{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T19:40:21Z","timestamp":1790106021839,"version":"4.0.1"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T00:00:00Z","timestamp":1722988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>To identify the risk factors for postoperative delirium (POD) after cardiac surgery in frail elderly patients and develop a receiver operating characteristic (ROC) prediction model to confirm the effectiveness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective observational study, patients were assessed preoperatively according to the frailty index (FI) scale. Cerebral (SctO<jats:sub>2<\/jats:sub>) was assessed at different time points using near-infrared spectroscopy (NIRS). On the basis of the occurrence of POD within 7 days after surgery, patients were divided into POD and non-POD groups. Risk factors were analyzed using logistic regression analysis, while their predictive values were evaluated using the receiver operating characteristic curve analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>POD was significantly associated with frailty, lower preoperative MMSE scores, hyperlipidemia, diabetes, cerebrovascular disease, lower hemoglobin level, lower albumin level, longer operation time, longer CPB time, lower SctO<jats:sub>2<\/jats:sub> at T5, and lower SctO<jats:sub>2baseline<\/jats:sub> (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05). SrtO<jats:sub>2<\/jats:sub> and SmtO<jats:sub>2<\/jats:sub> did not differ significantly between groups. FI, preoperative MMSE score, and operation time as independent risk factors (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05). Significant predictive value was demonstrated in all 3 variables (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.001; respectively). Among them, high sensitivity and specificity were observed with the FI (cut-off value 0.27, sensitivity 75%, specificity 73.5%) and operation time (cut-off value 237.5, sensitivity 62.5%, specificity 78.6%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The FI, preoperative MMSE score, and operation time were independent risk factors for POD in elderly patients after cardiac surgery, with high predictive value observed with the FI and operation time. Cerebral oxygen saturation was associated with POD but was not an independent risk factor.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Trial Registration<\/jats:title><jats:p>Chinese Clinical Trail Registry, No: chictr2200056038.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2024.1425621","type":"journal-article","created":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T04:41:38Z","timestamp":1723005698000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Risk factors for postoperative delirium in frail elderly patients undergoing on-pump cardiac surgery and development of a prediction model\u2014a prospective observational study"],"prefix":"10.3389","volume":"11","author":[{"given":"Yinyin","family":"Ding","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yali","family":"Ge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianfeng","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,8,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"107426","DOI":"10.1016\/j.clineuro.2022.107426","article-title":"Frailty predicts readmission, reoperation, and infection after posterior spinal fusion: an institutional series of 3,965 patients","volume":"222","author":"Cloney","year":"2022","journal-title":"Clin Neurol Neurosurg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1186\/s12877-022-03416-6","article-title":"Sensory and motor correlates of frailty: dissociation between frailty phenotype and frailty index","volume":"22","author":"Beier","year":"2022","journal-title":"BMC Geriatr"},{"key":"B3","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1016\/j.bja.2022.08.002","article-title":"Surgery in older patients: learning from shared decision-making in intensive care","volume":"129","author":"Fowler","year":"2022","journal-title":"Br J Anaesth"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e2230959","DOI":"10.1001\/jamanetworkopen.2022.30959","article-title":"Comparison of multidimensional frailty instruments for estimation of long-term patient-centered outcomes after cardiac surgery","volume":"5","author":"Sun","year":"2022","journal-title":"JAMA Netw Open"},{"key":"B5","doi-asserted-by":"publisher","first-page":"104568","DOI":"10.1016\/j.archger.2021.104568","article-title":"Changes in frailty status after cardiac surgery. A prospective cohort study","volume":"98","author":"Miguelena-Hycka","year":"2022","journal-title":"Arch Gerontol Geriatr"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2314","DOI":"10.1002\/ejhf.2011","article-title":"Cachexia, muscle wasting, and frailty in cardiovascular disease","volume":"22","author":"Bielecka-Dabrowa","year":"2020","journal-title":"Eur J Heart Fail"},{"key":"B7","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1111\/ggi.14340","article-title":"Surgical risk assessment for super-elderly patients","volume":"22","author":"Miura","year":"2022","journal-title":"Geriatr Gerontol Int"},{"key":"B8","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1097\/ACO.0000000000001075","article-title":"Frailty and cardiac surgery: to operate or not?","volume":"35","author":"Emmert","year":"2022","journal-title":"Curr Opin Anaesthesiol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1187","DOI":"10.1016\/j.hlc.2019.10.007","article-title":"Frailty in elderly patients undergoing cardiac surgery increases hospital stay and 12-month readmission rate","volume":"29","author":"Lal","year":"2020","journal-title":"Heart Lung Circ"},{"key":"B10","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1177\/2048872619882359","article-title":"Predictors and prognosis of delirium among older subjects in cardiac intensive care unit: focus on potentially preventable forms","volume":"9","author":"Mossello","year":"2020","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"B11","doi-asserted-by":"publisher","first-page":"100557","DOI":"10.1016\/j.bj.2022.08.003","article-title":"Association of preoperative frailty and postoperative delirium in older cancer patients undergoing elective abdominal surgery: a prospective observational study in Taiwan","volume":"46","author":"Tsai","year":"2022","journal-title":"Biomed J"},{"key":"B12","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1038\/s41582-022-00698-7","article-title":"The inter-relationship between delirium and dementia: the importance of delirium prevention","volume":"18","author":"Fong","year":"2022","journal-title":"Nat Rev Neurol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2865","DOI":"10.1007\/s40520-022-02215-8","article-title":"Incidence and interaction factors of delirium as an independent risk of mortality in elderly patients in the intensive units: a retrospective analysis from MIMIC-IV database","volume":"34","author":"Liu","year":"2022","journal-title":"Aging Clin Exp Res"},{"key":"B14","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1177\/2048872615624239","article-title":"The impact of delirium on outcomes in acute, non-intubated cardiac patients","volume":"6","author":"Sato","year":"2017","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"B15","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1186\/s12877-022-02932-9","article-title":"Incidence, predictors and health outcomes of delirium in very old hospitalized patients: a prospective cohort study","volume":"22","author":"Zhang","year":"2022","journal-title":"BMC Geriatr"},{"key":"B16","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1016\/S0140-6736(13)60688-1","article-title":"Delirium in elderly people","volume":"383","author":"Inouye","year":"2014","journal-title":"Lancet"},{"key":"B17","doi-asserted-by":"publisher","first-page":"n1007","DOI":"10.1136\/bmj.n1007","article-title":"Delirium and long term cognition in critically ill patients","volume":"373","author":"Wilcox","year":"2021","journal-title":"Br Med J"},{"key":"B18","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1111\/nicc.12526","article-title":"Prevalence and risk factors of delirium in the intensive care unit: an observational study","volume":"26","author":"Gravante","year":"2021","journal-title":"Nurs Crit Care"},{"key":"B19","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1080\/07853890.2022.2039405","article-title":"Increased postoperative myeloperoxidase concentration associated with low baseline antioxidant capacity as the risk factor of delirium after cardiac surgery","volume":"54","author":"Kazmierski","year":"2022","journal-title":"Ann Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e060142","DOI":"10.1136\/bmjopen-2021-060142","article-title":"Models of integrated care for older people with frailty: a horizon scanning review","volume":"12","author":"Kjelsnes","year":"2022","journal-title":"BMJ Open"},{"key":"B21","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1161\/CIRCULATIONAHA.120.051583","article-title":"Fibroblast-specific proteotranscriptomes reveal distinct fibrotic signatures of human sinoatrial node in nonfailing and failing hearts","volume":"144","author":"Kalyanasundaram","year":"2021","journal-title":"Circulation"},{"key":"B22","doi-asserted-by":"publisher","first-page":"2167","DOI":"10.1093\/ageing\/afab111","article-title":"Developing and evaluating a frailty index for older South Africans-findings from the HAALSI study","volume":"50","author":"Barker","year":"2021","journal-title":"Age Ageing"},{"key":"B23","doi-asserted-by":"publisher","first-page":"78","DOI":"10.3171\/2020.5.JNS20766","article-title":"The 5-factor modified frailty index: an effective predictor of mortality in brain tumor patients","volume":"135","author":"Khalafallah","year":"2020","journal-title":"J Neurosurg"},{"key":"B24","doi-asserted-by":"publisher","first-page":"831930","DOI":"10.3389\/fimmu.2022.831930","article-title":"Inflammation and oxidative stress in the context of extracorporeal cardiac and pulmonary support","volume":"13","author":"Hatami","year":"2022","journal-title":"Front Immunol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"345","DOI":"10.3760\/cma.j.cn112137-20200527-01681","article-title":"The value of intraoperative monitoring of cerebral oxygen saturation on postoperative cognitive function in elderly patients undergoing cardiac surgery","volume":"101","author":"Qin","year":"2021","journal-title":"Zhonghua Yi Xue Za Zhi"},{"key":"B26","doi-asserted-by":"publisher","first-page":"2188","DOI":"10.1177\/0271678X221124644","article-title":"Cerebral perfusion in untreated, controlled, and uncontrolled hypertension","volume":"42","author":"Christie","year":"2022","journal-title":"J Cereb Blood Flow Metab"},{"key":"B27","doi-asserted-by":"publisher","first-page":"110395","DOI":"10.1016\/j.jclinane.2021.110395","article-title":"The association of bispectral index values and metrics of cerebral perfusion during cardiopulmonary bypass","volume":"74","author":"Liu","year":"2021","journal-title":"J Clin Anesth"},{"key":"B28","doi-asserted-by":"publisher","first-page":"031414","DOI":"10.1117\/1.NPh.3.3.031414","article-title":"Review of functional near-infrared spectroscopy in neurorehabilitation","volume":"3","author":"Mihara","year":"2016","journal-title":"Neurophotonics"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e14058","DOI":"10.7717\/peerj.14058","article-title":"Correlation and agreement of regional cerebral oxygen saturation measured from sensor sites at frontal and temporal areas in adult patients undergoing cardiovascular anesthesia","volume":"10","author":"Tribuddharat","year":"2022","journal-title":"PeerJ"},{"key":"B30","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1016\/j.bja.2019.09.042","article-title":"Association between postoperative delirium and postoperative cerebral oxygen desaturation in older patients after cardiac surgery","volume":"124","author":"Eertmans","year":"2020","journal-title":"Br J Anaesth"},{"key":"B31","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1159\/000494462","article-title":"Low renal oxygen saturation at near-infrared spectroscopy on the first day of life is associated with developing acute kidney injury in very preterm infants","volume":"115","author":"Bonsante","year":"2019","journal-title":"Neonatology"},{"key":"B32","doi-asserted-by":"publisher","first-page":"361","DOI":"10.4097\/kja.d.17.00002","article-title":"Correlation between regional tissue perfusion saturation and lactate level during cardiopulmonary bypass","volume":"71","author":"Lee","year":"2018","journal-title":"Korean J Anesthesiol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"9232","DOI":"10.1038\/s41598-020-66276-3","article-title":"Incidence & risk factors of postoperative delirium after spinal surgery in older patients","volume":"10","author":"Kang","year":"2020","journal-title":"Sci Rep"},{"key":"B34","doi-asserted-by":"publisher","first-page":"10459","DOI":"10.21037\/apm-21-2190","article-title":"A systematic review and meta-analysis of the correlation between operation time and postoperative delirium in total hip arthroplasty","volume":"10","author":"Zhang","year":"2021","journal-title":"Ann Palliat Med"},{"key":"B35","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1002\/aorn.13252","article-title":"Risk factors of postoperative delirium in older adult spine surgery patients: a meta-analysis","volume":"112","author":"Baek","year":"2020","journal-title":"AORN J"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2024.1425621\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T04:41:42Z","timestamp":1723005702000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2024.1425621\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,7]]},"references-count":35,"alternative-id":["10.3389\/fcvm.2024.1425621"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2024.1425621","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,7]]},"article-number":"1425621"}}