Impact of Cardiopulmonary Bypass Duration on the Development of Postoperative Delirium in Cardiac Surgery: A Secondary Subgroup Analysis of an Observational Study.

Abstract

Objectives: Postoperative delirium (POD) is an acute brain impairment linked to higher morbidity and mortality after surgery. This issue is especially prevalent in older cardiac surgery patients receiving cardiopulmonary bypass (CPB), who face unique pathophysiological risks and heightened POD susceptibility. Identifying risk factors is crucial for targeted prevention and therapy.

Design: This investigation represents a subgroup analysis derived from a prospective observational study.

Setting: In this subgroup analysis, 274 cardiac surgery patients from a prospective observational study were examined. Data collection was performed during the patients' postoperative hospital stay across 5 consecutive assessment days.

Participants: A total of 274 adult patients were included in the analysis. POD was considered present if any of the following screening tools indicated delirium on at least 1 of the 5 evaluation days: Confusion Assessment Method for the ICU, Confusion Assessment Method, 4 'A's Test, or Delirium Observation Screening scale.

Intervention: No intervention was performed; the study was purely observational.

Measurement and main results: The incidence of POD was 50.4% in a cohort with a mean age of 70.7 years (standard deviation, 6.4 years). The regression model showed a significant effect of CPB duration category (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.12-1.75; p = 0.003) and preoperative troponin T level (OR, 1.64; 95% CI, 1.07-2.51; p = 0.024) on POD.

Conclusions: This subgroup analysis examined several risk factors for POD in a cardiac surgery cohort. The duration of CPB has been shown to be a risk factor for the development of POD. This information can help identify patients at increased risk of POD during the perioperative period.