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Preoperative exercise capacity is associated with the prevalence of postoperative delirium in elective cardiac surgery

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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.

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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.

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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.

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Corresponding author

Correspondence to Kazuhiro P. Izawa.

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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.

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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

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  • DOI: https://doi.org/10.1007/s40520-017-0736-5

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