Abstract
Background
Postoperative delirium (POD) is a critical complication that is closely associated with mortality and major morbidity in elective cardiac surgery. The identification of patients at risk for POD is crucial but has not been fully explored.
Aims
The aim of this study was to determine the predictive value of the assessment of preoperative exercise capacity for POD.
Methods
We enrolled 313 consecutive patients (mean age, 68.6 ± 14.8 years) undergoing elective cardiac surgery. We measured physical functions such as the 6-minute walking distance (6MWD) and Timed Up-and-Go test (TUG) before surgery. The assessment of delirium was conducted every 8 h from the day of surgery to 5 days after surgery using the Intensive Care Delirium Screening Checklist.
Results
POD occurred in 46 patients (14.6%). Age, 6MWD, TUG, serum hemoglobin, estimated glomerular filtration rate, and length of intensive care unit stay were significantly different based on the presence or absence of POD (p < 0.05 for each). After multivariate analysis, 6MWD remained a statistically significant indicator for developing POD (OR 0.98; p = 0.02). The cut-off value of 6MWD for predicting POD was 345 m (AUC = 0.75; p = 0.001).
Conclusions
Poor exercise capacity was found to be an independent predictor of POD following elective cardiac surgery. This finding suggests the importance of preoperative functional evaluation in the prevention and management of POD in cardiac surgery patients.
Similar content being viewed by others
Abbreviations
- 6MWD:
-
6-minute walking distance
- ADL:
-
Activities of daily living
- BMI:
-
Body mass index
- BNP:
-
Brain natriuretic peptide
- CABG:
-
Coronary artery bypass surgery
- eGFR:
-
Estimated glomerular filtration rate
- Hb:
-
Serum hemoglobin
- ICDSC:
-
Intensive Care Delirium Screening Checklist
- ICU:
-
Intensive care unit
- MMSE:
-
Mini Mental State Examination
- NYHA:
-
New York Heart Association
- POD:
-
Postoperative delirium
- TUG:
-
Timed Up-and-Go test.
References
Rudolph JL, Inouye SK, Jones RN et al (2010) Delirium: an independent predictor of functional decline after cardiac surgery. J Am Geriatr Soc 58:643–649
Inouye SK, Westendorp RG, Saczynski JS (2014) Delirium in elderly people. The Lancet 383:911–922
Sockalingam S, Parekh N, Bogoch II et al (2005) Delirium in the postoperative cardiac patient: a review. J Card Surg 20:560–567
Saczynski JS, Marcantonio ER, Quach L et al (2012) Cognitive trajectories after postoperative delirium. N Engl J Med 367:30–39
Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Masuda M et al (2014) Thoracic and cardiovascular surgery in Japan during 2012: annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg 12:734–764
Shehabi Y, Riker RR, Bokesch PM, Wisemandle W, Shintani A, Ely EW (2010) Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients. Crit Care Med 38:2311–2318
Franco K, Litaker D, Locala J, Bronson D (2001) The cost of delirium in the surgical patient. Psychosomatics 42:68–73
Kalisvaart KJ, de Jonghe JF, Bogaards MJ et al (2005) Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study. J Am Geriatr Soc 53:1658–1666
Inouye SK, Bogardus ST Jr, Charpentier PA et al (1999) A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 340:669–676
Ford AH (2016) Preventing delirium in dementia: managing risk factors. Maturitas 92:35–40
Ford AH, Flicker L, Passage J et al (2016) The healthy heart-mind trial: melatonin for prevention of delirium following cardiac surgery: study protocol for a randomized controlled trial. Trials 17:55
Dasgupta M, Dumbrell AC (2006) Preoperative risk assessment for delirium after noncardiac surgery: a systematic review. J Am Geriatr Soc 54:1578–1589
Marcantonio ER, Goldman L, Mangione CM et al (1994) A clinical prediction rule for delirium after elective noncardiac surgery. JAMA 271:134–139
Litaker D, Locala J, Franco K, Bronson DL, Tannous Z (2001) Preoperative risk factors for postoperative delirium. Gen Hosp Psychiatry 23:84–89
Ogawa M, Izawa KP, Kitamura A et al (2015) Preoperative physical activity in relation to postoperative delirium in elective cardiac surgery patients. Int J Cardiol 201:154–156
Galanakis P, Bickel H, Gradinger R, Von Gumppenberg S, Forstl H (2001) Acute confusional state in the elderly following hip surgery: incidence, risk factors and complications. Int J Geriatr Psychiatry 16:349–355
Afilalo J, Eisenberg MJ, Morin JF et al (2010) Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol 56:1668–1676
Nashef SA, Roques F, Sharples LD et al (2012) EuroSCORE II. Eur J Cardiothorac Surg 41:734–745
Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148
Costa HS, Lima MM, de Sousa GR et al (2014) Functional capacity and risk stratification by the Six-minute Walk Test in Chagas heart disease: comparison with cardiopulmonary exercise testing. Int J Cardiol 177:661–663
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166:111–117
Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y (2001) Intensive care delirium screening checklist: evaluation of a new screening tool. Intensive Care Med 27:859–864
Youden WJ (1950) Index for rating diagnostic tests. Cancer 3:32–35
Akobeng AK (2007) Understanding diagnostic tests 3: receiver operating characteristic curves. Acta Paediatr 96:644–647
Clarke SP, McRae ME, Del Signore S, Schubert M, Styra R (2010) Delirium in older cardiac surgery patients: directions for practice. J Gerontol Nurs 36:34–45
Zaal IJ, Devlin JW, Peelen LM, Slooter AJ (2015) A systematic review of risk factors for delirium in the ICU. Crit Care Med 43:40–47
Middlekauff HR (2010) Making the case for skeletal myopathy as the major limitation of exercise capacity in heart failure. Circ Heart Fail 3:537–546
Okita K, Kinugawa S, Tsutsui H (2013) Exercise intolerance in chronic heart failure–skeletal muscle dysfunction and potential therapies. Circ J 77:293–300
Mu DL, Wang DX, Li LH et al (2010) High serum cortisol level is associated with increased risk of delirium after coronary artery bypass graft surgery: a prospective cohort study. Crit Care 14:R238
Smith JL, Verrill TA, Boura JA, Sakwa MP, Shannon FL, Franklin BA (2013) Effect of cardiorespiratory fitness on short-term morbidity and mortality after coronary artery bypass grafting. Am J Cardiol 112:1104–1109
Hughes CG, Patel MB, Pandharipande PP (2012) Pathophysiology of acute brain dysfunction: what’s the cause of all this confusion? Curr Opin Crit Care 18:518–526
Al Tmimi L, Van de Velde M, Meyns B et al (2016) Serum protein S100 as marker of postoperative delirium after off-pump coronary artery bypass surgery: secondary analysis of two prospective randomized controlled trials. Clin Chem Lab Med 54:1671–1680
Bellelli G, Mazzola P, Morandi A et al (2014) Duration of postoperative delirium is an independent predictor of 6-month mortality in older adults after hip fracture. J Am Geriatr Soc 62:1335–1340
Robinson TN, Wu DS, Sauaia A et al (2013) Slower walking speed forecasts increased postoperative morbidity and 1-year mortality across surgical specialties. Ann Surg 258:582–590
Ingle L, Rigby AS, Carroll S et al (2007) Prognostic value of the 6 min walk test and self-perceived symptom severity in older patients with chronic heart failure. Eur Heart J 28:560–568
Lee JT, Chaloner EJ, Hollingsworth SJ (2006) The role of cardiopulmonary fitness and its genetic influences on surgical outcomes. Br J Surg 93:147–157
Yamada S, Kamiya K, Kono Y (2015) Frailty may be a risk marker for adverse outcome in patients with congestive heart failure. ESC Heart Fail 2:168–170
European Heart Failure Training Group (1998) Experience from controlled trials of physical training in chronic heart failure. Protocol and patient factors in effectiveness in the improvement in exercise tolerance. European Heart Failure Training Group. Eur Heart J 19:466–475
Baldasseroni S, Pratesi A, Francini S et al (2016) Cardiac rehabilitation in very old adults: effect of baseline functional capacity on treatment effectiveness. J Am Geriatr Soc 64:1640–1645
Clark AL, Poole-Wilson PA, Coats AJ (1996) Exercise limitation in chronic heart failure: central role of the periphery. J Am Coll Cardiol 28(5):1092–1102
Acknowledgements
We thank the staff members of Kobe University Hospital who collaborated in this study.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that there are no conflicts of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Ogawa, M., Izawa, K.P., Satomi-Kobayashi, S. et al. Preoperative exercise capacity is associated with the prevalence of postoperative delirium in elective cardiac surgery. Aging Clin Exp Res 30, 27–34 (2018). https://doi.org/10.1007/s40520-017-0736-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40520-017-0736-5