Objective: Delirium is a serious disorder of late life whose poor outcomes include increased death rates, loss of the capacity for independent living, decreases in functional and cognitive capacity, an increased number of hospital complications, increased lengths of stay, and an increased risk of dementia. Cardiac surgery patients, in specific coronary artery bypass grafting surgery (“CABG”) patients, have postoperative delirium rates up to 32%, but few reports exist to address ways to mitigate that risk or its longer term sequelae. The purpose of this retrospective review was to determine whether an intervention designed to mitigate specific risk factors for postoperative delirium in CABG patients was helpful in reducing the incidence of delirium as well as its poor outcomes. Design: The charts of a total of 100 CABG patients were examined, using 50 control and 50 intervention patients. Materials and Methods: The intervention included the screening of all charts by the PI for chart based symptoms of delirium or early risk factors for delirium, including the presence of urinary tract infection, drop in hematocrit to <9, increase in BUN of 100% from baseline, use of any psychotropic agents other than a total daily dose of <3 mg or haloperidol equivalents, oxygen saturation less than 90%, sodium <130, and white blood cell count above laboratory normal. Patients identified as having any of these criteria were then provided a formal psychiatric consultation with recommendations provided to mitigate these risks. All charts were examined for the incidence of postoperative delirium, survival and rehospitalizations at 14 months. Results: A small overall effect size limited our power. Among the group older than 60, despite a higher incidence of delirium in the intervention group, death rates were lower; the control group was 3.3 x more likely to die (CI .82-13.7). There was no impact on rehospitalization rates in the older group. 10/36 control patients died at 14 months versus only 3/33 intervention patients. Conclusions: It appears that a risk-factor based intervention in elderly CABG patients may have improved survival in the older population studied despite the higher incidence of delirium noted in the intervention group. This study requires a multisite replication to demonstrate its effectiveness over larger populations and to determine the relative impact of this intervention method on the course of delirium versus global postoperative recovery.
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