From the School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia.
Department of Anaesthesia, St Vincent's Hospital, Melbourne, Victoria, Australia.
Anesth Analg. 2023 Jun 1;136(6):1174-1181. doi: 10.1213/ANE.0000000000006226. Epub 2022 Oct 6.
Postoperative delirium (POD) is an acute syndrome including inattention and impaired cognition that affects approximately 42% of older cardiac surgical patients. POD is linked to adverse outcomes including morbidity, mortality, and further cognitive decline. Less is known about the subjective psychological experience of POD and its ongoing impact on well-being.
We performed a qualitative analysis of the long-term psychological sequelae of older adults who experience POD after cardiac surgery. We sampled 30 patients aged 60 years and older who experienced at least 2 episodes of POD during a prior hospital admission. We administered semistructured interviews with participants via telephone 3 to 5 years postoperatively. Interviews were transcribed and thematically analyzed. Data were interpreted in accordance with the naturalist paradigm.
Three overarching themes emerged in our qualitative analysis. The first reflected the multifaceted presentation of POD, including distortion of time and reality; feelings of isolation; and a loss of self, identity, and control. The second theme reflected the psychological challenges associated with functional decline after surgery. Common examples of functional decline included cognitive difficulties, excessive fatigue, and a perceived loss of independence. The final theme captured the emotional sequelae of acute illness, which included low mood, reduced motivation, and social comparisons.
Our findings emphasize the multidimensional experience of POD and long-term effects on psychological wellbeing. Our research highlights the beneficial role multidisciplinary clinicians play in managing POD including strategies that may be embedded into clinical practice and helps anesthesiologists understand why patients who have experienced POD in the past may present with specific concerns should they require subsequent surgery.
术后谵妄（POD）是一种包括注意力不集中和认知障碍在内的急性综合征，影响大约 42%的老年心脏手术患者。POD 与不良后果有关，包括发病率、死亡率和进一步的认知衰退。对于 POD 的主观心理体验及其对幸福感的持续影响知之甚少。
我们对经历过心脏手术后发生 POD 的老年患者的长期心理后遗症进行了定性分析。我们从之前住院期间至少经历过 2 次 POD 的 30 名 60 岁及以上的患者中抽取样本。我们通过电话对参与者进行了半结构化访谈，术后 3 至 5 年。访谈记录被转录，并进行了主题分析。数据是根据自然主义范式进行解释的。
我们的定性分析中出现了三个总体主题。第一个主题反映了 POD 的多方面表现，包括时间和现实的扭曲；孤立感；以及自我、身份和控制感的丧失。第二个主题反映了手术后与功能下降相关的心理挑战。常见的功能下降包括认知困难、过度疲劳和感知到的独立性丧失。最后一个主题描述了急性疾病的情绪后遗症，包括情绪低落、动力不足和社会比较。
我们的研究结果强调了 POD 的多维体验及其对心理健康的长期影响。我们的研究强调了多学科临床医生在管理 POD 方面的有益作用，包括可能嵌入临床实践的策略，并帮助麻醉师了解为什么过去经历过 POD 的患者在需要再次手术时可能会出现特定的担忧。
