Delirium: An independent predictor of functional decline after cardiac surgery

James L. Rudolph, Sharon K. Inouye, Richard N. Jones, Frances M. Yang, Tamara G. Fong, Sue E. Levkoff, Edward R. Marcantonio

Research output: Contribution to journalArticle

158 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)643-649
Number of pages7
JournalJournal of the American Geriatrics Society
Volume58
Issue number4
DOIs
StatePublished - Apr 1 2010

Fingerprint

Delirium
Thoracic Surgery
Confidence Intervals
Activities of Daily Living
Veterans Hospitals
Confusion
Aptitude
Cognition
Comorbidity
Cohort Studies
Prospective Studies

Keywords

  • Aged
  • Cardiac surgery
  • Delirium
  • Function
  • Instrumental activities of daily living

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

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), 643-649. https://doi.org/10.1111/j.1532-5415.2010.02762.x

Delirium : An independent predictor of functional decline after cardiac surgery. / Rudolph, James L.; Inouye, Sharon K.; Jones, Richard N.; Yang, Frances M.; Fong, Tamara G.; Levkoff, Sue E.; Marcantonio, Edward R.

In: Journal of the American Geriatrics Society, Vol. 58, No. 4, 01.04.2010, p. 643-649.

Research output: Contribution to journalArticle

Rudolph, JL, Inouye, SK, Jones, RN, Yang, FM, Fong, TG, Levkoff, SE & Marcantonio, ER 2010, 'Delirium: An independent predictor of functional decline after cardiac surgery', Journal of the American Geriatrics Society, vol. 58, no. 4, pp. 643-649. https://doi.org/10.1111/j.1532-5415.2010.02762.x
Rudolph, James L. ; Inouye, Sharon K. ; Jones, Richard N. ; Yang, Frances M. ; Fong, Tamara G. ; Levkoff, Sue E. ; Marcantonio, Edward R. / Delirium : An independent predictor of functional decline after cardiac surgery. In: Journal of the American Geriatrics Society. 2010 ; Vol. 58, No. 4. pp. 643-649.
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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.",
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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.

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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.

AB - 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.

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