Characteristics and influencing factors of postoperative delirium among elderly patients in intensive care unit

doi:10.3969/j.issn.1674-8115.2021.12.006

Abstract

Abstract: Objective

·To investigate the characteristics and influencing factors of postoperative delirium among elderly patients admitted to intensive care unit (ICU).

Methods

·The convenience sampling method was used to select cardiothoracic surgical ICU patients after operation in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from May to September 2020. Delirium was assessed using the Confusion Assessment Method-ICU (CAM-ICU) and the assessment was performed until ICU discharge or for a maximum of 7 d, whichever occurred first. Patients′ demographics and clinical data were collected. The influencing factors were analyzed by univariate analysis and multivariate Logistic regression.

Results

·A total of 343 patients were included for this study and 103 developed postoperative delirium, with an incidence of 30.03%. All the delirium occurred within 7.5?130.0 h after operation, with a mean of (47.4±29.7) h and a median of 35.5(23.0, 61.0) h. On the whole, delirium uniformly distributed throughout the day. Only the delirium that occurred within 24 h after surgery showed a central tendency with the high-incidence time at 11:53 am while the others did not. Delirium duration lasted 6.5?131.0 h, with a mean of (32.4±28.1) h and a median of 20.5(14.0, 45.0) h. Comparison of the characteristics of patients in the delirium group and non-delirium group showed that there were statistical differences in gender, history of diabetes, heart function classification, American Society of Anesthesiologists (ASA) classification, operation duration, intraoperative blood loss, intraoperative cardiopulmonary bypass, intraoperative hypotension, postoperative mechanical ventilation and postoperative oxygenation index. Multivariate Logistic regression analysis showed that ASA classification, intraoperative hypotension and cardiopulmonary bypass had significant influence on postoperative delirium (all P<0.05).

Conclusion

·The incidence of postoperative delirium is high among elderly patients who are admitted in ICU after operation. Higher ASA classification, intraoperative hypotension and cardiopulmonary bypass are influencing factors of delirium. To reduce delirium occurrence and shorten its duration, medical staff should understand the characteristics and influencing factors of postoperative delirium, evaluate delirium and implement preventive interventions.

Key words: postoperative delirium, intensive care unit (ICU), the aged, characteristic analysis, influencing factor

CLC Number:

R741.02

Zhi-shan WU, Run HUANG, Li-ping LIANG, Yu-ting ZHU, Qiao-mu ZHENG, Li-ping JIANG. Characteristics and influencing factors of postoperative delirium among elderly patients in intensive care unit[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(12): 1580-1586.

Figures/Tables 6

TrendMD

References 46

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Item	Non-delirium group （n=240）	Delirium group （n=103）	t/Z/χ² value	P value
Gender/n （%）			3.894	0.048
Male	147 （61.3）	74 （71.8）
Female	93 （38.7）	29 （28.2）
Age/year	68.13±5.54	69.18±5.96	-1.570	0.118
BMI/n （%）			1.335	0.513
<18.5 （kg·m^-2）	19 （7.9）	5 （4.9）
≥18.5 and <24.0 （kg·m^-2）	120 （50.0）	50 （48.5）
≥24.0 （kg·m^-2）	101 （42.1）	48 （46.6）
Smoking history/n （%）			3.383	0.066
Yes	52 （21.7）	32 （31.1）
No	188 （78.3）	71 （68.9）
Drinking history/n （%）			0.249	0.618
Yes	23 （9.6）	12 （11.7）
No	217 （90.4）	91 （88.3）
Hypertension/n （%）			0.847	0.646
Yes	127 （52.9）	59 （57.3）
No	113 （47.1）	44 （42.7）
Diabetes/n （%）			4.033	0.045
Yes	40 （16.7）	28 （27.2）
No	200 （83.3）	75 （72.8）
Stroke/n （%）			2.243	0.134
Yes	27 （11.2）	19 （18.4）
No	213 （88.8）	84 （81.6）
Kinds of drug/n （%）			0.015	0.902
<5	220 （91.7）	94 （91.3）
≥5	20 （8.3）	9 （8.7）
Prealbumin/（mg·L^-1）	225.51±56.97	226.05±61.28	0.380	0.704
Albumin/（g·L^-1）	41.83±7.24	40.46±4.07	1.785	0.075
Cardiac function/n （%）			14.328	0.000
<Ⅲ	180 （75.0）	56 （54.4）
≥Ⅲ	60 （25.0）	47 （45.6）
ASA/n （%）			25.389	0.000
Ⅱ	97 （40.4）	14 （13.6）
Ⅲ	110 （45.8）	62 （60.2）
Ⅳ	33 （13.8）	27 （26.2）
Operation duration/min	196.44±87.68	233.49±79.98	-3.674	0.001
Intraoperative blood loss/mL	100 （50， 200）	200 （95， 300）	-3.776	0.000
Cardiopulmonary bypass/n （%）			18.050	0.000
Yes	40 （16.7）	40 （38.8）
No	200 （83.3）	63 （61.2）
Intraoperative hypotension/n （%）			30.616	0.000
Yes	60 （25.0）	57 （55.3）
No	180 （75.0）	46 （44.7）
Mechanical ventilation/n （%）			8.579	0.003
Yes	175 （72.9）	90 （87.4）
No	65 （27.1）	13 （12.6）
Oxygenation index/mmHg	316.94±119.26	259.27±128.51	4.037	0.000
Lactic acid/（mg·L^-1）	2.70 （2.20， 3.80）	2.90 （2.10， 4.00）	-1.065	0.287

Item	Non-delirium group （n=240）	Delirium group （n=103）	t/Z/χ² value	P value
Gender/n （%）			3.894	0.048
Male	147 （61.3）	74 （71.8）
Female	93 （38.7）	29 （28.2）
Age/year	68.13±5.54	69.18±5.96	-1.570	0.118
BMI/n （%）			1.335	0.513
<18.5 （kg·m^-2）	19 （7.9）	5 （4.9）
≥18.5 and <24.0 （kg·m^-2）	120 （50.0）	50 （48.5）
≥24.0 （kg·m^-2）	101 （42.1）	48 （46.6）
Smoking history/n （%）			3.383	0.066
Yes	52 （21.7）	32 （31.1）
No	188 （78.3）	71 （68.9）
Drinking history/n （%）			0.249	0.618
Yes	23 （9.6）	12 （11.7）
No	217 （90.4）	91 （88.3）
Hypertension/n （%）			0.847	0.646
Yes	127 （52.9）	59 （57.3）
No	113 （47.1）	44 （42.7）
Diabetes/n （%）			4.033	0.045
Yes	40 （16.7）	28 （27.2）
No	200 （83.3）	75 （72.8）
Stroke/n （%）			2.243	0.134
Yes	27 （11.2）	19 （18.4）
No	213 （88.8）	84 （81.6）
Kinds of drug/n （%）			0.015	0.902
<5	220 （91.7）	94 （91.3）
≥5	20 （8.3）	9 （8.7）
Prealbumin/（mg·L^-1）	225.51±56.97	226.05±61.28	0.380	0.704
Albumin/（g·L^-1）	41.83±7.24	40.46±4.07	1.785	0.075
Cardiac function/n （%）			14.328	0.000
<Ⅲ	180 （75.0）	56 （54.4）
≥Ⅲ	60 （25.0）	47 （45.6）
ASA/n （%）			25.389	0.000
Ⅱ	97 （40.4）	14 （13.6）
Ⅲ	110 （45.8）	62 （60.2）
Ⅳ	33 （13.8）	27 （26.2）
Operation duration/min	196.44±87.68	233.49±79.98	-3.674	0.001
Intraoperative blood loss/mL	100 （50， 200）	200 （95， 300）	-3.776	0.000
Cardiopulmonary bypass/n （%）			18.050	0.000
Yes	40 （16.7）	40 （38.8）
No	200 （83.3）	63 （61.2）
Intraoperative hypotension/n （%）			30.616	0.000
Yes	60 （25.0）	57 （55.3）
No	180 （75.0）	46 （44.7）
Mechanical ventilation/n （%）			8.579	0.003
Yes	175 （72.9）	90 （87.4）
No	65 （27.1）	13 （12.6）
Oxygenation index/mmHg	316.94±119.26	259.27±128.51	4.037	0.000
Lactic acid/（mg·L^-1）	2.70 （2.20， 3.80）	2.90 （2.10， 4.00）	-1.065	0.287

Variable	Assignment instruction
Gender	Male=0； Female=1
Diabetes	No=0； Yes=1
Cardiac function	<Ⅲ（Ⅰ、Ⅱ）=0； ≥Ⅲ（Ⅲ、Ⅳ）=1
ASA classification	Ⅱ=1（reference group）； Ⅲ=2； Ⅳ=3
Operation duration	Original value
Intraoperative blood loss	Original value
Intraoperative hypotension	No=0； Yes=1
Cardiopulmonary bypass	No=0； Yes=1
Mechanical ventilation	No=0； Yes=1
Oxygenation index	Original value

Variable	Assignment instruction
Gender	Male=0； Female=1
Diabetes	No=0； Yes=1
Cardiac function	<Ⅲ（Ⅰ、Ⅱ）=0； ≥Ⅲ（Ⅲ、Ⅳ）=1
ASA classification	Ⅱ=1（reference group）； Ⅲ=2； Ⅳ=3
Operation duration	Original value
Intraoperative blood loss	Original value
Intraoperative hypotension	No=0； Yes=1
Cardiopulmonary bypass	No=0； Yes=1
Mechanical ventilation	No=0； Yes=1
Oxygenation index	Original value

Item	β	SE	Wald χ²	P value	OR	95%CI
Intraoperative hypotension	1.273	0.261	23.775	0.000	3.573	2.142‒5.962
Cardiopulmonary bypass	0.729	0.291	6.290	0.012	2.073	1.173‒3.666
ASA（Ⅱ）	‒	‒	15.068	0.001	1.000	‒
ASA（Ⅲ）	1.216	0.343	12.547	0.000	3.373	1.721‒6.609
ASA（Ⅳ）	1.455	0.416	12.199	0.000	4.283	1.893‒9.687
Constant	-2.499	0.324	59.482	0.000	0.082	‒