Congestive heart failure as a determinant of postoperative delirium
Revista Portuguesa de Cardiologia
Postoperative delirium (POD) is a frequent post-surgical complication that is associated with increased mortality and poor patient outcomes. POD is a complex disorder with multiple risk factors such as pre-existing patient comorbidities and perioperative complications. The aim of this study was to evaluate the incidence of POD and to identify risk factors for the development of POD in a post-anesthesia care unit (PACU). Methods: We enrolled 97 adult patients admitted to a PACU over a five-day
... U over a five-day period (start date September 6, 2010). Patient demographics and intraoperative and postoperative data were collected. Patients were followed for the development of delirium using the Intensive Care Delirium Screening Checklist. Descriptive analyses of variables were used to summarize data, and the Mann---Whitney U test was used to compare continuous variables; the chi-square or Fisher's exact test was used for comparisons. Univariate analysis was performed using simple binary logistic regression with odds ratios (OR) and 95% confidence intervals (95% CI). The significance level for multiple comparisons was controlled by applying the Bonferroni correction for multiple comparisons and variables were deemed significant if p≤0.0025. Results: Six percent of patients developed POD. These patients were older and more likely to have higher American Society of Anesthesiologists (ASA) physical status (83 vs. 22% with ASA III/IV, p=0.004) as well as a higher frequency of congestive heart failure (50 vs. 3%, p=0.003) and a higher Revised Cardiac Risk Index (RCRI) score (33 vs. 6% with RCRI ≥2, p=0.039). The duration of anesthesia for patients with POD was also longer and they received a greater volume of crystalloids, colloids, and erythrocytes during surgery. Congestive heart disease was an independent risk factor for POD (OR 29.3, 95% CI 4.1---210.6; p<0.001). In addition, patients who developed POD had higher in-hospital mortality and longer PACU and hospital stays. Conclusions: Patients who developed POD had longer hospital and PACU stays and higher inhospital mortality. Congestive heart disease was considered an independent risk factor for POD. Document downloaded from http://www.elsevier.pt, day 09/08/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Resultados: Seis por cento dos doentes desenvolveram DPO. Os doentes que desenvolveram DPO eram mais velhos, tinham maior probabilidade de apresentar estado físico da American Society of Anesthesiologists (ASA) III/IV (83 versus 22%, p = 0,004), tinham insuficiência cardíaca congestiva em maior frequência (50 versus 3%, p = 0,003) e um maior score no Revised Cardiac Risk Index (RCRI) (33 versus 6% para RCRI ≥ 2, p = 0,039). Os doentes com DPO tiveram uma maior duração da anestesia e receberam um maior volume de cristaloides, coloides e eritrócitos durante a cirurgia. A doença cardíaca congestiva foi um fator de risco independente para DPO (OR 29,3, IC 95% 4,1-210,6, p < 0,001). Os doentes que desenvolveram DPO tiveram maior mortalidade hospitalar e maior tempo de internamento na UCPA e no hospital. Conclusões: Os doentes que desenvolveram DPO tiveram maior tempo de internamento no hospital e na UCPA e tiveram maiores taxas de mortalidade hospitalar. A existência de doença cardíaca congestiva prévia foi considerado fator de risco independente para a ocorrência de DPO.