Impact of postoperative delirium on long-term neurologic and neuropsychiatric outcome after cardiac surgery or percutaneous valve replacement–a prospective observational study
Bibliographic record
Abstract
Background Patients undergoing cardiac surgery or percutaneous valve replacement may experience long-term neurologic and neuropsychiatric complications. The impact of postoperative delirium (POD) on these long-term complications remains controversial. We intended to illustrate the neurological and neuropsychiatric outcome associated with the occurrence of POD in patients undergoing elective cardiac surgery or percutaneous valve replacement. Methods We included 179 patients who underwent elective cardiac surgery or percutaneous valve replacement. Patients were evaluated postoperatively for delirium status. Neurological (score A) and neuropsychiatric (score B) outcomes were assessed using a structured examination protocol and interview at 1 year postoperatively and combined into a composite neurological and neuropsychiatric score (score A + B). Cognitive function was examined using the Montreal Cognitive Assessment (MoCA). Depression, fatigue and quality of life were assessed using the Beck's Depression Inventory (BDI), the Fatigue Impact Scale (FIS) and the Short-Form Health Survey (SF-12). Clinical outcome was assessed using the Barthel-Index (BI) and Frailty Index (FI). All data were collected prospectively. Results One year after cardiac surgery or percutaneous valve replacement, a high number of patients suffered from neurological and neuropsychiatric symptoms with depressive symptoms ( n = 36, 20.1%) and symptoms of fatigue ( n = 72, 40.2%). Multivariable regression analysis showed that POD was associated with higher values on the A + B composite score, indicating worse neurological and neuropsychiatric outcome (POD status: b:1.172; 95%-CI, 0.070–2.273, p = 0.037; age: b:0.134; 95%-CI, 0.086–0.182, p < 0.001; NYHA classification at 1 year: b:1.998; 95%-CI,1.169–2.828, p < 0.001; rehospitalization b:1.786; 95%-CI, 0.640–2.932, p = 0.002). Patients with POD had lower postoperative MoCA scores ( p = 0.001) and lower scores on both the SF12 Physical ( p = 0.022) and the SF12 Mental Component Summary ( p = 0.048). POD was not associated with depressive symptoms ( p = 0.855), fatigue ( p = 0.122) or rehospitalization ( p = 0.379). Conclusions POD in patients undergoing cardiac surgery or percutaneous valve replacement was independently associated with worse long-term neurological and neuropsychiatric outcome. POD may be a relevant prognostic marker indicating the need for specific follow-up services, whereas other clinical parameters were not predictive of outcome.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".