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. 2020 Aug 24:15:1471-1479.
doi: 10.2147/CIA.S257079. eCollection 2020.

Physical Performance and Risk of Postoperative Delirium in Older Adults Undergoing Aortic Valve Replacement

Aarti Rao  1 , Sandra M Shi  2   3 , Jonathan Afilalo  4 , Jeffrey J Popma  5 , Kamal R Khabbaz  6 , Roger J Laham  5 , Kimberly Guibone  5 , Edward R Marcantonio #  2   7 , Dae Hyun Kim #  2   3
Affiliations

Physical Performance and Risk of Postoperative Delirium in Older Adults Undergoing Aortic Valve Replacement

Aarti Rao et al. Clin Interv Aging. .

Abstract

Background: Delirium is a major risk factor for poor recovery after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). It is unclear whether preoperative physical performance tests improve delirium prediction.

Objective: To examine whether physical performance tests can predict delirium after SAVR and TAVR, and adapt an existing delirium prediction rule for cardiac surgery, which includes Mini-Mental State Examination (MMSE), depression, prior stroke, and albumin level.

Design: Prospective cohort, 2014-2017.

Setting: Single academic center.

Subjects: A total of 187 patients undergoing SAVR (n=77) or TAVR (n=110).

Methods: The Short Physical Performance Battery (SPPB) score was calculated based on gait speed, balance, and chair stands (range: 0-12 points, lower scores indicate poor performance). Delirium was assessed using the Confusion Assessment Method. We fitted logistic regression to predict delirium using SPPB components and risk factors of delirium.

Results: Delirium occurred in 35.8% (50.7% in SAVR and 25.5% in TAVR). The risk of delirium increased for lower SPPB scores: 10-12 (28.2%), 7-9 (34.5%), 4-6 (37.5%) and 0-3 (44.1%) (p-for-trend=0.001). A model that included gait speed <0.46 meter/second (OR, 2.7; 95% CI, 1.2-6.4), chair stands time ≥11.2 seconds (OR, 3.5; 95% CI, 1.0-12.4), MMSE <24 points (OR, 2.9; 95% CI, 1.3-6.4), isolated SAVR (OR, 5.4; 95% CI, 2.1-13.8), and SAVR and coronary artery bypass grafting (OR, 15.8; 95% CI, 5.5-45.7) predicted delirium better than the existing prediction rule (C statistics: 0.71 vs 0.61; p=0.035).

Conclusion: Assessing physical performance, in addition to cognitive function, can help identify high-risk patients for delirium after SAVR and TAVR.

Keywords: aortic valve replacement; delirium; physical performance; prediction.

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Conflict of interest statement

Jeffrey J. Popma reports grants from Medtronic, Boston Scientific, and Abbott, and grants and personal fees from Edwards, outside the submitted work. Kimberly Guibone reports personal fees from Medtronic, outside the submitted work. Dae Hyun Kim reports grants from NIH, during the conduct of the study. Sandra M. Shi receives sponsorship from the Harvard Translational Research in Aging Training Program, T32 AG023480. The authors report no other potential conflicts of interest for this work.

Figures

Figure 1
Figure 1
An adapted delirium risk scoring system for aortic valve replacement. Abbreviations: CABG, coronary artery bypass grafting; MMSE, Mini-Mental Status Examination; SAVR, surgical aortic valve replacement.
Figure 2
Figure 2
Delirium prediction risk scores and delirium severity. (A) Spearman correlation coefficient between Rudolph risk score and CAM-S maximum score. (B) Spearman correlation coefficient between SPPB and CAM-S maximum score. (C) Spearman correlation coefficient between adapted model risk score and CAM-S maximum score. Abbreviations: CAM, Confusion Assessment Methods; SPPB, Short Physical Performance Battery.
See this image and copyright information in PMC

References

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