Effect of postoperative delirium after cardiovascular surgery on 5-year mortality.

Pub Date : 2023-10-13 DOI:10.1186/s40981-023-00658-0

Chisaki Yokoyama, Kenji Yoshitnai, Soshiro Ogata, Satsuki Fukushima, Hitoshi Matsuda

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Abstract

Introduction: Postoperative delirium is a common complication after cardiovascular surgery. A meta-analysis revealed that postoperative delirium was associated with cognitive decline and dementia, which may affect long-term mortality. However, few studies have reported the association between postoperative delirium after cardiovascular surgery and long-term postoperative mortality. Therefore, we investigated the effect of postoperative delirium on 5-year survival rates of patients who underwent cardiovascular surgery.

Methods: We retrospectively reviewed the records of patients who underwent cardiovascular surgery with cardiopulmonary bypass from January 2016 to December 2019. Postoperative delirium was defined as an Intensive Care Delirium Screening score ≥ 3, which might include subclinical delirium. Cox proportional hazards modeling was performed to assess the association between postoperative delirium and mortality. Postoperative mortality in patients with and without delirium was assessed using the Kaplan-Meier method and compared using the log-rank test.

Results: Postoperative delirium was observed in 562 (31.9%) of 1731 patients. There were more elderly patients, more emergent surgery procedures, longer operative time, and larger transfusion volume in the postoperative delirium group. Cox regression analyses showed that delirium (hazard ratio (HR), 1.501; 95% confidence interval (CI), 1.053-2.140; p = 0.025) and emergent surgery (HR, 3.380; 95% CI, 2.231-5.122; p < 0.001) are significantly associated with 5-year mortality. Among patients who underwent elective surgery, postoperative delirium (HR, 1.987; 95% CI, 1.135-3.481; p = 0.016) is significantly associated with 5-year mortality. Kaplan-Meier survival analysis revealed that patients with postoperative delirium had significantly higher 5-year mortality.

Conclusions: Patients with postoperative delirium after cardiovascular surgery have significantly higher 5-year mortality.

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心血管手术后谵妄对5年死亡率的影响。

引言：术后谵妄是心血管手术后常见的并发症。一项荟萃分析显示，术后谵妄与认知能力下降和痴呆有关，这可能会影响长期死亡率。然而，很少有研究报道心血管手术后的术后谵妄与长期术后死亡率之间的关系。因此，我们研究了心血管手术患者术后谵妄对5年生存率的影响。方法：我们回顾性回顾了2016年1月至2019年12月接受体外循环心血管手术的患者的记录。术后谵妄被定义为重症监护谵妄筛查评分 ≥ 3，可能包括亚临床谵妄。采用Cox比例风险模型评估术后谵妄与死亡率之间的关系。使用Kaplan-Meier方法评估有谵妄和无谵妄患者的术后死亡率，并使用对数秩检验进行比较。结果：1731例患者中有562例（31.9%）出现术后谵妄。术后谵妄组老年患者较多，手术次数较多，手术时间较长，输液量较大。Cox回归分析表明，谵妄（HR）为1.501；95%置信区间为1.053-2.140；p = 0.025）和紧急手术（HR，3.380；95%CI，2.231-5.122；p 结论：心血管手术后出现谵妄的患者5年死亡率明显较高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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