Delirium after coronary artery bypass graft surgery and late mortality.
Delirium after coronary artery bypass graft surgery and late mortality.
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DOI：
10.1002/ana.21899
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发表时间：
2010-03
影响因子：
11.2
通讯作者：
McKhann, Guy M.
中科院分区：
文献类型：
--
作者：
Gottesman, Rebecca F.;Grega, Maura A.;Bailey, Maryanne M.;Pham, Luu D.;Zeger, Scott L.;Baumgartner, William A.;Selnes, Ola A.;McKhann, Guy M.
谵妄在心脏手术后很常见，尽管认识不足，其长期后果可能被低估。本研究的主要目的是确定冠状动脉旁路移植术（CABG）后谵妄患者与无谵妄的CABG患者相比是否具有更高的长期院外死亡率。我们研究了1997-2007年在一家机构接受CABG手术的5,034例连续患者。前瞻性评估是否存在神经系统并发症，包括谵妄。进行生存分析以确定谵妄在死亡危险中的作用，包括调整潜在混杂因素的倾向评分。重复这些分析以确定术后卒中与长期死亡率之间的关系。在调整围手术期和血管风险因素后，谵妄患者术后10年的死亡风险增加（调整后HR 1.65，95% CI 1.38，1.97）。术后卒中患者的HR为2.34（95% CI 1.87-2.92）。谵妄对随后死亡率的影响在既往无卒中的患者中最强（HR 1.83 vs HR 1.11（既往有卒中）（p-交互作用=0.02）或年轻患者中最强（HR 2.42（65岁以下）vs HR 1.49（65岁及以上）（p-交互作用=0.04）。心脏手术后谵妄是术后10年内死亡率的一个强有力的独立预测因素，尤其是在年轻人和既往无卒中史的患者中。未来的研究需要确定谵妄预防和/或治疗对长期患者死亡率的影响。
Delirium is common after cardiac surgery, although underrecognized, and its long-term consequences are likely underestimated. The primary goal of this study was to determine whether patients with delirium after coronary artery bypass graft (CABG) surgery have higher long-term out-of-hospital mortality when compared to CABG patients without delirium. We studied 5,034 consecutive patients undergoing CABG surgery at a single institution from 1997–2007. Presence or absence of neurologic complications, including delirium, was assessed prospectively. Survival analysis was performed to determine the role of delirium in the hazard of death, including a propensity score to adjust for potential confounders. These analyses were repeated to determine the association between postoperative stroke and long-term mortality. Individuals with delirium had an increased hazard of death (adjusted HR 1.65, 95% CI 1.38, 1.97), up to 10 years postoperatively, after adjustment for perioperative and vascular risk factors. Patients with postoperative stroke had a HR of 2.34 (95% CI 1.87–2.92). The effect of delirium on subsequent mortality was the strongest among those without a prior stroke (HR 1.83 vs HR 1.11 (with a prior stroke) (p-interaction=0.02) or who were younger (HR 2.42 (under 65 yo) vs HR 1.49 (65 yo and older) (p-interaction=0.04). Delirium after cardiac surgery is a strong independent predictor of mortality up to 10 years postoperatively, especially in younger individuals and in those without prior stroke. Future studies are needed to determine the impact of delirium prevention and/or treatment in long-term patient mortality.
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影响因子：
158.5
作者：
Inouye, SK;Bogardus, ST;Cooney, LW
通讯作者：
Cooney, LW
影响因子：
1.5
作者：
Prakanrattana, U.;Prapaitrakool, S.
通讯作者：
Prapaitrakool, S.
影响因子：
--
作者：
McCusker, J;Cole, M;Belzile, E
通讯作者：
Belzile, E
影响因子：
4.6
作者：
Yildizeli, B;Özyurtkan, O;Yüksel, M
通讯作者：
Yüksel, M
影响因子：
2.2
作者：
Loponen, Pertti;Luther, Michael;Tarkka, Matti R.
通讯作者：
Tarkka, Matti R.