Implementation of Evidence-Based International Recommendations Reduces Postoperative Delirium Rate in Patients Undergoing Cardiac Surgery or Interventions: A System-Based Quality Improvement Study.

Abstract

Background: Delirium is a frequent and serious complication of cardiac procedures that can lead to serious long-term health restrictions. As primary prevention is more effective in reducing rate of delirium than the therapy itself, this study aimed to investigate the effect of a multidisciplinary delirium prevention bundle on the postoperative delirium rate in patients undergoing cardiac procedures.

Methods: In this system-based quality improvement study, a four-component delirium prevention bundle was implemented in patients undergoing cardiac procedures at a single high-volume center. The program included preoperative delirium risk stratification, multidisciplinary education of consensus guidelines, written memory aids, and post-anesthetic visits with delirium screening until postoperative day three.

Results: Overall, 234 patients were included and analyzed during the 6-month study period. The overall delirium incidence rate was 12.4%. After the first 3-month baseline implementation period, the delirium rate was 17.2%, compared with 7.6% (p = 0.026) after implementation of the delirium prevention bundle. Multivariate analysis revealed independent risk factors such as age [adjusted odds ratio (OR): 1.046; 95% confidence interval (CI): 1.002-1.092; p = 0.042], double valve surgery [adjusted OR: 13.1; 95% CI: 3.240-52.974; p < 0.0001], and peripheral artery disease [adjusted OR: 8.131; 95% CI: 2.336-28.306; p < 0.001]. Hospital stay was significantly longer in patients with delirium [median 13 (12-19.5) versus 12 (11-14) days, p = 0.009].

Conclusions: This multidisciplinary system-based quality improvement study demonstrated a beneficial effect on the delirium rate after the implementation of a four-component delirium prevention bundle in patients undergoing cardiac surgery or intervention. Furthermore, multivariate analysis revealed important independent risk factors for delirium development. This might improve early risk stratification and strategies for this high-risk patient collective.