Postoperative Delirium in Cardiovascular Surgery: Analysis of PredictiveFactors Based on the ARGEN-CCV National Registry

pp. 405-412

Abstract

Background: Delirium is a common and potentially preventable complication in the postoperative period following cardiovascular surgery (CVS). Its onset is associated with poorer clinical outcomes, such as longer hospital length of stay and higher mortality.
Internationally, delirium in the postoperative context of cardiovascular surgery has been extensively studied in multicenter cohorts and observational studies, with varying prevalences. In Argentina, we have previous registries of CVS, but despite this, this complication has not been explored in depth.

Objective: The aim of this study was to analyze the incidence of postoperative delirium following CVS and to identify predictors that
contribute to its development.
Methods: We conducted an analysis of the Argentine National Registry of Cardiovascular Surgery (ARGEN-CCV), a cross-sectional, multicenter study spanning 13 months from July 2021 to August 2022. Patients were recruited from 48 public and private cent-
ers. Data from consecutive patients aged 18 years or older admitted for central CVS were analyzed. Surgeries for congenital heart defects and peripheral vascular surgery were excluded from the registry. The diagnosis of delirium was based on clinical assessment. Univariate and multivariate analyses were performed to define independent predictors of delirium onset.
Results: A total of 1515 patients were included in the analysis with an incidence of delirium of 9.1%. Patients with delirium were
older (68 vs. 64 years, p<0.001) and had a higher prevalence of chronic obstructive pulmonary disease (COPD), alcoholism, and frailty, as well as a higher incidence of postoperative atrial fibrillation (AF). On multivariate analysis, coronary artery disease (OR
1.64; 95% CI: 1.02–2.64; p=0.041), postoperative sepsis (OR 3.13; 95% CI: 1.65–5.96; p<0.001), postoperative AF (OR 2.07; 95% CI: 1.29–3.32; p=0.003), and prolonged mechanical ventilation (OR 2.86; 95% CI 1.68–4.86; p<0.001), were identified as independent predictors of delirium, while frailty showed a trend (OR 2.16; p=0.068). A predictive model was constructed using these variables,
which demonstrated good discrimination, with an area under the curve (AUC) of 0.76 (95% CI: 0.71–0.80) and excellent calibration (Hosmer-Lemeshow test with p value = 0.999).
Conclusions: Postoperative delirium occurs in 9.1% of patients undergoing cardiovascular surgery in our series. Coronary artery
disease, postoperative AF, and prolonged MV were identified as predictors for the development of delirium.