Clinical Interventions in Aging (Apr 2022)
Prediction of Postoperative Delirium After Cardiac Surgery with A Quick Test of Cognitive Speed, Mini-Mental State Examination and Hospital Anxiety and Depression Scale
Abstract
Anna Segernäs,1,* Johan Skoog,2,* Eva Ahlgren Andersson,3 Sofia Almerud Österberg,4,5 Hans Thulesius,6,7,* Helene Zachrisson2,* 1Primary Health Care Center Ekholmen in Linköping and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; 2Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; 3Department of Thoracic Surgery and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; 4Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden; 5Department of Research and Development, Region Kronoberg, Växjö, Sweden; 6Department of Clinical Sciences, Malmö, Faculty of Medicine, Lunds University, Lund, Sweden; 7Department of Medicine and Optometry, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden*These authors contributed equally to this workCorrespondence: Johan Skoog, Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden, Tel +46 10 103 00 00, Email [email protected]: To evaluate if preoperative assessment with A Quick Test of Cognitive Speed (AQT) could increase the accuracy of predicting delirium after cardiac surgery compared to Mini-Mental State Examination (MMSE), and examine if a composite of variables, including cognitive function and depressive symptoms, could be useful to predict delirium.Patients and Methods: Cardiac surgery was performed in 218 patients (mean age 72 years). Preoperative evaluation involved AQT, MMSE and Hospital Anxiety And Depression Scale (HADS). Postoperative delirium was assessed using Nursing Delirium Screening Scale (Nu-DESC) and Confusion Assessment Method-ICU (CAM-ICU). Logistic regression was performed to detect predictors of postoperative delirium and receiver operator characteristic curves (ROC) with area under the curve (AUC) to determine the accuracy.Results: Postoperative delirium occurred in 47 patients (22%) who had lower MMSE scores (median (range), 27 (19– 30) vs 28 (20– 30), p=0.009) and slower AQT (median (range), 76 (48– 181) vs 70 (40– 182) seconds, p=0.030) than patients without delirium. Predictive power measured as AUC (95% CI) was 0.605 (0.51– 0.70) for AQT and 0.623 (0.53– 0.72) for MMSE. Logistic regression (OR, 95% CI) showed MMSE 70 sec (2.26, 1.03– 4.95), HADS-D > 4 points (2.60, 1.21– 5.58) and longer cardiopulmonary bypass-time (1.007, 1.002– 1.013) to be associated with postoperative delirium. Combining these parameters yielded an AUC of 0.736 (0.65– 0.82).Conclusion: The ability of predicting delirium using AQT was similar to MMSE, and only slightly higher by combining AQT and MMSE. Adding HADS-D and cardiopulmonary bypass-time to MMSE and AQT increased the predictive power to a borderline acceptable discriminatory value. Preoperative cognitive tests and screening for depressive symptoms may help identify patients at risk of postoperative delirium. Yet, there is still a need to establish useful preoperative tests.Keywords: postoperative delirium, cardiopulmonary bypass, Mini Mental State Examination, A Quick Test of Cognitive Speed, The Hospital Anxiety and Depression Scale
