Milz Simon, Holaubek Caroline, Siebel Jan, Hulde Nikolai, Wefer Franziska, Fruend Andreas, Tigges-Limmer Katharina, Gummert Jan, von Dossow Vera
Institute of Anaesthesiology and Pain Therapy, Heart and Diabetescenter Bad Oeynhausen, NRW, Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany.
Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Wien, Austria.
Rev Cardiovasc Med. 2024 Oct 16;25(10):369. doi: 10.31083/j.rcm2510369. eCollection 2024 Oct.
Delirium is a frequent and serious complication of cardiac procedures that can lead to serious long-term health restrictions. As primary prevention is more effective in reducing rate of delirium than the therapy itself, this study aimed to investigate the effect of a multidisciplinary delirium prevention bundle on the postoperative delirium rate in patients undergoing cardiac procedures.
In this system-based quality improvement study, a four-component delirium prevention bundle was implemented in patients undergoing cardiac procedures at a single high-volume center. The program included preoperative delirium risk stratification, multidisciplinary education of consensus guidelines, written memory aids, and post-anesthetic visits with delirium screening until postoperative day three.
Overall, 234 patients were included and analyzed during the 6-month study period. The overall delirium incidence rate was 12.4%. After the first 3-month baseline implementation period, the delirium rate was 17.2%, compared with 7.6% ( = 0.026) after implementation of the delirium prevention bundle. Multivariate analysis revealed independent risk factors such as age [adjusted odds ratio (OR): 1.046; 95% confidence interval (CI): 1.002-1.092; = 0.042], double valve surgery [adjusted OR: 13.1; 95% CI: 3.240-52.974; < 0.0001], and peripheral artery disease [adjusted OR: 8.131; 95% CI: 2.336-28.306; < 0.001]. Hospital stay was significantly longer in patients with delirium [median 13 (12-19.5) versus 12 (11-14) days, = 0.009].
This multidisciplinary system-based quality improvement study demonstrated a beneficial effect on the delirium rate after the implementation of a four-component delirium prevention bundle in patients undergoing cardiac surgery or intervention. Furthermore, multivariate analysis revealed important independent risk factors for delirium development. This might improve early risk stratification and strategies for this high-risk patient collective.
谵妄是心脏手术常见且严重的并发症，可导致严重的长期健康限制。由于一级预防在降低谵妄发生率方面比治疗本身更有效，本研究旨在探讨多学科谵妄预防综合措施对接受心脏手术患者术后谵妄发生率的影响。
在这项基于系统的质量改进研究中，一个包含四个组成部分的谵妄预防综合措施在一家高容量单一中心接受心脏手术的患者中实施。该计划包括术前谵妄风险分层、多学科共识指南教育、书面记忆辅助工具以及术后麻醉访视并进行谵妄筛查直至术后第三天。
在为期6个月的研究期间，共纳入并分析了234例患者。总体谵妄发生率为12.4%。在最初3个月的基线实施期后，谵妄发生率为17.2%，而实施谵妄预防综合措施后为7.6%（P = 0.026）。多变量分析显示了独立的危险因素，如年龄[调整后的优势比（OR）：1.046；95%置信区间（CI）：1.002 - 1.092；P = 0.042]、双瓣手术[调整后的OR：13.1；95%CI：3.240 - 52.974；P < 0.0001]和外周动脉疾病[调整后的OR：8.131；95%CI：2.336 - 28.306；P < 0.001]。谵妄患者的住院时间明显更长[中位数13（12 - 19.5）天对12（11 - 14）天，P = 0.009]。
这项基于多学科系统的质量改进研究表明，在接受心脏手术或介入治疗的患者中实施包含四个组成部分的谵妄预防综合措施后，对谵妄发生率有有益影响。此外，多变量分析揭示了谵妄发生的重要独立危险因素。这可能会改善对这一高危患者群体的早期风险分层和策略。
