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Delirium: an independent predictor of functional decline after cardiac surgery.
J Am Geriatr Soc 2010; 58(4):643-9JA

Abstract

OBJECTIVES

To determine whether patients who developed delirium after cardiac surgery were at risk of functional decline.

DESIGN

Prospective cohort study.

SETTING

Two academic hospitals and a Veterans Affairs Medical Center.

PARTICIPANTS

One hundred ninety patients aged 60 and older undergoing elective or urgent cardiac surgery.

MEASUREMENTS

Delirium was assessed daily and was diagnosed according to the Confusion Assessment Method. Before surgery and 1 and 12 months postoperatively, patients were assessed for function using the instrumental activities of daily living (IADL) scale. Functional decline was defined as a decrease in ability to perform one IADL at follow-up.

RESULTS

Delirium occurred in 43.1% (n=82) of the patients (mean age 73.7+/-6.7). Functional decline occurred in 36.3% (n=65/179) at 1 month and in 14.6% (n=26/178) at 12 months. Delirium was associated with greater risk of functional decline at 1 month (relative risk (RR)=1.9, 95% confidence interval (CI)=1.3-2.8) and tended toward greater risk at 12 months (RR=1.9, 95% CI=0.9-3.8). After adjustment for age, cognition, comorbidity, and baseline function, delirium remained significantly associated with functional decline at 1 month (adjusted RR=1.8, 95% CI=1.2-2.6) but not at 12 months (adjusted RR=1.5, 95% CI=0.6-3.3).

CONCLUSION

Delirium was independently associated with functional decline at 1 month and had a trend toward association at 12 months. These findings provide justification for intervention trials to evaluate whether delirium prevention or treatment strategies might improve postoperative functional recovery.

Authors+Show Affiliations

Geriatric Research, Education, and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts 02130, USA. jrudolph@partners.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20345866

Citation

Rudolph, James L., et al. "Delirium: an Independent Predictor of Functional Decline After Cardiac Surgery." Journal of the American Geriatrics Society, vol. 58, no. 4, 2010, pp. 643-9.
Rudolph JL, Inouye SK, Jones RN, et al. Delirium: an independent predictor of functional decline after cardiac surgery. J Am Geriatr Soc. 2010;58(4):643-9.
Rudolph, J. L., Inouye, S. K., Jones, R. N., Yang, F. M., Fong, T. G., Levkoff, S. E., & Marcantonio, E. R. (2010). Delirium: an independent predictor of functional decline after cardiac surgery. Journal of the American Geriatrics Society, 58(4), pp. 643-9. doi:10.1111/j.1532-5415.2010.02762.x.
Rudolph JL, et al. Delirium: an Independent Predictor of Functional Decline After Cardiac Surgery. J Am Geriatr Soc. 2010;58(4):643-9. PubMed PMID: 20345866.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Delirium: an independent predictor of functional decline after cardiac surgery. AU - Rudolph,James L, AU - Inouye,Sharon K, AU - Jones,Richard N, AU - Yang,Frances M, AU - Fong,Tamara G, AU - Levkoff,Sue E, AU - Marcantonio,Edward R, Y1 - 2010/03/22/ PY - 2010/3/30/entrez PY - 2010/3/30/pubmed PY - 2010/5/15/medline SP - 643 EP - 9 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 58 IS - 4 N2 - OBJECTIVES: To determine whether patients who developed delirium after cardiac surgery were at risk of functional decline. DESIGN: Prospective cohort study. SETTING: Two academic hospitals and a Veterans Affairs Medical Center. PARTICIPANTS: One hundred ninety patients aged 60 and older undergoing elective or urgent cardiac surgery. MEASUREMENTS: Delirium was assessed daily and was diagnosed according to the Confusion Assessment Method. Before surgery and 1 and 12 months postoperatively, patients were assessed for function using the instrumental activities of daily living (IADL) scale. Functional decline was defined as a decrease in ability to perform one IADL at follow-up. RESULTS: Delirium occurred in 43.1% (n=82) of the patients (mean age 73.7+/-6.7). Functional decline occurred in 36.3% (n=65/179) at 1 month and in 14.6% (n=26/178) at 12 months. Delirium was associated with greater risk of functional decline at 1 month (relative risk (RR)=1.9, 95% confidence interval (CI)=1.3-2.8) and tended toward greater risk at 12 months (RR=1.9, 95% CI=0.9-3.8). After adjustment for age, cognition, comorbidity, and baseline function, delirium remained significantly associated with functional decline at 1 month (adjusted RR=1.8, 95% CI=1.2-2.6) but not at 12 months (adjusted RR=1.5, 95% CI=0.6-3.3). CONCLUSION: Delirium was independently associated with functional decline at 1 month and had a trend toward association at 12 months. These findings provide justification for intervention trials to evaluate whether delirium prevention or treatment strategies might improve postoperative functional recovery. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/20345866/Delirium:_an_independent_predictor_of_functional_decline_after_cardiac_surgery_ L2 - https://doi.org/10.1111/j.1532-5415.2010.02762.x DB - PRIME DP - Unbound Medicine ER -