Preoperative physical performance-related postoperative delirium in patients after cardiovascular surgery

Ryohei Otsuka; Keiichi Oyanagi; Misaki Hokari; Taku Shinoda; Jumpei Harada; Takayuki Shimogai; Yusuke Takahashi; Takeshi Kitai; Kentaro Iwata; Atsuhiro Tsubaki

doi:10.1016/j.archger.2020.104172

Preoperative physical performance-related postoperative delirium in patients after cardiovascular surgery

Arch Gerontol Geriatr. 2020 Nov/Dec:91:104172. doi: 10.1016/j.archger.2020.104172. Epub 2020 Jul 1.

Authors

Affiliations

¹ Department of Rehabilitation, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo Prefecture, Japan; Graduate School of Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata Prefecture, Japan. Electronic address: r.otsuka0811@gmail.com.
² Department of Rehabilitation, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo Prefecture, Japan.
³ Department of Rehabilitation, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo Prefecture, Japan; Graduate School of Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata Prefecture, Japan.
⁴ Department of Rehabilitation, Kaetsu Hospital, 1459-1 Higashi Kanazawa, Akiha-ku, Niigata City, Niigata Prefecture, Japan.
⁵ Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo Prefecture, Japan.
⁶ Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata Prefecture, Japan.

PMID: 32707522
DOI: 10.1016/j.archger.2020.104172

Abstract

Objectives: This investigation clarified the relationship between a short physical performance battery (SPPB) that can comprehensively and safely evaluate balance function, walking ability, lower limb muscle strength, and postoperative delirium.

Methods: This was a retrospective observational study performed at Kobe City Medical Center General Hospital. Patients who underwent surgery at the Kobe City Medical Center General Hospital Cardiovascular Surgery from August 1, 2016 to July 31, 2017 were included. Preoperative physical functions were obtained. Those showing positive results using the confusion assessment method for intensive care unit (ICU) during the ICU stay were considered as the delirium group, and the postoperative and non-postoperative delirium groups were compared. A multiple logistic regression analysis was performed with the presence or absence of onset of delirium as the dependent variable and the SPPB total score and age as dependent variables.

Results: There were 193 subjects in this study (120 males and 73 females). Sixteen patients (8.4 %) had postoperative delirium. The age in the postoperative delirium group was significantly higher than in the postoperative delirium group (77.8 (7.0) years vs. 70.0 (11.1) years). BMI and SPPB total score were significantly lower in the postoperative delirium group. From the multiple logistic regression, the SPPB total score (OR: 0.754, 95 % CI: 0.643-0.883, p < 0.001) was extracted as a factor related to postoperative delirium onset.

Conclusion: It was illuminated that in patients with cardiovascular surgery, preoperative low physical function was not affected by age and became a risk factor of postoperative delirium onset.

Keywords: Frailty; Postoperative delirium; Preoperative physical function; Short physical performance battery.