Association Between Postoperative Delirium and Long-Term Subjective Cognitive Decline in Older Patients Undergoing Cardiac Surgery: A Secondary Analysis of the Minimizing Intensive Care Unit Neurological Dysfunction with Dexmedetomidine-Induced Sleep Trial. Namirembe GE, et al, J Cardiothorac Vasc Anesth 2023.
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Résumé et points clés
Objectives: This study aimed to evaluate whether a measure of subjective cognitive decline (SCD), the Patient-Reported Outcomes Measurement Information System (PROMIS) Applied Cognition-Abilities questionnaire, was associated with postoperative delirium. It was hypothesized that delirium during the surgical hospitalization would be associated with a decrease in subjective cognition up to 6 months after cardiac surgery.
Design: This was a secondary analysis of data from the Minimizing Intensive Care Unit Neurological Dysfunction with Dexmedetomidine-induced Sleep randomized, placebo-controlled, parallel-arm superiority trial.
Setting: Data from patients recruited between March 2017 and February 2022 at a tertiary medical center in Boston, Massachusetts were analyzed in February 2023.
Participants: Data from 337 patients aged 60 years or older who underwent cardiac surgery with cardiopulmonary bypass were included. INTERVENTIONS: Patients were assessed preoperatively and postoperatively at 30, 90, and 180 days using the subjective PROMIS Applied Cognition-Abilities and telephonic Montreal Cognitive Assessment. MEASUREMENT AND
Main results: Postoperative delirium occurred within 3 days in 39 participants (11.6%). After adjusting for baseline function, participants who developed postoperative delirium self-reported worse cognitive function (mean difference [MD] -2.64 [95% CI -5.25, -0.04]; p = 0.047) up to 180 days after surgery, as compared with nondelirious patients. This finding was consistent with those obtained from objective t-MoCA assessments (MD -0.77 [95% CI -1.49, -0.04]; p = 0.04).
Conclusions: In this cohort of older patients undergoing cardiac surgery, in-hospital delirium was associated with SCD up to 180 days after surgery. This finding suggested that measures of SCD may enable population-level insights into the burden of cognitive decline associated with postoperative delirium.
Références de l'article
- Association Between Postoperative Delirium and Long-Term Subjective Cognitive Decline in Older Patients Undergoing Cardiac Surgery: A Secondary Analysis of the Minimizing Intensive Care Unit Neurological Dysfunction with Dexmedetomidine-Induced Sleep Trial.
- Association Between Postoperative Delirium and Long-Term Subjective Cognitive Decline in Older Patients Undergoing Cardiac Surgery: A Secondary Analysis of the Minimizing Intensive Care Unit Neurological Dysfunction with Dexmedetomidine-Induced Sleep Trial.
- Namirembe GE, Baker S, Albanese M, Mueller A, Qu JZ, Mekonnen J, Wiredu K, Westover MB, Houle TT, Akeju O, Minimizing Intensive Care Unit Neurological Dysfunction with Dexmedetomidine-Induced Sleep Study Team
- Journal of cardiothoracic and vascular anesthesia
- 2023
- J Cardiothorac Vasc Anesth. 2023 Sep;37(9):1700-1706. doi: 10.1053/j.jvca.2023.04.035. Epub 2023 Apr 30.
- Humans, Aged, *Emergence Delirium, *Dexmedetomidine/adverse effects, *Delirium/chemically induced/diagnosis/epidemiology, *Cardiac Surgical Procedures/adverse effects, *Cognitive Dysfunction/chemically induced/diagnosis/epidemiology, Intensive Care Units, Sleep, Postoperative Complications/diagnosis/epidemiology/prevention & control
- Syndromes_Geriatriques, Neurocognitif, Sommeil, Confusion
- Liens
- Traduction automatique en Français sur Google Translate
- DOI: 10.1053/j.jvca.2023.04.035
- PMID: 37217424
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