Morbidity and related risk factors of postoperative delirium in the patients undergoing coronary artery bypass grafting / 中华神经科杂志

ABSTRACT

Objective To explore the morbidity and risk factors of postoperative delirium in the patients undergoing coronary artery bypass grafting (CABG).Methods A total of 286 patients were continuously enrolled for CABG surgery from January to December 2013 in cardiac surgery ward in Beijing Anzhen Hospital.Delirium Rating Scale-Revised-98 was used as the diagnostic tool for the analysis of the morbidity and risk factors of postoperative delirium.Results (1) Delirium occurred in 24 patients of 286 patients and morbidity of postoperative delirium was 8.4％.Sixteen of 24 patients (66.7％) suffered from transient delirium (＜24 h).Eight of 24 patients (33.3％) suffered from continuous delirium (≥48 h).(2) The common clinical presentation of postoperative delirium included increased psychomotor activity, a disordered sleep-wake cycle and a reduced level of consciousness.(3) Univariate Logistic regression analysis results showed that delirium was associated with advanced age over 70 years old (OR =3.05, 95％ CI 2.55-72.94, P =0.023), previous cerebral infarction(OR =1.78, 95％ CI 1.07-2.96, P =0.026), previous brain heamorrhage (OR =1.99, 95 ％ CI 1.20-3.31, P =0.003), surgery time (OR =1.05, 95％ CI0.05-2.04, P =0.047), intensive care unit (ICU) staying time (OR =2.87, 95％ CI 1.43-5.72, P=0.003), use offentanyl (OR=2.78, 95％ CI 1.02-7.57, P=0.045).(4) The multiple Logistic stepwise regression analysis indicated that the perioperative risk factors of delirium included advanced age over 70 years old (OR =3.196, 95％ CI 1.574-6.488, P =0.001), cerebrovascular accident history(OR =2.610, 95％ CI 1.538-4.431, P =0.000) and ICU duration time(OR =1.480, 95 ％ CI 1.070-2.046, P =0.018).Conclusions The morbidity of postoperative delirium after CABG is 8.4％.Many predisposing and precipitating factors contribute to postoperative delirium.These factors include age ＞ 70 years, cerebral infarction and ICU staying time.Assessment and preventive strategies should be considered to reduce the incidence of delirium, particularly among those patients with high risks.