while change of rScO at T >50.5 (OR, 0.832 [95% CI 0.736-0.941];