Postoperative delirium and its risk factors in elderly patients undergoing heart valve surgery
DOI:
https://doi.org/10.55958/jcvd.v20i2.171Keywords:
Post-operative delirium, Heart valve surgery, Risk factors, Cardiopulmonary bypass time, Clamp timeAbstract
Introduction
Neurological complications following cardiac surgery present a complex issue, with delirium being a notable neuropsychiatric syndrome observed since the advent of cardiopulmonary bypass (CPB), historically termed postcardiotomy delirium1. In recent time neurological complications from cardiac surgery has been categorized into Types of injuries I and II, with delirium often representing the most common symptom of Type-II injuries2. However, the distinction between delirium and the earlier nomenclature of postcardiotomy delirium remains unclear3.
Objective: To investigate the incidence rate and risk factors of postoperative delirium in elder patients who were undergoing heart valve surgery.
Methodology: This observational prospective study was conducted at NICVD, Larkana, Pakistan from December 2022 to May 2023. Patients of age above 18 years and admitted for elective valvular surgery were included in the study. The CAM-ICU was used as the diagnostic tool to evaluate delirium after surgery, applicable to both mechanically ventilated and extubated patients. This assessment tool involves four steps: (1) identifying fluctuating mental state, (2) reduced attention level (3) assessing for disoriented thinking, and (4) detecting altered mental condiction.
Results: Among 230, 52 patients (22.6%) developed delirium, while 178 patients (77.4%) did not. The mean cardiopulmonary bypass (CPB) time was prolong in patients with delirium (116.42±8.99 minutes) compared to the non-delirium group (97.03±8.24 minutes) (p<0.001). Conversely, the mean aortic clamp time was shorter in the delirium group (61.62±4.51 minutes) compared to the non-delirium group (86.54±8.92 minutes) (p<0.001). Additionally, the mean ventilator time was significantly longer in the delirium group (3.54±0.64 days) compared to the non-delirium group (1.56±0.54 days) (p<0.001).
Conclusion: Delirium in post-operative period was found in 22.6% patients after open heart valvular surgery with elederly patients were identified as non-modifiable risk factor and modifiable risk factors include ventilation time and cardiopulmonary bypass time.
Keywords: Post-operative delirium, Heart valve surgery, Risk factors, Cardiopulmonary bypass time, Clamp time
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