The Association Between Enhanced Recovery After Cardiac Surgery-Guided Analgesics and Postoperative Delirium

Objectives: Delirium is a common postoperative complication associated with death and long-term cognitive impairment. The authors studied the association between opioid-sparing anesthetics, incorporating Enhanced Recovery After Cardiac Surgery (ERACS)-guided analgesics and postoperative delirium.Design: The authors performed a retrospective review of nonemergent coronary, valve, or ascending aorta surgery patients.Setting: A tertiary academic medical institution.Participants: The study authors analyzed a dataset of elective adult cardiac surgical patients. All patients >18 years undergoing elective cardiac surgery from November 2, 2017 until February 2, 2021 were eligible for inclusion.Interventions: The ERACS-guided multimodal pain regimen included preoperative oral acetaminophen and gabapentin, and intraoperative intra-venous lidocaine, ketamine, and dexmedetomidine.Measurements and Main Results: Delirium was measured by bedside nurses using the Confusion Assessment Method for the intensive care unit (ICU). Delirium occurred in 220 of the 1,675 patients (13.7%). The use of any component of the multimodal pain regimen was not associated with delirium (odds ratio [OR]: 0.85 [95% CI: 0.63-1.16]). Individually, acetaminophen was associated with reduced odds of delirium (OR: 0.60 [95% CI: 0.37-0.95]). Gabapentin (OR: 1.36 [95% CI: 0.97-2.21]), lidocaine (OR: 0.86 [95% CI: 0.53-1.37]), ketamine (OR: 1.15 [95% CI: 0.72-1.83]), and dexmedetomidine (OR: 0.79 [95% CI: 0.46-1.31]) were not individually associated with postoperative delirium. Individual ERACS elements were associated with secondary outcomes of hospital length of stay, ICU duration, postoperative opioid administration, and postoperative intubation duration.Conclusions: The use of an opioid-sparing perioperative ERACS pain regimen was not associated with reduced postoperative delirium, opioid consumption, or additional poor outcomes. Individually, acetaminophen was associated with reduced delirium.(c) 2023 Elsevier Inc. All rights reserved.

Automated summary

This study aimed to investigate the association between opioid-sparing anesthetics and postoperative delirium. The use of the multimodal pain regimen was not associated with delirium, except for acetaminophen, which was associated with reduced delirium.