Delirium: An Independent Predictor of Functional Decline After Cardiac Surgery

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Delirium: An Independent Predictor of Functional Decline After Cardiac Surgery

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Title: Delirium: An Independent Predictor of Functional Decline After Cardiac Surgery
Author: Rudolph, James; Inouye, Sharon; Jones, Richard N.; Yang, Frances Margaret; Fong, Tamara G; Levkoff, Sue E.; Marcantonio, Edward Ralph

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Citation: Rudolph, James L., Sharon K. Inouye, Richard N. Jones, Frances M. Yang, Tamara G. Fong, Sue E. Levkoff, and Edward R. Marcantonio. 2010. “Delirium: An Independent Predictor of Functional Decline After Cardiac Surgery.” Journal of the American Geriatrics Society 58 (4) (March 22): 643–649. doi:10.1111/j.1532-5415.2010.02762.x.
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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.
Published Version: doi:10.1111/j.1532-5415.2010.02762.x
Other Sources: http://www.ncbi.nlm.nih.gov/pubmed/20345866
Terms of Use: This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA
Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:33750344
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