Prediction of delirium after cardiac surgery and the use of a risk checklist

• Published in: European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology Vol. 12; no. 3; p. 284
• Main Authors: Koster, Sandra, Hensens, Ab G, Schuurmans, Marieke J, van der Palen, Job
• Format: Journal Article
• Language: English
• Published: England 01.06.2013
• Subjects: Aged; Aged, 80 and over; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - psychology; Checklist; Cohort Studies; Delirium - diagnosis; Delirium - etiology; Depressive Disorder - complications; Elective Surgical Procedures - adverse effects; Elective Surgical Procedures - psychology; Female; Heart Diseases - complications; Heart Diseases - psychology; Heart Diseases - surgery; Humans; Internal-External Control; Male; Middle Aged; Predictive Value of Tests; Risk Factors; Somatoform Disorders - complications; Stress, Psychological - complications; Aging; cardiac surgery; delirium; prevention
• ISSN: 1873-1953
• DOI: 10.1177/1474515112450244

Delirium is a temporary mental disorder, which occurs frequently among patients who undergo cardiac surgery. Delirium prediction and its associated prevention is essential. In a previous study, a risk checklist for delirium was developed. The present study validated this checklist in a new, larger study population, and also investigated new risk factors. Risk factors were obtained during the preoperative outpatient screening in 300 patients who underwent elective cardiac surgery. The Delirium Observation Screening scale was utilized pre- and postoperatively to assess delirium. The incidence of delirium was 17.3%. A higher Euroscore, but not a disturbance in electrolytes, was confirmed as a predictor of postoperative delirium. Based on this study, a new risk model was constructed with the following risk factors: a higher Euroscore, older age (≥70 years), cognitive impairment, number of comorbidities, history of delirium, alcohol use and type of surgery. When using a probability of delirium of 20%, as predicted by the model, the sensitivity was 80.8% and the specificity 82.2%. The area under the curve was 0.89. With the revised delirium risk checklist, including seven new risk factors, patients with an increased risk of developing delirium following cardiac surgery could be identified more accurately.