Incidence of Postoperative Delirium with Use of Benzodiazepines in Adult Cardiac Surgery: A Comparative Study of On-Pump and Off- Pump Procedures

Abstract Background: Postoperative delirium (POD) is a common neurocognitive complication after adult cardiac surgery, associated with morbidity and longer hospital stays1. Both cardiopulmonary bypass (CPB, on-pump) and benzodiazepine use have been proposed as risk factors. This study compared POD incidence in on-pump versus off- pump surgeries, with midazolam used for induction. Elective cardiac surgery was included. Fifty underwent on-pump surgery and fifty underwent off-pump surgery. All patients received midazolam during induction. POD was assessed postoperatively using standardized clinical criteria. Occurred in 8 on-pump patients (16%) and 6 off-pump patients (12%). The relative risk (RR) of POD with on-pump versus off-pump surgery was 1.33 (95% CI: 0.49–3.65). Odds ratio (OR) was 1.39 (95% CI: 0.45–4.27). Statistical analysis using chi-square showed p=0.57, indicating no significant difference. Conclusion: In this cohort, POD incidence was not significantly different between on- pump and off-pump cardiac surgery when midazolam was used for induction. Midazolam did not appear to increase the risk of POD. Larger multicenter trials are needed for confirmation.