Delirium After Cardiac Surgery and Predictive Validity of a Risk Checklist

• Published in: The Annals of thoracic surgery Vol. 86; no. 6; pp. 1883 - 1887
• Main Authors: Koster, Sandra, MANP, Oosterveld, Frits G.J., MS, PhD, Hensens, Ab G., MS, Wijma, Arie, MS, van der Palen, Job, MS, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.2008; Elsevier
• Subjects: Age Distribution; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Cardiology. Vascular system; Cardiopulmonary Bypass - adverse effects; Cardiopulmonary Bypass - methods; Cardiothoracic Surgery; Cohort Studies; Delirium - diagnosis; Delirium - epidemiology; Delirium - etiology; Education, Medical, Continuing; Elective Surgical Procedures - adverse effects; Elective Surgical Procedures - methods; Female; Follow-Up Studies; Geriatrics; Humans; Incidence; Male; Medical sciences; Middle Aged; Netherlands; Neuropsychological Tests; Pneumology; Postoperative Complications - diagnosis; Postoperative Complications - psychology; Predictive Value of Tests; Preoperative Care - methods; Probability; Prospective Studies; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Reproducibility of Results; Risk Assessment; Sensitivity and Specificity; Sex Distribution; Surgery; Netherlands; 18; Delirium; Validity; Risk factor; Anesthesia; Risk; Circulatory system; Cardiac surgery; Cardiology; Predictive factor; Mental confusion; Organic mental disorder
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2008.08.020

Background Delirium or acute confusion is a temporary mental disorder that occurs frequently among hospitalized elderly patients. Patients who undergo cardiac surgery have an increased risk of delirium, which is associated with many negative consequences. Therefore, prevention or early recognition of delirium is essential. Methods In this observational study, a risk checklist for delirium was used during the preoperative outpatient screening in 112 patients who underwent elective cardiac surgery. The Delirium Observation Screening (DOS) scale was used before and after surgery to assess whether delirium had developed in patients. The psychiatrist was consulted to confirm or refute the diagnosis delirium. Results The incidence of delirium after cardiac surgery was 21%, and the mean duration of delirium was 2.5 days. The time to discharge was 11 days longer for patients with delirium. The delirium risk checklist could accurately predict postoperative delirium in patients who underwent elective cardiac surgery based on a disturbance in the electrolytes sodium and potassium and on EuroSCORE (European System for Cardiac Operative Risk Evaluation). When using a probability of delirium of 50%, the sensitivity of the risk checklist was 25.0% and specificity was 95.5%. The predictive value of a positive test was 60.0%, and the predictive value of a negative test was 82.4%. The area under the receiver-operating characteristic curve was 0.75. Conclusions With the risk checklist for delirium, patients at an increased risk of delirium after elective cardiac surgery can be identified.