{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T19:19:17Z","timestamp":1789154357072,"version":"build-2803163510"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T00:00:00Z","timestamp":1697068800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Japan Society for the Promotion of Science (JSPS) Grants-in-Aid for Scientific Research","award":["22K15331"],"award-info":[{"award-number":["22K15331"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Postoperative delirium (PD) is an acute brain dysfunction, with a particularly high incidence after cardiovascular surgery. Pharmacist-led interventions show limited evidence in attenuating PD in cardiovascular surgery. In this retrospective cohort study, we aimed to clarify the risk factors of PD for cardiovascular surgery focused on pharmacotherapy and elucidate the effect of pharmacist-led intervention on the PD attenuation rate based on protocol-based pharmaceutical management (PBPM). This study included 142 adult patients who underwent elective valve replacement or valvuloplasty. The risk factors for PD were investigated using multivariate logistic regression analysis. Taking risk factors into consideration, a protocol was developed to discontinue benzodiazepines prescriptions by ward pharmacists, and replace with ramelteon and suvorexant if all the following factors apply: 1) number of medications \u2265 6 drugs, 2) number of doses to take \u2265 4 times, and 3) regular use of benzodiazepines or insomnia. Subsequently, the PD rate was compared during a period of two years and 6 months between the pre-PBPM (n = 39) and post-PBPM (n = 62). The PD rate for elective valve replacement or valvuloplasty was 25% (35\/142). The adjusted odds ratio for polypharmacy was 3.3 (95% confidence interval: 1.2\u20138.9, <jats:italic>p<\/jats:italic> = 0.016), suggesting that preoperative risk assessment may be essential for patients with polypharmacy. The PD rate significantly decreased to 13% (8\/62) in the post-PBPM group compared with 33% (13\/39) in the pre-PBPM group (<jats:italic>p<\/jats:italic> = 0.014). There was a significant decrease in benzodiazepines use in post-PBPM compared with pre-PBPM (<jats:italic>p<\/jats:italic> = 0.026); however, the rate of ramelteon and orexin receptor antagonists use increased by PBPM introduction (<jats:italic>p<\/jats:italic> &lt; 0.001). Although the present PBPM still requires further modification, it is simple and potentially useful for pharmacists to assess the risk of patients undergoing any elective cardiovascular surgery.<\/jats:p>","DOI":"10.1371\/journal.pone.0292786","type":"journal-article","created":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T17:26:50Z","timestamp":1697131610000},"page":"e0292786","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Effect of pharmacist-led intervention protocol on preventing postoperative delirium after elective cardiovascular surgery"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1933-8592","authenticated-orcid":true,"given":"Yuki","family":"Asai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuki","family":"Yanagawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaaki","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,10,12]]},"reference":[{"key":"pone.0292786.ref001","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.jvs.2018.05.001","article-title":"The effect of preoperative cognitive impairment and type of vascular surgery procedure on postoperative delirium with associated cost implications","volume":"69","author":"R Styra","year":"2019","journal-title":"J Vasc Surg"},{"key":"pone.0292786.ref002","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijsu.2016.09.001","article-title":"Risk factors of post-operative delirium after elective vascular surgery in the elderly: A systematic review","volume":"35","author":"JW Raats","year":"2016","journal-title":"Int J Surg"},{"key":"pone.0292786.ref003","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1053\/j.jvca.2013.05.005","article-title":"Detailed insight into the impact of postoperative neuropsychiatric complications on mortality in a cohort of cardiac surgery subjects: a 23,000-patient-year analysis.","volume":"28","author":"LJ Krzych","year":"2014","journal-title":"J Cardiothorac Vasc Anesth."},{"key":"pone.0292786.ref004","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1111\/aas.12717","article-title":"Post-anaesthetic emergence delirium in adults: incidence, predictors and consequences.","volume":"60","author":"L Munk","year":"2016","journal-title":"Acta Anaesthesiol Scand"},{"key":"pone.0292786.ref005","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/S0193-953X(18)30240-5","article-title":"Update on delirium.","volume":"15","author":"ZJ Lipowski","year":"1992","journal-title":"Psychiatr Clin North Am"},{"key":"pone.0292786.ref006","doi-asserted-by":"crossref","first-page":"11922","DOI":"10.1038\/s41598-021-91314-z","article-title":"Comparative effectiveness of pharmacological interventions to prevent postoperative delirium: a network meta-analysis.","volume":"11","author":"SK Park","year":"2021","journal-title":"Sci Rep"},{"key":"pone.0292786.ref007","first-page":"e39","article-title":"Collaborative drug therapy management and comprehensive medication management-2015.","volume":"35","author":"American College of Clinical Pharmacy","year":"2015","journal-title":"Pharmacotherapy"},{"key":"pone.0292786.ref008","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1002\/jcph.2133","article-title":"Exploratory Study of Pharmacists\u2019 Monitoring Methods Based on Left Ventricular Function for Hypermagnesemia by Magnesium Oxide in Heart Failure.","volume":"63","author":"Y Asai","year":"2023","journal-title":"J Clin Pharmacol"},{"key":"pone.0292786.ref009","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s40780-020-00165-9","article-title":"Impact of physician-pharmacist collaborative protocol-based pharmacotherapy management for HIV outpatients: a retrospective cohort study.","volume":"6","author":"K Urano","year":"2020","journal-title":"J Pharm Health Care Sci"},{"key":"pone.0292786.ref010","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s40780-021-00191-1","article-title":"Effectiveness of protocol-based pharmacotherapy management collaboration between hospital and community pharmacists to address capecitabine-related hand-foot syndrome in cancer patients: a retrospective study","volume":"7","author":"N Nakamura","year":"2021","journal-title":"J Pharm Health Care Sci"},{"key":"pone.0292786.ref011","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1186\/s12877-021-02100-5","article-title":"Delirium in older patients undergoing aortic valve replacement: incidence, predictors, and cognitive prognosis.","volume":"21","author":"M Humbert","year":"2021","journal-title":"BMC Geriatr"},{"key":"pone.0292786.ref012","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1007\/s001340100909","article-title":"Intensive Care Delirium Screening Checklist: evaluation of a new screening tool.","volume":"27","author":"N Bergeron","year":"2001","journal-title":"Intensive Care Med."},{"key":"pone.0292786.ref013","doi-asserted-by":"crossref","first-page":"e0254654","DOI":"10.1371\/journal.pone.0254654","article-title":"Availability of preoperative neutrophil-lymphocyte ratio to predict postoperative delirium after head and neck free-flap reconstruction: A retrospective study.","volume":"16","author":"H Kinoshita","year":"2021","journal-title":"PLoS One."},{"key":"pone.0292786.ref014","doi-asserted-by":"crossref","first-page":"1628","DOI":"10.1097\/CCM.0000000000005657","article-title":"Impact of Family Presence on Delirium in Critically Ill Patients: A Retrospective Cohort Study.","volume":"50","author":"S Mohsen","year":"2022","journal-title":"Crit Care Med."},{"key":"pone.0292786.ref015","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1186\/s13019-022-01938-z","article-title":"Risk factors for postoperative delirium on oxygen delivery-guided perfusion.","volume":"17","author":"H Mukaida","year":"2022","journal-title":"J Cardiothorac Surg"},{"key":"pone.0292786.ref016","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.jpsychores.2010.02.009","article-title":"Incidence and predictors of delirium after cardiac surgery: Results from The IPDACS Study.","volume":"69","author":"IPDACS Study.","year":"2010","journal-title":"J Psychosom Res"},{"key":"pone.0292786.ref017","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1093\/icvts\/ivt304","article-title":"Pre-existing cerebral infarcts as a risk factor for delirium after coronary artery bypass graft surgery","volume":"17","author":"S Otomo","year":"2013","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"pone.0292786.ref018","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1093\/icvts\/ivt323","article-title":"Delirium after cardiac surgery: incidence and risk factors","volume":"17","author":"N Smulter","year":"2013","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"pone.0292786.ref019","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1177\/1474515119886155","article-title":"Preoperative cardiac function parameters as valuable predictors for nurses to recognise delirium after cardiac surgery: A prospective cohort study","volume":"19","author":"S Cai","year":"2020","journal-title":"Eur J Cardiovasc Nurs"},{"key":"pone.0292786.ref020","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1111\/j.1447-0594.2012.00868.x","article-title":"High risk of adverse drug reactions in elderly patients taking six or more drugs: analysis of inpatient database.","volume":"12","author":"T Kojima","year":"2012","journal-title":"Geriatr Gerontol Int."},{"key":"pone.0292786.ref021","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s10388-017-0570-z","article-title":"Postoperative delirium after pharyngolaryngectomy with esophagectomy: a role for ramelteon and suvorexant.","volume":"14","author":"E Booka","year":"2017","journal-title":"Esophagus"},{"key":"pone.0292786.ref022","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1001\/jamapsychiatry.2013.3320","article-title":"Preventive effects of ramelteon on delirium: a randomized placebo-controlled trial","volume":"71","author":"DELIRIA-J Group","year":"2014","journal-title":"JAMA Psychiatry"},{"key":"pone.0292786.ref023","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s40780-014-0002-3","article-title":"Clinical risk factors associated with postoperative delirium and evaluation of delirium management and assessment team in lung and esophageal cancer patients","volume":"1","author":"K Murakawa","year":"2015","journal-title":"J Pharm Health Care Sci"},{"key":"pone.0292786.ref024","doi-asserted-by":"crossref","first-page":"323491","DOI":"10.1155\/2013\/323491","article-title":"Incidence and risk factors of early delirium after cardiac surgery","volume":"2013","author":"I Norkien\u0117","year":"2013","journal-title":"Biomed Res Int"},{"key":"pone.0292786.ref025","doi-asserted-by":"crossref","first-page":"8387","DOI":"10.1007\/s00464-022-09099-9","article-title":"Polypharmacy is predictive of postoperative complications in older adults undergoing ventral hernia repair.","volume":"36","author":"TR Holden","year":"2022","journal-title":"Surg Endosc."},{"key":"pone.0292786.ref026","doi-asserted-by":"crossref","first-page":"21514593211058947","DOI":"10.1177\/21514593211058947","article-title":"Review of Postoperative Delirium in Geriatric Patients After Hip Fracture Treatment.","volume":"13","author":"AM Albanese","year":"2022","journal-title":"Geriatr Orthop Surg Rehabil."},{"key":"pone.0292786.ref027","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1097\/BSD.0000000000000467","article-title":"Prevention and Management of Postoperative Delirium in Elderly Patients Following Elective Spinal Surgery.","volume":"30","author":"AK Nazemi","year":"2017","journal-title":"Clin Spine Surg"},{"key":"pone.0292786.ref028","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1017\/cjn.2020.62","article-title":"Effect of Sleep Disorder on Delirium in Post-Cardiac Surgery Patients","volume":"47","author":"H Wang","year":"2020","journal-title":"Can J Neurol Sci"},{"key":"pone.0292786.ref029","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1093\/fampra\/cmi065","article-title":"Predictors of discontinuation of benzodiazepine prescription after sending a letter to long-term benzodiazepine users in family practice.","volume":"23","author":"WJ Gorgels","year":"2006","journal-title":"Fam Pract."},{"key":"pone.0292786.ref030","doi-asserted-by":"crossref","first-page":"20503121211037903","DOI":"10.1177\/20503121211037903","article-title":"Characteristics of patients who were able to switch from benzodiazepine hypnotics to lemborexant.","volume":"9","author":"H Suzuki","year":"2021","journal-title":"SAGE Open Med"},{"key":"pone.0292786.ref031","doi-asserted-by":"crossref","first-page":"1873","DOI":"10.1016\/j.jtcvs.2021.07.027","article-title":"Prevention of postoperative delirium after cardiovascular surgery: A team-based approach","volume":"165","author":"K Enomoto","year":"2023","journal-title":"J Thorac Cardiovasc Surg"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0292786","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T17:27:14Z","timestamp":1697131634000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0292786"}},"subtitle":[],"editor":[{"given":"Tomoki","family":"Nakamizo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,10,12]]},"references-count":31,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0292786","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,12]]}}}