The effect of multi-component interventions on the incidence rate, severity, and duration of post open heart surgery delirium among hospitalized patients

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Abstract

Background

Delirium is one of the prevalent complications of post open heart surgery. The present research aimed to assess the effect of multi-component interventions on the incidence rate, severity, and duration of post open heart surgery delirium among hospitalized patients.

Methods

In this quasi-experimental study, 96 patients under open heart surgery were selected using convenience sampling and divided into a control and an intervention group. The interventions included the patients’ preoperative education, nurses’ education, and in-ward environmental interventions. The demographic information and Mini-Mental State Examination (MMSE) questionnaires were completed a day before surgery. The patients in both groups were also surveyed after extubation until the fourth day post operation using Delirium Observation Screening (DOS) scale considering the incidence, severity, and duration of delirium. The data were analyzed using the SPSS statistical software, version 20.

Results

The incidence rate of delirium was 14.6 and 6.2% in the control and intervention groups, respectively ( p > 0.05). Besides, the mean severity of delirium was 0.53 in the control group and 0.40 in the intervention group ( p > 0.05). Finally, the mean duration of delirium was 4.5 and 3.25 h in the two groups, respectively ( p > 0.05).

Conclusions

Since prevention of delirium can play a considerable role in the patients’ recovery after heart surgery, it is necessary to carry out some measures to prevent such complications. Even though the interventions performed in this study did not cause significant changes in this regard, the results suggested that prevention interventions should be performed with stronger and more integrated planning for achieving better outcomes.

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Most cited references 26

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Postoperative delirium.

Fabio Vannucci, E Whitlock, M Avidan (2011)

Delirium is a common complication during the postoperative period. Because of its significant associations with physical and cognitive morbidity, clinicians should be aware of the evidence-based practices relating to its diagnosis, treatment, and prevention. Here, we review select recent literature pertaining to the epidemiology and impact of postoperative delirium, the perioperative risk factors for its development and/or exacerbation, and the strategies for its management, with additional attention paid to the population of patients in intensive care units.

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The effect of a pre- and postoperative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial (Oslo Orthogeriatric Trial)

Leiv Otto Watne, Anne Cathrine Torbergsen, Simon Conroy … (2014)

Background Delirium is a common complication in patients with hip fractures and is associated with an increased risk of subsequent dementia. The aim of this trial was to evaluate the effect of a pre- and postoperative orthogeriatric service on the prevention of delirium and longer-term cognitive decline. Methods This was a single-center, prospective, randomized controlled trial in which patients with hip fracture were randomized to treatment in an acute geriatric ward or standard orthopedic ward. Inclusion and randomization took place in the Emergency Department at Oslo University hospital. The key intervention in the acute geriatric ward was Comprehensive Geriatric Assessment including daily interdisciplinary meetings. Primary outcome was cognitive function four months after surgery measured using a composite outcome incorporating the Clinical Dementia Rating Scale (CDR) and the 10 words learning and recalls tasks from the Consortium to Establish a Registry for Alzheimer’s Disease battery (CERAD). Secondary outcomes were pre- and postoperative delirium, delirium severity and duration, mortality and mobility (measured by the Short Physical Performance Battery (SPPB)). Patients were assessed four and twelve months after surgery by evaluators blind to allocation. Results A total of 329 patients were included. There was no significant difference in cognitive function four months after surgery between patients treated in the acute geriatric and the orthopedic wards (mean 54.7 versus 52.9, 95% confidence interval for the difference -5.9 to 9.5; P = 0.65). There was also no significant difference in delirium rates (49% versus 53%, P = 0.51) or four month mortality (17% versus 15%, P = 0.50) between the intervention and the control group. In a pre-planned sub-group analysis, participants living in their own home at baseline who were randomized to orthogeriatric care had better mobility four months after surgery compared with patients randomized to the orthopedic ward, measured with SPPB (median 6 versus 4, 95% confidence interval for the median difference 0 to 2; P = 0.04). Conclusions Pre- and postoperative orthogeriatric care given in an acute geriatric ward was not effective in reducing delirium or long-term cognitive impairment in patients with hip fracture. The intervention had, however, a positive effect on mobility in patients not admitted from nursing homes. Trial registration ClinicalTrials.gov NCT01009268 Registered November 5, 2009

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The Impact of Delirium After Cardiac Surgical Procedures on Postoperative Resource Use.

Charles Brown, Andrew LaFlam, Laura Max … (2016)

Delirium is a common complication after cardiac surgical procedures and is associated with increased morbidity and mortality. However, whether rigorously assessed postoperative delirium is associated with an increased length of stay in the intensive care unit (LOS-ICU), length of stay (LOS), and hospital charges is not clear.

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Author and article information

Contributors

Banafsheh Tehranineshat:

ORCID: https://orcid.org/0000-0002-2066-5689

tbanafsheh@yahoo.com , b_tehrani@sums.ac.ir

Nima Hosseinpour: hosseinpournima842@yahoo.com

Arash Mani: mani_arash@yahoo.com

Mahnaz Rakhshan:

ORCID: https://orcid.org/0000-0003-1687-5154

mzrakhshan@gmail.com , rakhshanm@sums.ac.ir

Journal

Journal ID (nlm-ta): J Cardiothorac Surg

Journal ID (iso-abbrev): J Cardiothorac Surg

Title: Journal of Cardiothoracic Surgery

Publisher: BioMed Central (London )

ISSN (Electronic): 1749-8090

Publication date (Electronic): 20 March 2021

Publication date PMC-release: 20 March 2021

Publication date Collection: 2021

Volume: 16

Electronic Location Identifier: 32

Affiliations

[1 ]GRID grid.412571.4, ISNI 0000 0000 8819 4698, Community Based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, , Shiraz University of Medical Sciences, ; Zand St., Nemazee Sq, Shiraz, 7193613119 Iran

[2 ]GRID grid.412571.4, ISNI 0000 0000 8819 4698, Student Research Committee, School of Nursing and Midwifery, , Shiraz University of Medical Sciences, ; Shiraz, Iran

[3 ]GRID grid.412571.4, ISNI 0000 0000 8819 4698, Psychiatry Department, Research Center for Psychiatry & Behavioral Sciences, , Shiraz University of Medical Sciences, Shiraz, Iran , ; Shiraz, Iran

Author information

Banafsheh Tehranineshat https://orcid.org/0000-0002-2066-5689

Mahnaz Rakhshan https://orcid.org/0000-0003-1687-5154

Article

Publisher ID: 1422

DOI: 10.1186/s13019-021-01422-0

PMC ID: 7980563

SO-VID: a9e4a029-a6c1-46d6-b232-864404b4aca1

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 30 October 2020

Date accepted : 11 March 2021

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ScienceOpen disciplines: Surgery

Keywords: open heart surgery,delirium,multi-component interventions,nursing

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ScienceOpen disciplines: Surgery

Keywords: open heart surgery, delirium, multi-component interventions, nursing

The effect of multi-component interventions on the incidence rate, severity, and duration of post open heart surgery delirium among hospitalized patients

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Chinese Journal of General Practice

Most cited references 26

Postoperative delirium.

The effect of a pre- and postoperative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial (Oslo Orthogeriatric Trial)

The Impact of Delirium After Cardiac Surgical Procedures on Postoperative Resource Use.

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