Key result
Postoperative delirium was independently associated with a more than threefold increased risk of major adverse cardiac events (HR 3.36) in patients undergoing elective cardiac surgery.
Why the study?
Does postoperative delirium predict postoperative frailty and major adverse cardiac events in patients undergoing elective cardiac surgery?
Cohort (n=326)
No
Does postoperative delirium predict postoperative frailty and major adverse cardiac events in patients undergoing elective cardiac surgery?
Postoperative delirium is a strong independent predictor of both postoperative frailty and long-term major adverse cardiac events following elective cardiac surgery, highlighting its importance in risk stratification.
Answers are grounded in this paper and cite their sources.
May warrant postoperative delirium screening after cardiac surgery; leaves open whether prevention reduces long-term MACE risk.
BACKGROUND: Postoperative delirium (POD) is a common and critical complication after cardiac surgery. However, the relationship between POD and postoperative physical frailty and the effect of both on long-term clinical outcomes have not been fully explored. OBJECTIVE: We aimed to examine the associations among POD, postoperative frailty, and major adverse cardiac events (MACE). DESIGN: This was a prospective cohort study. METHODS: We studied 329 consecutive patients undergoing elective cardiac surgery. The intensive care delirium screening checklist was used to assess POD. Postoperative frailty was defined by handgrip strength and walking speed. Patients were subsequently followed-up to detect MACE. RESULTS: POD was present in 13.2%, while the incidence of postoperative frailty was 27.0%. POD was independently associated with development of postoperative frailty (adjusted odds ratio = 2.98). During follow-up, MACE occurred in 14.1% of all participants. On multivariate Cox proportional hazard analysis, POD (adjusted hazard ratio (HR) = 3.36), postoperative frailty (HR = 2.21), postoperative complications (HR = 1.54), and left ventricular ejection fraction (HR = 0.95) were independently associated with increased risk of MACE. LIMITATIONS: It is a single-center study with a risk of bias. We did not investigate follow up cognitive function. CONCLUSIONS: POD was a predictor of postoperative frailty after cardiac surgery. Both postoperative frailty and POD were associated with the incidence of MACE, while POD was the stronger predictor of MACE. Thus, POD and frailty play critical roles in the risk stratification of patients undergoing cardiac surgery.
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Ogawa et al. (2017) conducted a cohort in Elective cardiac surgery (n=326). Postoperative delirium vs. No postoperative delirium was evaluated on Major adverse cardiac events (MACE) after discharge (HR 3.36, 95% CI 1.32-7.32, p=0.016). Postoperative delirium was independently associated with a more than threefold increased risk of major adverse cardiac events (HR 3.36) in patients undergoing elective cardiac surgery.
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