{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:51:41Z","timestamp":1791564701407,"version":"4.3.4"},"reference-count":0,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiology"],"abstract":"<jats:p>Background Postoperative hallucination experiences are distressing but under-recognized complications of cardiac surgery. This study investigated whether sex differences exist in their incidence and in the factors associated with postoperative visual and auditory hallucination experiences. Methods We conducted a prospective multicenter cohort study of 1,331 adults (1,000 males and 331 females) undergoing isolated coronary artery bypass grafting or isolated valve surgery at 10 cardiac surgery centers in the West Bank, Palestine (September 2022-May 2025). Postoperative visual (VH) and auditory hallucination (AH) experiences were assessed using daily QPE interviews through postoperative day 4, followed by clinical checks or telephone follow-up through day 7, with QPE-based confirmation of newly reported experiences. Sex-stratified multivariable Cox proportional hazards models evaluated associated factors within an exploratory, hypothesis-generating framework. This study was conducted as part of the VAACS Study (https:\/\/www.isrctn.com\/ISRCTN18368253). Results Within the first postoperative week, 155 patients (11.6%) experienced visual hallucination experiences (11.2% of males vs. 13.0% of females), and 92 (6.9%) experienced auditory hallucination experiences (7.0% vs. 6.6%). Among males, lower body mass index (adjusted HR 0.91; 95% CI 0.83\u20130.99; P = 0.034), higher EuroSCORE II (adjusted HR 1.03; 95% CI 1.02\u20131.04; P &lt; 0.001), higher serum creatinine (adjusted HR 1.21; 95% CI 1.15\u20131.27; P &lt; 0.001), and postoperative blood transfusion (adjusted HR 1.65; 95% CI 1.20\u20132.28; P = 0.002) were associated with visual hallucination experiences. Among females, higher EuroSCORE II (adjusted HR 1.05; 95% CI 1.04\u20131.06; P &lt; 0.001) and longer postoperative ventilation duration (adjusted HR 0.93; 95% CI 0.89\u20130.97; P &lt; 0.001) were associated with visual hallucination experiences. Higher EuroSCORE II (adjusted HR 1.07; 95% CI 1.04\u20131.10; P &lt; 0.001) and longer postoperative ventilation duration (adjusted HR 0.91; 95% CI 0.83\u20130.99; P = 0.029) were associated among males; intraoperative fentanyl exposure did not reach statistical significance (adjusted HR 0.51; 95% CI 0.26\u20131.02; P = 0.057). Among females, lower age (adjusted HR 0.98; 95% CI 0.97\u20131.00; P = 0.007), higher EuroSCORE II (adjusted HR 1.08; 95% CI 1.07\u20131.10; P &lt; 0.001), and postoperative noradrenaline requirement (adjusted HR 4.35; 95% CI 2.18\u20138.68; P &lt; 0.001) were associated with auditory hallucination experiences; this model included only 22 events. Conclusions Postoperative hallucination experiences captured by the QPE occurred at similar rates in male and female patients after cardiac surgery, but exploratory sex-stratified association patterns differed by hallucination modality. These findings should be interpreted irrespective of delirium status and require confirmation in future studies incorporating structured delirium assessment.<\/jats:p>","DOI":"10.1159\/crd\/absag015","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T11:22:08Z","timestamp":1790594528000},"source":"Crossref","is-referenced-by-count":0,"title":["Exploratory Sex-Stratified Associations of Postoperative Visual and Auditory Hallucinations After Cardiac Surgery: Insights from the VAACS Study"],"prefix":"10.1159","author":[{"given":"Nizar","family":"Abu Hamdeh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamza 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