Delirium After Transcatheter Aortic Valve Replacement.
Jennifer L Giuseffi, Nyal E Borges, Leanne M Boehm and 6 others
PMID 28668927WHAT IT FOUND
Delirium occurred in 20% of patients after aortic valve replacement.
Rates were similar in TAVR and SAVR patients. After accounting for age and other factors, TAVR patients were less likely to have delirium. Delirium was linked to higher 6-month mortality.
Key findings
01Postoperative delirium occurred in 20% of patients overall, 19% after TAVR and 21% after SAVR; the difference was not statistically significant (P = .65).
02After adjustment for age, Charlson Comorbidity Index, ejection fraction, and intraoperative midazolam dose, TAVR patients had lower odds of delirium than SAVR patients (odds ratio, 0.4; 95% CI, 0.18-0.92; P = .03).
03Delirium was associated with a 3-fold higher risk for death by 6 months, independent of procedure type and age (hazard ratio, 3.4; 95% CI, 1.3-8.8; P = .01).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was retrospective and single-center, so it cannot prove that TAVR reduced delirium or that delirium caused death. Patients who died within 24 hours or had persistent coma were excluded, which may miss the most severe cases. The model adjusted for age, Charlson Comorbidity Index, ejection fraction, and midazolam dose, but unknown confounders may remain. The number of patients with delirium and deaths was limited, so the analysis could not test all interactions or nonlinear associations. Delirium was detected by routine RASS and CAM-ICU assessments without confirmatory evaluation, so it may have been underreported. The model fit statistics indicated a possible slight overfit.
The easy way to misread this
Do not conclude that TAVR prevents delirium or that treating delirium will reduce mortality. The study was observational, and residual confounding may explain the lower adjusted odds of delirium after TAVR. The association between delirium and 6-month mortality does not show that delirium caused the higher mortality.