Perioperative predictors of delirium and incidence factors in adult patients post cardiac surgery

Figures & data

Table 1 Demographic, clinical, and perioperative patients’ characteristics

Characteristics	Mean (± SD)
Age (years)	63.3 (12.7)
BMI (kg/m^2)	28.1 (5.1)
CPB (min)	121.2 (42.6)
Ischemia time during CPB (min)	77.4 (31.5)
ICU LOS (hours)	35.1 (19.8)
ICU LOS (days)	1.6 (1.8)
In-hospital LOS (days)	7.4 (2.9)
Total sedation time (hours)	7.2 (8.4)
LOS with endotracheal tube (hours)	10.7 (11.4)
EuroSCORE II (%)	4 (6.0)
	n (%)
Gender
Male	129 (72.1)
Female	50 (27.9)
Type of surgical operation
CABG	94 (52.5)
AVR/MVR	45 (25.1)
Bentall/–ascending aorta (±arch) replacement	12 (6.7)
AVR + MVR (±CABG)	23 (12.8)
ASD/VSD	5 (2.8)
Transfer to HDU
Yes	21 (11.7)
No	158 (88.3)
Blood transfusion
Yes	13 (7.3)
No	166 (92.7)

Abbreviations: AVR, aortic valve replacement; BMI, body mass index; CABG, coronary artery bypass grafting; CPB, cardiopulmonary bypass; HDU, high-dependency unit; ICU, intensive care unit; LOS, length of stay; MVR, mitral valve replacement.

Table 2 Patient outcomes

Outcome	N (%)
Delirium
No	159 (88.8)
Yes	20 (11.2)

Table 3 Types of surgical operation and perioperative patient characteristics and outcomes associated with delirium

Surgical operation	Number of patients, N (%)	Outcome (delirium)		p-value
		No	Yes
CABG				0.032a
No		71 (44.7)	14 (70.0)
Yes	94 (52.5)	88 (55.3)	6 (30.0)
AVR/MVR				0.267a
No		117 (73.6)	17 (85.0)
Yes	45 (25.1)	42 (26.4)	3 (15.0)
Bentall/±ascending aorta (±arch) replacement				0.746a
No		148 (93.1)	19 (95.0)
Yes	12 (6.7)	11 (6.9)	1 (5.0)
AVR + MVR (± CABG)				<0.001a
No		146 (91.8)	10 (50.0)
Yes	23 (12.8)	13 (8.2)	10 (50.0)
ASD/VSD				0.549a
No		154 (96.9)	20 (100.0)
Yes	5 (2.8)	5 (3.1)	0 (0.0)
Transfer to HDU				0.321c
No	158 (88.3)	139 (87.4)	19 (95.0)
Yes	21 (11.7)	20 (12.6)	1 (5.0)
Blood transfusion				0.157a
No	166 (92.7)	149 (93.7)	17 (85.0)
Yes	13 (7.3)	10 (6.3)	3 (15.0)
EuroSCORE IIb,c	6.2 (8.9)/1.1 (13.7)	1.7 (2/6)/3.7 (5.9)	3.7 (5.3)/6.3 (6.6)	0.001d

Notes: Values are presented as n (%) unless they are mentioned otherwise.

a χ² test,

b median (interquartile range),

c mean (standard deviation),

d Mann–Whitney test. Bold data are statistically significant.

Abbreviations: ASD, atrial septal defect; AVR, aortic valve replacement; CABG, coronary artery bypass grafting; HDU, high-dependency unit; ICU, intensive care unit; MVR, mitral valve replacement; VSD, ventricular septal defect.

Table 4 Bivariate associations between delirium and patient perioperative outcomes

	Mean (standard deviation)	Median (interq range)	Outcome delirium		p-value
			No	Yes
CPB (min)	121.2 (42.6)	42.6 (113.0)	118.8 (40.2)	140.2 (56.0)	0.113a
Ischemia time during CPB (min)	77.4 (31.5)	31.5 (70.0)	75.8 (29.7)	90.1 (42.0)	0.155a
ICU LOS (days)b,c	1.6 (1.8)	1.8 (1.0)	1.5 (0.7)/1.0 (1.0)	2.4 (1.6)/2.0 (1.8)	<0.001d
In-hospital LOS (days)	7.4 (2.9)	2.9 (7.0)	7.3 (2.7)/7.0 (2.0)	8.8 (4.6)/7.5 (3.5)	0.028d
ICU LOS (h)	35.1 (19.8)	19.8 (29.0)	32.6 (14.5)/26.0 (19.0)	55.9 (37.7)/45.5 (31.2)	<0.001d
Total sedation time (h)b,c	7.2 (8.4)	8.4 (5.0)	6.5 (5.0)/5.0 (3.0)	13.2 (20.7)/6.3 (6.6)	0.189d
Length of stay with endotracheal tube (h)b,c	10.7 (11.4)	11.4 (8.0)	9.7 (8.1)/8.0 (4.0)	19.5 (24.1)/11.5 (10.6)	0.001d

Notes: Values are presented as mean (standard deviation) unless they are mentioned otherwise.

a t-test,

b mean (standard deviation),

c median (interquartile range),

d Mann–Whitney test. Bold data are statistically significant.

Abbreviations: CPB, cardiopulmonary bypass; ICU, intensive care unit; LOS, length of stay.

Table 5 Bivariate associations between demographic and other data and delirium development

Independent variable	Delirium		p-value
	No	Yes
Agea	62.5 (12.6)	69.6 (11.9)	0.020b
Sex			0.202c
Male	117 (73.6)	12 (60.0)
Female	42 (26.4)	8 (40.0)
Weighta	81.0 (17.0)	81.4 (12.2)	0.906b
Heighta	170.1 (8.1)	167.2 (10.4)	0.230b
BMIa	27.9 (5.2)	29.2 (4.2)	0.226b
Surgical type of operation
CABG			0.032c
No	71 (44.7)	14 (70.0)
Yes	88 (55.3)	6 (30.0)
AVR/MVR			0.267c
No	117 (73.6)	17 (85.0)
Yes	42 (26.4)	3 (15.0)
Bentall ± ascending aorta ± arch replacement			0.746c
No	148 (93.1)	19 (95.0)
Yes	11 (6.9)	1 (5.0)
AVR and MVR (± CABG)			<0.001c
No	146 (91.8)	10 (50.0)
Yes	13 (8.2)	10 (50.0)
ASD/VSD			0.549c
No	154 (96.9)	20 (100.0)
Yes	5 (3.1)	0 (0.0)
Transfer to HDU			0.321c
No	139 (87.4)	19 (95.0)
Yes	20 (12.6)	1 (5.0)
EuroSCORE IIa,d	1.7 (2.6)/3.7 (5.9)	3.7 (5.3)/6.3 (6.6)	0.001e
CPB (min)a	118.8 (40.2)	140.2 (56.0)	0.113b
Ischemia time during CPB (min)a	75.8 (29.7)	90.1 (42.0)	0.155b
In-hospital LOS (days)d	7.0 (2.0)	7.5 (3.5)	0.028f
ICU LOS (hours)d	26.0 (19.0)	45.5 (31.2)	<0.001f
Total sedation time (hours)d	5.0 (3.0)	6.2 (6.6)	0.189f
LOS with endotracheal tube (hours)d	8.0 (4.0)	11.5 (10.6)	0.001f
NL ratio, 2nd postoperative dayd	9.2 (7.3)	16.4 (17.9)	0.001f
Urea operation dayd	41.0 (19.0)	49.5 (29.0)	0.025f
Urea 2nd postoperative dayd	40.0 (25.0)	52.5 (45.5)	0.016f
Creatinine operation dayd	1.0 (0.3)	1.1 (0.5)	0.018f
Creatinine 1st postoperative dayd	1.0 (0.5)	1.3 (0.5)	0.006f
Creatinine 2nd postoperative dayd	1.0 (0.5)	1.3 (0.5)	0.026f
Sodium 1st postoperative day^Citation3	142.7 (3.6)	144.5 (3.4)	0.039b
Sodium 2nd postoperative daya	141.2 (3.7)	143.4 (4.0)	0.033b
PT operation daya	13.1 (1.3)	14.4 (2.4)	<0.001b
INR operation daya	1.0 (0.1)	1.2 (0.2)	<0.001b

Notes:

a Mean (standard deviation),

b 2-sided t-test,

c χ²,

d median (interquartile range),

e Monte-Carlo test,

f Mann–Whitney test. Bold data are statistically significant.

Abbreviations: ASD, atrial septal defect; AVR, aortic valve replacement; BMI, body mass index; CABG, coronary artery bypass grafting; CPB, cardiopulmonary bypass; HDU, high-dependency unit; ICU, intensive care unit; INR, International Normalized Ratio; LOS, length of stay; MVR, mitral valve replacement; NL, neutrophil-to-lymphocyte; PT, prothrombin time; VSD, ventricular septal defect.

Table 6 Bivariate associations between perioperative blood results and delirium

Characteristics	Delirium	Delirium	p-value
	No	Yes
NL ratio, operation daya	2.2 (1.7)/3.1 (3.0)	2.9 (1.9)/4.6 (4.8)	0.061b
NL ratio, 1st postoperative daya	14.0 (9.1)/15.2 (7.3)	16.0 (11.6)/23.2 (22.0)	0.166b
NL ratio, 2nd postoperative daya	9.3 (7.1)/10.8 (6.8)	16.4 (17,9)/18.1 (10.4)	0.001b
Hematocrit operation day	38.0 (4.8)	36.9 (4.4)	0.292c
Hematocrit 1st postoperative day	32.5 (3.9)	30.4 (3.3)	0.013c
Hematocrit 2nd postoperative day	30.9 (3.6)	28.7 (3.0)	0.005c
Hb operation day	12.8 (1.8)	12.2 (1.6)	0.105c
Hb 1st postoperative day	10.9 (1.4)	10.0 (1.1)	0.004c
Hb 2nd postoperative day	10.3 (1.3)	9.4 (1.0)	0.001c
Plt operation day	223.6 (65.9)	215.5 (62.6)	0.588c
Plt 1st postoperative day	188.2 (67.1)	149.9 (52.0)	0.006c
Plt 2nd postoperative day	175.6 (66.9)	135.4 (54.4)	0.005c
Urea operation daya	41.0 (19.0)/44.8 (22.0)	49.5 (29.0)/53.9 (23.1)	0.025c
Urea 1st postoperative daya	40.0 (23.0)/45.5 (22.3)	47.5 (35.3)/52.9 (26.1)	0.126b
Urea 2nd postoperative daya	40.0 (25.0)/48.0 (26.1)	52.5 (45.5)/62.8 (30.5)	0.016b
Creatinine operation daya	1.0 (0.3)/1.2 (1.0)	1.1 (0.6)/12 (0.4)	0.018b
Creatinine 1st postoperative daya	10 (0.5)/1.2 (1.0)	1.3 (0.5)/1.3 (0.4)	0.006b
Creatinine 2nd postoperative daya	1.0 (0.5)/1.2 (1.0)	1.3 (0.5)/1.3 (0.6)	0.026b
Sodium operation day	140.5 (3.1)	141.3 (4.1)	0.433c
Sodium 1st postoperative day	142.7 (36)	1445 (34)	0.039c
Sodium 2nd postoperative day	141.2 (3.7)	143.4 (4.0)	0.033c
Albumin operation day	4.0 (0.6)	3.9 (0.4)	0.136c
Albumin 1st postoperative day	3.5 (0.4)	3.4 (0.4)	0.271c
Albumin 2nd postoperative day	3.5 (0.4)	3.5 (0.4)	0.405c
CRP operation daya	0.4 (1.3)/1.7 (3.3)	0.3 (1.6)/1.1 (1.4)	0.719b
CRP 1st postoperative day	7.4 (7.3)/8.8 (6.6)	5.6 (6.4)/6.9 (6.0)	0.183b
CRP 2nd postoperative daya	16.5 (14.1)/16.6 (8.8)	13.2 (11.4)/13.6 (7.9)	0.163b
PT operation day	13.1 (1.3)	14.4 (2.4)	<0.001c
PT 1st postoperative day	14.1 (3.0)	14.6 (2.8)	0.448c
PT 2nd postoperative day	14.5 (5.6)	16.3 (9.0)	0.397c
INR operation day	1.0 (0.1)	1.2 (0.2)	<0.001c
INR 1st postoperative day	1.1 (0.3)	1.2 (0.2)	0.529c
INR 2nd postoperative day	1.2 (0.4)	1.3 (0.8	0.375c

Notes: Values are presented as mean (standard deviation) unless they are mentioned otherwise.

a Median (interquartile range),

b Mann–Whitney test,

c paired t-test. Bold data are statistically significant.

Abbreviations: CRP, C-reactive protein; Hb, hemoglobin; INR, International Normalized Ratio; NL, neutrophil-to-lymphocyte; Plt, platelet; PT, prothrombin time.

Table 7 Multivariable logistic regression with delirium as dependent variable

	Odds ratio	95% confidence interval	p-value
ICU LOS (hours)	1.043	1.010–1.078	0.011
NL ratio, 2nd postoperative day	1.077	1.009–1.151	0.026
AVR + MVR (± CABG)	12.157	3.410–43.338	<0.001

Note: Bold data are statistically significant.

Abbreviations: AVR, aortic valve replacement; CABG, coronary artery bypass grafting; ICU, intensive care unit; LOS, length of stay; MVR, mitral valve replacement; NL, neutrophil-to-lymphocyte.

MeagherDMotor subtypes of delirium: past, present and futureInt Rev Psychiatry2009211597319219713

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