Can we predict the occurence of postoperative delirium after cardiac surgery in the elderly by a clinical and frailty assessment?

<p>At present, the majority of cardiac surgery interventions have been performed in the elderly with successful short-term mortality and morbidity, however significant difficulties must to be underlined about our capacity to predict long-term outcomes such as disability, worsening quality of life and loss of functional capacity.<br />The reason probably resides on inability to capture preoperative frailty phenotype with current cardiac surgery risk scores and consequently we are unable to outline the postoperative trajectory of an important patients’ centered outcome such as disability free survival. In this perspective, more than one geriatric statements have stressed the systematic underuse of patient reported outcomes in cardiovascular trials even after taking account of their relevance to older feel and wishes. Thus, in the next future is mandatory for geriatric cardiology community closes this gap of evidences through planning of trials in which patients’ centered outcomes are considered as primary goals of therapies as well as cardiovascular ones.</p>

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Cardiac Surgery in the Elderly

Principles and Practice of Geriatric Surgery ◽

10.1007/978-1-4419-6999-6_52 ◽

2011 ◽

pp. 649-660

Author(s):

Margarita T. Camacho ◽

Pooja R. Raval

Keyword(s):

Cardiac Surgery ◽

The Elderly ◽

Surgery In The Elderly

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Elevated Procalcitonin as a Risk Factor for Postoperative Delirium in the Elderly after Cardiac Surgery—A Prospective Observational Study

Journal of Clinical Medicine ◽

10.3390/jcm9123837 ◽

2020 ◽

Vol 9 (12) ◽

pp. 3837

Author(s):

Anna Kupiec ◽

Barbara Adamik ◽

Natalia Kozera ◽

Waldemar Gozdzik

Keyword(s):

Cardiac Surgery ◽

Depressive Symptoms ◽

Elderly Patients ◽

Odds Ratio ◽

Postoperative Delirium ◽

Prospective Observational Study ◽

Reference Range ◽

The Elderly ◽

Daily Functioning ◽

Multivariable Logistic Regression Model

One of the most common complications after cardiac surgery with cardiopulmonary bypass (CBP) is delirium. The purpose of this study was to prospectively investigate the risk of developing postoperative delirium in a group of elderly patients using a multivariate assessment of preoperative and intraoperative risk factors. A total of 149 elderly patients were included. Thirty patients (20%) developed post-operative delirium. Preoperative procalcitonin (PCT) above the reference range (>0.05 ng/mL) was recorded more often in patients who postoperatively developed delirium than in the non-delirium group (50% vs. 27%, p = 0.019). After surgery, PCT was significantly higher in the delirium than the non-delirium group: ICU admission after surgery: 0.08 ng/mL vs. 0.05 ng/mL p = 0.011), and for consecutive days (day 1: 0.59 ng/mL vs. 0.25 ng/mL, p = 0.003; day 2: 1.21 ng/mL vs. 0.36 ng/mL, p = 0.006; day 3: 0.76 ng/mL vs. 0.34 ng/mL, p = 0.001). Patients with delirium were older (74 vs. 69 years, p = 0.038), more often had impaired daily functioning (47% vs. 28%, p = 0.041), depressive symptoms (40% vs. 17%, p = 0.005), and anemia (43% vs. 19%, p = 0.006). In a multivariable logistic regression model, preoperative procalcitonin (odds ratio (OR) = 3.05), depressive symptoms (OR = 5.02), age (OR = 1.14), impaired daily functioning (OR = 0.76) along with CPB time (OR = 1.04) were significant predictors of postoperative delirium.

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