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 Kim2,3,* 1Icahn School of Medicine at Mount Sinai, New York, NY, USA; 2Division of Gerontology, Department of Medicine, Beth Israel Deaconess Med...

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Autores principales:	Rao A, Shi SM, Afilalo J, Popma JJ, Khabbaz KR, Laham RJ, Guibone K, Marcantonio ER, Kim DH
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	delirium physical performance aortic valve replacement prediction Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/73056f95ca1b4dc29d749069025e65f3
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spelling	oai:doaj.org-article:73056f95ca1b4dc29d749069025e65f32021-12-02T10:32:38ZPhysical Performance and Risk of Postoperative Delirium in Older Adults Undergoing Aortic Valve Replacement1178-1998https://doaj.org/article/73056f95ca1b4dc29d749069025e65f32020-08-01T00:00:00Zhttps://www.dovepress.com/physical-performance-and-risk-of-postoperative-delirium-in-older-adult-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Aarti 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 workCorrespondence: Dae Hyun KimHinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Boston, MA 02131, USATel +1 617-971-8320Fax +1 617-971-5339Email daehyunkim@hsl.harvard.eduBackground: 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, predictionRao AShi SMAfilalo JPopma JJKhabbaz KRLaham RJGuibone KMarcantonio ERKim DHDove Medical Pressarticledeliriumphysical performanceaortic valve replacementpredictionGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 15, Pp 1471-1479 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	delirium physical performance aortic valve replacement prediction Geriatrics RC952-954.6
spellingShingle	delirium physical performance aortic valve replacement prediction Geriatrics RC952-954.6 Rao A Shi SM Afilalo J Popma JJ Khabbaz KR Laham RJ Guibone K Marcantonio ER Kim DH Physical Performance and Risk of Postoperative Delirium in Older Adults Undergoing Aortic Valve Replacement
description	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 workCorrespondence: Dae Hyun KimHinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Boston, MA 02131, USATel +1 617-971-8320Fax +1 617-971-5339Email daehyunkim@hsl.harvard.eduBackground: 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
format	article
author	Rao A Shi SM Afilalo J Popma JJ Khabbaz KR Laham RJ Guibone K Marcantonio ER Kim DH
author_facet	Rao A Shi SM Afilalo J Popma JJ Khabbaz KR Laham RJ Guibone K Marcantonio ER Kim DH
author_sort	Rao A
title	Physical Performance and Risk of Postoperative Delirium in Older Adults Undergoing Aortic Valve Replacement
title_short	Physical Performance and Risk of Postoperative Delirium in Older Adults Undergoing Aortic Valve Replacement
title_full	Physical Performance and Risk of Postoperative Delirium in Older Adults Undergoing Aortic Valve Replacement
title_fullStr	Physical Performance and Risk of Postoperative Delirium in Older Adults Undergoing Aortic Valve Replacement
title_full_unstemmed	Physical Performance and Risk of Postoperative Delirium in Older Adults Undergoing Aortic Valve Replacement
title_sort	physical performance and risk of postoperative delirium in older adults undergoing aortic valve replacement
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/73056f95ca1b4dc29d749069025e65f3
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Physical Performance and Risk of Postoperative Delirium in Older Adults Undergoing Aortic Valve Replacement

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