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

Authors Rao A, Shi SM, Afilalo J, Popma JJ, Khabbaz KR, Laham RJ, Guibone K, Marcantonio ER, Kim DH

Received 30 April 2020

Accepted for publication 1 July 2020

Published 24 August 2020 Volume 2020:15 Pages 1471—1479


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Richard Walker

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 Kim2,3,*

1Icahn School of Medicine at Mount Sinai, New York, NY, USA; 2Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; 3Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; 4Division of Cardiology and Centre for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; 5Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; 6Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; 7Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

*These authors contributed equally to this work

Correspondence: Dae Hyun Kim
Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Boston, MA 02131, USA
Tel +1 617-971-8320
Fax +1 617-971-5339

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: delirium, physical performance, aortic valve replacement, prediction

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