Miarca Ten Broeke1, Sandra Koster2, Thomas Konings3, Ab G Hensens1, Job van der Palen4,5. 1. 1 Department of Cardiothoracic Surgery, Medisch Spectrum Twente, The Netherlands. 2. 2 Department of Medical School Twente, The Netherlands. 3. 3 Department of Cardiology, Ziekenhuisgroep Twente, The Netherlands. 4. 4 Department of Epidemiology, Medisch Spectrum Twente, The Netherlands. 5. 5 Department of Research Methodology, Measurement and Data Analysis, University of Twente, The Netherlands.
Abstract
BACKGROUND: Delirium is a common temporary mental disorder that often occurs in patients who undergo cardiac surgery. It is important to prevent the negative side effects of delirium by identifying high-risk patients before surgery. Koster and colleagues designed a risk model to identify patients with an increased risk of postoperative delirium after cardiac surgery. AIM: The aim of this study was to validate the risk model for delirium and further improve the risk model. METHODS: A delirium risk checklist containing predictors associated with postoperative delirium was used during the preoperative outpatient screening in 329 patients. The delirium observation screening scale was used preoperatively and postoperatively to assess delirium. RESULTS: Compared with the model of Koster and colleagues age greater than 70 years and a history of delirium were confirmed as statistically significant predictors of postoperative delirium, while cognitive impairment and alcohol abuse were almost significant factors. The European system for cardiac operative risk evaluation (EuroSCORE), comorbidity and type of surgery could not predict a postoperative delirium again. The area under the curve of this model was 0.79 (95% confidence interval (CI) 0.73-0.86; P<0.001). Based on the data of this study the model was improved with the following independent predictors of postoperative delirium: age, more than one comorbidity, history of delirium and a lower standardised mini mental state examination score as with an area under the curve of 0.79 (95% CI 0.73-0.85; P<0.001). CONCLUSION: The risk model could not be fully validated. It is difficult to validate a risk model over time; there are different circumstances such as the increased focus on the prevention of delirium.
BACKGROUND: Delirium is a common temporary mental disorder that often occurs in patients who undergo cardiac surgery. It is important to prevent the negative side effects of delirium by identifying high-risk patients before surgery. Koster and colleagues designed a risk model to identify patients with an increased risk of postoperative delirium after cardiac surgery. AIM: The aim of this study was to validate the risk model for delirium and further improve the risk model. METHODS: A delirium risk checklist containing predictors associated with postoperative delirium was used during the preoperative outpatient screening in 329 patients. The delirium observation screening scale was used preoperatively and postoperatively to assess delirium. RESULTS: Compared with the model of Koster and colleagues age greater than 70 years and a history of delirium were confirmed as statistically significant predictors of postoperative delirium, while cognitive impairment and alcohol abuse were almost significant factors. The European system for cardiac operative risk evaluation (EuroSCORE), comorbidity and type of surgery could not predict a postoperative delirium again. The area under the curve of this model was 0.79 (95% confidence interval (CI) 0.73-0.86; P<0.001). Based on the data of this study the model was improved with the following independent predictors of postoperative delirium: age, more than one comorbidity, history of delirium and a lower standardised mini mental state examination score as with an area under the curve of 0.79 (95% CI 0.73-0.85; P<0.001). CONCLUSION: The risk model could not be fully validated. It is difficult to validate a risk model over time; there are different circumstances such as the increased focus on the prevention of delirium.
Entities:
Keywords:
Delirium; adult; cardiac; postoperative care
Authors: Chung Kwan Wong; Barbara C van Munster; Athanasios Hatseras; Else Huis In 't Veld; Barbara L van Leeuwen; Sophia E de Rooij; Rick G Pleijhuis Journal: BMJ Open Date: 2022-04-08 Impact factor: 2.692