Is Preoperative Anxiety and Depression Associated with Onset of Delirium After Cardiac Surgery in Older Patients? A Prospective Cohort Study.
Detroyer, Elke RN, MSN *; Dobbels, Fabienne PhD *,+; Verfaillie, Els RN, MSN *; Meyfroidt, Geert MD ++; Sergeant, Paul MD, PhD [S]; Milisen, Koen RN, PhD *,[//]
Journal of the American Geriatrics Society.
56(12):2278-2284, December 2008.
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OBJECTIVES: To investigate the prevalence of preoperative anxiety and depressive symptoms and their relationship with the occurrence of postcardiac delirium and to describe the evolution of these symptoms from preoperative admission until discharge.
DESIGN: Descriptive, prospective, longitudinal study.
SETTING: The intensive care unit and two cardiac surgery units in a university hospital setting.
PARTICIPANTS: One hundred four patients (median age 71; 78.8% men) admitted for elective cardiac surgery.
MEASUREMENTS: Anxiety measured preoperatively using the State-Trait Anxiety Inventory (STAI) and the Hospital Anxiety and Depression Scale (HADS); depression using the HADS; cognitive functioning using the Mini-Mental State Examination (MMSE); delirium using the Confusion Assessment Method (CAM), the CAM for the Intensive Care Unit (CAM-ICU), and the Delirium Index (DI); and activities of daily living using the Katz index of activities of daily living (Katz ADL scale). MMSE, CAM/CAM-ICU, and DI were obtained on postoperative Days 1, 3, and 7. On Day 7 and at discharge, the STAI, HADS, and Katz ADL scale were repeated.
RESULTS: Postoperative delirium occurred in 26%; 55.8% reported preoperative state anxiety, 25.2% generalized anxiety, and 15.5% depressive symptoms, but no association was found with delirium occurrence. Based on multivariable analysis, prolonged intubation time (odds ratio (OR)=1.10, CI: 1.05-1.15, P=.001) and a low intraoperative lowest body temperature (OR=0.86, CI: 0.74-0.99, P=.03) were independent predictors of delirium onset. At discharge, 35.7% and 12.2% of patients reported state anxiety and generalized, and 15.3% reported depressive symptoms.
CONCLUSION: Despite the high prevalence of preoperative anxiety and depressive symptoms in older patients with cardiac surgery, no association was found with postoperative delirium.
(C) 2008 by the American Geriatrics Society