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Original Articles: Adult Cardiac

The Long-Term Cognitive and Functional Outcomes of Postoperative Delirium After Cardiac Surgery

^a Department of Thoracic Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
^b Department of Epidemiology, Medisch Spectrum Twente, Enschede, the Netherlands

Accepted for publication February 26, 2009.

^_* Address correspondence to Dr Koster, Haaksbergerstraat 55, Enschede, 7500 KA, the Netherlands (Email: s.koster{at}ziekenhuis-mst.nl).

Background: Delirium or acute confusion is a temporary mental disorder, which occurs frequently among hospitalized elderly patients. Patients who undergo cardiac surgery have an increased risk of developing delirium. This is associated with many negative consequences such as prolonged hospital stay, nursing home placement, and reduced cognitive and functional recovery.

Methods: In this prospective follow-up study, a questionnaire was used 1 to 1.5 years after cardiac surgery in our earlier cohort of 112 patients who underwent elective cardiac surgery, of which 24 patients (21%) developed postoperative delirium as diagnosed by a single psychiatrist.

Results: Postoperative delirium after cardiac surgery may be associated with increased mortality (12.5% in patients with delirium versus 4.5% in patients without delirium; p = 0.16), more readmissions to the hospital (47.6% vs 32.6%; p = 0.19), dysfunction in memory (31.6% vs 22.6%; p = 0.39), and concentration problems (36.8% vs 20.2%; p = 0.13); and is associated with sleep disturbance (47.4% vs 23.8%; p = 0.03).

Conclusions: Postoperative delirium after cardiac surgery may be associated with increased mortality and readmissions to the hospital, as well as poorer cognitive and functional outcomes. Therefore, prevention and (or) early recognition of delirium must be improved. In addition, patients and caregivers (family and general practitioner) must be better informed about the long-term consequences of delirium and what they can do about it.

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Invited Commentary

Ashish C. Sinha and Albert T. Cheung
Ann. Thorac. Surg. 2009 87: 1474. [Extract] [Full Text] [PDF]

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