Association of earlier extubation and postoperative delirium after coronary artery bypass grafting
Earlier extubation after cardiac surgery is reported to have benefits on length of stay and complication rates, but the influence on postoperative delirium remains unclear. We sought to determine the effect of earlier extubation on delirium after coronary artery bypass grafting. A single-center retr...
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| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2020-01, Vol.159 (1), p.182-190.e7 |
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| container_title | The Journal of thoracic and cardiovascular surgery |
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| creator | Muller Moran, Hellmuth R. Maguire, Duncan Maguire, Doug Kowalski, Stephen Jacobsohn, Eric Mackenzie, Scott Grocott, Hilary Arora, Rakesh C. |
| description | Earlier extubation after cardiac surgery is reported to have benefits on length of stay and complication rates, but the influence on postoperative delirium remains unclear. We sought to determine the effect of earlier extubation on delirium after coronary artery bypass grafting.
A single-center retrospective review of consecutive isolated coronary artery bypass grafting patients from January 1, 2010, to December 31, 2015, was conducted. Baseline demographic characteristics, preoperative comorbidities, intraoperative data, and postoperative data were collected. A multivariable logistic regression was performed with analysis limited to extubation within the first 24 hours postoperatively.
We identified 2561 eligible patients. Delirium occurred in 13.9% (n = 357). Duration of postoperative mechanical ventilation was associated with higher delirium rates following adjustment, particularly after 12 to 24 hours (hourly odds ratio, 1.12; 95% confidence interval, 1.05-1.19; P |
| doi_str_mv | 10.1016/j.jtcvs.2019.03.047 |
| format | Article |
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A single-center retrospective review of consecutive isolated coronary artery bypass grafting patients from January 1, 2010, to December 31, 2015, was conducted. Baseline demographic characteristics, preoperative comorbidities, intraoperative data, and postoperative data were collected. A multivariable logistic regression was performed with analysis limited to extubation within the first 24 hours postoperatively.
We identified 2561 eligible patients. Delirium occurred in 13.9% (n = 357). Duration of postoperative mechanical ventilation was associated with higher delirium rates following adjustment, particularly after 12 to 24 hours (hourly odds ratio, 1.12; 95% confidence interval, 1.05-1.19; P < .001). No association was observed during the time period from 0 to 12 hours (hourly odds ratio, 1.02; 95% confidence interval, 0.99-1.06; P = .218). Major adverse events were associated with duration of ventilation after 0 to 12 hours (hourly odds ratio, 1.08; 95% confidence interval, 1.03-1.14; P < .002) but not after 12 to 24 hours (hourly odds ratio, 1.04; 95% CI, 0.96-1.14; P = .316). The overall rate of reintubation was 2.9% (n = 73).
Our findings suggest that delirium rates increase with lengthier postoperative ventilation times. This study provides the basis for consideration of the appropriate selection of earlier extubation to minimize delirium in patients undergoing cardiac surgery.
After identifying suitable individuals and adjusting for potential confounders, delirium was associated with the occurrence of postoperative delirium after 12 to 24 hours of postoperative mechanical ventilation. [Display omitted]</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2019.03.047</identifier><identifier>PMID: 31076177</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>anesthesia ; coronary artery bypass grafting ; critical care ; delirium ; perioperative care</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2020-01, Vol.159 (1), p.182-190.e7</ispartof><rights>2019 The American Association for Thoracic Surgery</rights><rights>Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c359t-a5334431e0d398b37d10512d9dbb1b043de219e2bfb70c2c124865dc5646aeae3</citedby><cites>FETCH-LOGICAL-c359t-a5334431e0d398b37d10512d9dbb1b043de219e2bfb70c2c124865dc5646aeae3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jtcvs.2019.03.047$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31076177$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Muller Moran, Hellmuth R.</creatorcontrib><creatorcontrib>Maguire, Duncan</creatorcontrib><creatorcontrib>Maguire, Doug</creatorcontrib><creatorcontrib>Kowalski, Stephen</creatorcontrib><creatorcontrib>Jacobsohn, Eric</creatorcontrib><creatorcontrib>Mackenzie, Scott</creatorcontrib><creatorcontrib>Grocott, Hilary</creatorcontrib><creatorcontrib>Arora, Rakesh C.</creatorcontrib><title>Association of earlier extubation and postoperative delirium after coronary artery bypass grafting</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Earlier extubation after cardiac surgery is reported to have benefits on length of stay and complication rates, but the influence on postoperative delirium remains unclear. We sought to determine the effect of earlier extubation on delirium after coronary artery bypass grafting.
A single-center retrospective review of consecutive isolated coronary artery bypass grafting patients from January 1, 2010, to December 31, 2015, was conducted. Baseline demographic characteristics, preoperative comorbidities, intraoperative data, and postoperative data were collected. A multivariable logistic regression was performed with analysis limited to extubation within the first 24 hours postoperatively.
We identified 2561 eligible patients. Delirium occurred in 13.9% (n = 357). Duration of postoperative mechanical ventilation was associated with higher delirium rates following adjustment, particularly after 12 to 24 hours (hourly odds ratio, 1.12; 95% confidence interval, 1.05-1.19; P < .001). No association was observed during the time period from 0 to 12 hours (hourly odds ratio, 1.02; 95% confidence interval, 0.99-1.06; P = .218). Major adverse events were associated with duration of ventilation after 0 to 12 hours (hourly odds ratio, 1.08; 95% confidence interval, 1.03-1.14; P < .002) but not after 12 to 24 hours (hourly odds ratio, 1.04; 95% CI, 0.96-1.14; P = .316). The overall rate of reintubation was 2.9% (n = 73).
Our findings suggest that delirium rates increase with lengthier postoperative ventilation times. This study provides the basis for consideration of the appropriate selection of earlier extubation to minimize delirium in patients undergoing cardiac surgery.
After identifying suitable individuals and adjusting for potential confounders, delirium was associated with the occurrence of postoperative delirium after 12 to 24 hours of postoperative mechanical ventilation. [Display omitted]</description><subject>anesthesia</subject><subject>coronary artery bypass grafting</subject><subject>critical care</subject><subject>delirium</subject><subject>perioperative care</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kEtLxDAQgIMouq7-AkFy9NI6SfrYHjyI-ALBi4K3kMd0ydJtatIu7r83uurR0zAz38wwHyFnDHIGrLpc5avRbGLOgTU5iByKeo_MGDR1Vi3Kt30yA-A8KzkXR-Q4xhUA1Ik9JEeCQV2xup4RfR2jN06NzvfUtxRV6BwGih_jpHdV1Vs6-Dj6AUOqbJBa7Fxw05qqdkys8cH3KmypCindUr0dVIx0GVLb9csTctCqLuLpT5yT17vbl5uH7On5_vHm-ikzomzGTJVCFIVgCFY0Cy1qy6Bk3DZWa6ahEBY5a5DrVtdguGG8WFSlNWVVVAoVijm52O0dgn-fMI5y7aLBrlM9-inK5IE1UBVQJVTsUBN8jAFbOQS3Ti9IBvJLrlzJb7nyS64EIZPcNHX-c2DSa7R_M782E3C1AzC9uUkaZTQOe4PWBTSjtN79e-AToQuORA</recordid><startdate>202001</startdate><enddate>202001</enddate><creator>Muller Moran, Hellmuth R.</creator><creator>Maguire, Duncan</creator><creator>Maguire, Doug</creator><creator>Kowalski, Stephen</creator><creator>Jacobsohn, Eric</creator><creator>Mackenzie, Scott</creator><creator>Grocott, Hilary</creator><creator>Arora, Rakesh C.</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202001</creationdate><title>Association of earlier extubation and postoperative delirium after coronary artery bypass grafting</title><author>Muller Moran, Hellmuth R. ; Maguire, Duncan ; Maguire, Doug ; Kowalski, Stephen ; Jacobsohn, Eric ; Mackenzie, Scott ; Grocott, Hilary ; Arora, Rakesh C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c359t-a5334431e0d398b37d10512d9dbb1b043de219e2bfb70c2c124865dc5646aeae3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>anesthesia</topic><topic>coronary artery bypass grafting</topic><topic>critical care</topic><topic>delirium</topic><topic>perioperative care</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Muller Moran, Hellmuth R.</creatorcontrib><creatorcontrib>Maguire, Duncan</creatorcontrib><creatorcontrib>Maguire, Doug</creatorcontrib><creatorcontrib>Kowalski, Stephen</creatorcontrib><creatorcontrib>Jacobsohn, Eric</creatorcontrib><creatorcontrib>Mackenzie, Scott</creatorcontrib><creatorcontrib>Grocott, Hilary</creatorcontrib><creatorcontrib>Arora, Rakesh C.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Muller Moran, Hellmuth R.</au><au>Maguire, Duncan</au><au>Maguire, Doug</au><au>Kowalski, Stephen</au><au>Jacobsohn, Eric</au><au>Mackenzie, Scott</au><au>Grocott, Hilary</au><au>Arora, Rakesh C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of earlier extubation and postoperative delirium after coronary artery bypass grafting</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2020-01</date><risdate>2020</risdate><volume>159</volume><issue>1</issue><spage>182</spage><epage>190.e7</epage><pages>182-190.e7</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><abstract>Earlier extubation after cardiac surgery is reported to have benefits on length of stay and complication rates, but the influence on postoperative delirium remains unclear. We sought to determine the effect of earlier extubation on delirium after coronary artery bypass grafting.
A single-center retrospective review of consecutive isolated coronary artery bypass grafting patients from January 1, 2010, to December 31, 2015, was conducted. Baseline demographic characteristics, preoperative comorbidities, intraoperative data, and postoperative data were collected. A multivariable logistic regression was performed with analysis limited to extubation within the first 24 hours postoperatively.
We identified 2561 eligible patients. Delirium occurred in 13.9% (n = 357). Duration of postoperative mechanical ventilation was associated with higher delirium rates following adjustment, particularly after 12 to 24 hours (hourly odds ratio, 1.12; 95% confidence interval, 1.05-1.19; P < .001). No association was observed during the time period from 0 to 12 hours (hourly odds ratio, 1.02; 95% confidence interval, 0.99-1.06; P = .218). Major adverse events were associated with duration of ventilation after 0 to 12 hours (hourly odds ratio, 1.08; 95% confidence interval, 1.03-1.14; P < .002) but not after 12 to 24 hours (hourly odds ratio, 1.04; 95% CI, 0.96-1.14; P = .316). The overall rate of reintubation was 2.9% (n = 73).
Our findings suggest that delirium rates increase with lengthier postoperative ventilation times. This study provides the basis for consideration of the appropriate selection of earlier extubation to minimize delirium in patients undergoing cardiac surgery.
After identifying suitable individuals and adjusting for potential confounders, delirium was associated with the occurrence of postoperative delirium after 12 to 24 hours of postoperative mechanical ventilation. [Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31076177</pmid><doi>10.1016/j.jtcvs.2019.03.047</doi></addata></record> |
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| subjects | anesthesia coronary artery bypass grafting critical care delirium perioperative care |
| title | Association of earlier extubation and postoperative delirium after coronary artery bypass grafting |
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