THE EFFECT OF INTRAOPERATIVE BLOOD PRESSURE FLUCTUATIONS ON POSTOPERATIVE DELIRIUM AFTER CARDIAC SURGERY

Background: Postoperative delirium (POD) is a common postoperative neurocognitive complication following cardiac surgery, which leads to prolonged hospital stay and recovery. The study is focused on the relationship between IOBPV and POD, suggesting that BP fluctuations could be a risk factor for neurological outcomes. Patients: Sixty adult patients were selected from Ibn Al-Bitar Center and Iraqi Centers for Cardiac Surgery in Baghdad and subjected to cardiac surgeries between August–November 2018, excluding patients with significant pre-existing neurological and psychiatric disorders. The definition of significant BP fluctuations in this study was when the BP was more than 20% from baseline for more than 15 minutes; or required the use of vasoactive agents. Delirium was rated according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria and validated instruments following surgery. Results: Mean age was 52.4±13.6 years, and 38 (63.3%) patients were male. Thirty-six (60.0%) patients had BP fluctuations. POD developed in 30 (50.0%) patients. 22/36 (61.1%) of the patients with BP fluctuations had POD, while 8/24 (33.3%) of the patients without BP fluctuations had POD (p=0.03). In addition, age >60 years and a female sex were significantly associated with POD (p=0.03 for both). Diabetes mellitus was not statistically significant (p=0.20) and surgical procedure was not significantly associated with POD. Conclusion: This study suggests a strong relationship between changes in intra-operative blood pressure and the incidence of postoperative delirium (POD) after cardiac surgery. The study underscores the importance of systematic hemodynamic monitoring, personalized blood pressure regimen, preoperatively evaluating delirium risk, and organized postoperative monitoring. More studies are required to establish causality and selected targets of the hemodynamics.