Original Article

The effects of a tailored postoperative delirium prevention intervention after coronary artery bypass graft: A randomized controlled trial


Background & Aim: Delirium is a frequent complication in patients hospitalized in the intensive care unit following cardiac surgery. This study aimed to assess the effect of a tailored delirium preventive intervention on postoperative delirium and agitation reduction and length of intensive care unit stay in patients who underwent coronary artery bypass graft.
Methods & Materials: In this single-blinded, single-center, randomized controlled design, 60 patients from a hospital in Qom, Iran, were randomly allocated to an intervention or a control group. In the control group, patients received routine care. In the intervention group, patients received routine care, a video tutorial, and the Hospital Elder Life Program. Outcomes were measured using the Confusion Assessment Method for the intensive care unit, Richmond Agitation-Sedation Scale, and length of intensive care unit stay in the second and third days after coronary artery bypass graft.
Results: There were no significant differences in the rate of delirium episodes and mean scores of RASS between both groups in the second (P=0.301; P=0.125) and third days (P=0.389; P=0.057) after surgery, respectively. However, the mean duration of intensive care unit stays after surgery was significantly lower in the intervention group compared with the control group (P=0.042).
Conclusion: This study indicated the tailored delirium prevention intervention could reduce the length of intensive care unit stay. However, the intervention did not reduce postoperative delirium episodes, nor did the intervention improve the RASS scores in the second and third days after coronary artery bypass graft. A future large multicenter trial with long-term follow-up is needed to assess further the effect of such an intervention.

Michel JP, Walston JD. Oxford Textbook of Geriatric Medicine: Oxford University Press; 2018.
2. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet (London, England). 2014;383(9920):911-22.
3. Marcantonio ER. Postoperative delirium: a 76-year-old woman with delirium following surgery. Jama. 2012;308(1):73-81.
4. Rad M, Mohammadi N, Seyedoshohadaee M, Haghani H, Assarzadeh S. The assessment of risk factors related to delirium after coronary by-pass graft. Military Caring Sciences. 2015;2(3):158-66.
5. Ganavati A, Forooghi M, Esmaeili S, Hasantash S, Blourain A, Shahzamani M, et al. The relation between post cardiac surgery delirium and intraoperative factors. Iranian Journal of Surgery. 2009;17(3):15-25.
6. Ahmed S, Leurent B, Sampson EL. Risk factors for incident delirium among older people in acute hospital medical units: a systematic review and meta-analysis. Age and Ageing. 2014;43(3):326-33.
7. Elham A, Mohammad A, Abolfazl M, Mohammad A. Risk factors of readmission after coronary artery bypass graft surgery: A case-control study. Nursing Practice Today. 2020;7(4):295-301.
8. Kotfis K, Szylinska A, Listewnik M, Strzelbicka M, Brykczynski M, Rotter I, et al. Early delirium after cardiac surgery: an analysis of incidence and risk factors in elderly (>/=65 years) and very elderly (>/=80 years) patients. Clinical interventions in aging. 2018;13:1061-70.
9. Brown CH. Delirium in the cardiac surgical ICU. Current Opinion in Anaesthesiology. 2014;27(2):117-22.
10. Janssen TL, Alberts AR, Hooft L, Mattace-Raso F, Mosk CA, van der Laan L. Prevention of postoperative delirium in elderly patients planned for elective surgery: systematic review and meta-analysis. Clinical Interventions in Aging. 2019;14:1095-117.
11. Singler K, Thomas C. HELP–Hospital Elder Life Program–ein multimodales Interventionsprogramm zur Delirprävention bei älteren Patienten. Der Internist. 2017 Feb 1;58(2):125-31.
12. Hshieh TT, Yang T, Gartaganis SL, Yue J, Inouye SK. Hospital elder life program: Systematic review and meta-analysis of effectiveness. The American Journal of Geriatric Psychiatry. 2018;26(10):1015-33.
13. Inouye SK, Bogardus Jr ST, Baker DI, Leo-Summers L, Cooney Jr LM. The hospital elder life program: A model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital Elder Life Program. Journal of the American Geriatrics Society. 2000;48(12):1697-706.
14. Dias Dde S, Resende MV, Diniz Gdo C. Patient stress in intensive care: Comparison between a coronary care unit and a general postoperative unit. Revista Brasileira de terapia intensiva. 2015;27(1):18-25.
15. Crippen D. Understanding the neurohumoral causes of anxiety in the ICU. Clinical consequences include agitation, brain failure, delirium. The Journal of Critical Illness. 1995;10(8):550-5, 9-60.
16. Vidan MT, Sanchez E, Alonso M, Montero B, Ortiz J, Serra JA. An intervention integrated into daily clinical practice reduces the incidence of delirium during hospitalization in elderly patients. Journal of the American Geriatrics Society. 2009;57(11):2029-36.
17. Larsen LK, Møller K, Petersen M, Egerod I. Delirium prevalence and prevention in patients with acute brain injury: A prospective before-and-after intervention study. Intensive and Critical Care Nursing. 2020:102816.
18. Herling SF, Greve IE, Vasilevskis EE, Egerod I, Mortensen CB, Møller AM, et al. Interventions for preventing intensive care unit delirium in adults. Cochrane Database Syst Rev. 2018(11).
19. Mansoori M, Shegarf-Nakhaie M, Rakhshani MH, Koushan M. Reduction of the Incidence of delirium in CCU: A controlled clinical trial Journal of Client-Centered Nursing Care. 2018;4(2):104-11.
20. Shi Q, Warren L, Saposnik G, Macdermid JC. Confusion assessment method: A systematic review and meta-analysis of diagnostic accuracy. Neuropsychiatric Disease and Treatment. 2013;9:1359-70.
21. Chanques G, Ely EW, Garnier O, Perrigault F, Eloi A, Carr J, et al. The 2014 updated version of the confusion assessment method for the intensive care unit compared to the 5th version of the diagnostic and statistical manual of mental disorders and other current methods used by intensivists. Annals of Intensive Care. 2018;8(1):33.
22. Ely EW, Truman B, Shintani A, Thomason JW, Wheeler AP, Gordon S, et al. Monitoring sedation status over time in ICU patients: Reliability and validity of the Richmond Agitation-Sedation Scale (RASS). Jama. 2003;289(22):2983-91.
23. Han JH, Vasilevskis EE, Schnelle JF, Shintani A, Dittus RS, Wilson A, et al. The diagnostic performance of the Richmond Agitation Sedation Scale for detecting delirium in older emergency department patients. J Academic Emergency Medicine. 2015;22(7):878-82.
24. Lee J, Jung J, Noh JS, Yoo S, Hong YS. Perioperative psycho-educational intervention can reduce postoperative delirium in patients after cardiac surgery: a pilot study. The International Journal of Psychiatry in Medicine. 2013;45(2):143-58.
25. Hempenius L, Slaets JP, van Asselt D, de Bock GH, Wiggers T, van Leeuwen BL. Outcomes of a geriatric liaison intervention to prevent the development of postoperative delirium in frail elderly cancer patients: Report on a multicentre, randomized, controlled trial. PloS one. 2013;8(6):e64834.
26. Kazmierski J, Kowman M, Banach M, Fendler W, Okonski P, Banys A, et al. Incidence and predictors of delirium after cardiac surgery: Results from The IPDACS study. Journal of Psychosomatic Research. 2010;69(2):179-85.
27. Afonso A, Scurlock C, Reich D, Raikhelkar J, Hossain S, Bodian C, et al., editors. Predictive model for postoperative delirium in cardiac surgical patients. Seminars in cardiothoracic and vascular anesthesia; 2010: SAGE Publications Sage CA: Los Angeles, CA.
28. Tilouche N, Hassen MF, Ali HBS, Jaoued O, Gharbi R, El Atrous SS. Delirium in the intensive care unit: Incidence, risk factors, and impact on outcome. Indian Journal of Critical Care Medicine: Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine. 2018;22(3):144-9.
29. Pezzullo L, Streatfeild J, Hickson J, Teodorczuk A, Agar MR, Caplan GA. Economic impact of delirium in Australia: A cost of illness study. BMJ Open. 2019;9(9):e027514.
30. Hayhurst CJ, Pandharipande PP, Hughes CG. Intensive care unit delirium: A review of diagnosis, prevention, and treatment. Anesthesiology. 2016;125(6):1229-41.
IssueVol 8 No 3 (2021): Summer QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/npt.v8i3.5937
delirium; prevention; intensive care unit; coronary artery bypass graft

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How to Cite
Abbasinia M, Babaii A, Nadali Z, Pakzaban S, Abbasi M, Shamali M. The effects of a tailored postoperative delirium prevention intervention after coronary artery bypass graft: A randomized controlled trial. NPT. 8(3):226-233.