AUTHOR=Ding Yinyin , Gao Ju , Ge Yali , Huang Tianfeng , Zhang Yang 

TITLE=Risk factors for postoperative delirium in frail elderly patients undergoing on-pump cardiac surgery and development of a prediction model—a prospective observational study

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=11

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1425621

DOI=10.3389/fcvm.2024.1425621

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>To identify the risk factors for postoperative delirium (POD) after cardiac surgery in frail elderly patients and develop a receiver operating characteristic (ROC) prediction model to confirm the effectiveness.</p></sec><sec><title>Methods</title><p>This was a prospective observational study, patients were assessed preoperatively according to the frailty index (FI) scale. Cerebral (SctO<sub>2</sub>) was assessed at different time points using near-infrared spectroscopy (NIRS). On the basis of the occurrence of POD within 7 days after surgery, patients were divided into POD and non-POD groups. Risk factors were analyzed using logistic regression analysis, while their predictive values were evaluated using the receiver operating characteristic curve analysis.</p></sec><sec><title>Results</title><p>POD was significantly associated with frailty, lower preoperative MMSE scores, hyperlipidemia, diabetes, cerebrovascular disease, lower hemoglobin level, lower albumin level, longer operation time, longer CPB time, lower SctO<sub>2</sub> at T5, and lower SctO<sub>2baseline</sub> (<italic>P</italic> &lt; 0.05). SrtO<sub>2</sub> and SmtO<sub>2</sub> did not differ significantly between groups. FI, preoperative MMSE score, and operation time as independent risk factors (<italic>P</italic> &lt; 0.05). Significant predictive value was demonstrated in all 3 variables (<italic>P</italic> &lt; 0.001; respectively). Among them, high sensitivity and specificity were observed with the FI (cut-off value 0.27, sensitivity 75%, specificity 73.5%) and operation time (cut-off value 237.5, sensitivity 62.5%, specificity 78.6%).</p></sec><sec><title>Conclusions</title><p>The FI, preoperative MMSE score, and operation time were independent risk factors for POD in elderly patients after cardiac surgery, with high predictive value observed with the FI and operation time. Cerebral oxygen saturation was associated with POD but was not an independent risk factor.</p></sec><sec><title>Clinical Trial Registration</title><p>Chinese Clinical Trail Registry, No: chictr2200056038.</p></sec>