Incidence and Associated Factors of Postoperative Delirium in Adults Undergoing Cardiac Surgery With Cardiopulmonary Bypass: A Prospective Cohort Study

Background: Delirium is one of the most common and serious complications after cardiac surgery with cardiopulmonary bypass (CPB). A comprehensive assessment of independent risk factors for postoperative delirium (POD) is essential for early detection and prevention.

Aims and objectives: To investigate the incidence and independent associated factors of POD in adults undergoing cardiac surgery with CPB.

Design: Prospective cohort design.

Methods: A total of 203 patients were enrolled in this study from October 2022 to December 2023 in China. Richmond agitation and sedation scale (RASS) and confusion assessment method-intensive care unit (CAM-ICU) were used for assessing delirium symptom. This study analysed various factors for POD, including demographic, physical, psychological, social, spiritual and environmental aspects. Using logistic regression analysis to identify the independent associated factors.

Results: A totla of 60.1% (n = 122) of patients had POD. Of these cases, 86 (70.5%) were hypoactive delirium, 4 (3.3%) were hyperactive delirium and 32 (26.2%) were mixed delirium. Advanced age (OR = 1.069, 95% confidence interval [CI]: 1.031-1.107; p < 0.001), preoperative depression (OR = 1.847, 95% CI: 1.246-2.736; p = 0.002), postoperative albumin level (OR = 0.921, 95% CI: 0.851-0.997; p = 0.042) and duration of mechanical ventilation (OR > 1.000, 95% CI: 1.000-1.001; p < 0.001) were independent predictors of POD.

Conclusions: The incidence of POD in patients undergoing cardiac surgery with CPB was high. This study identified advanced age, preoperative depression, postoperative albumin level and duration of mechanical ventilation as significant and independent predictors of POD.

Relevance to clinical practice: The study's findings highlight the urgent necessity for improved clinical vigilance and proactive management strategies.

Patient or public contribution: No patient or public contribution.