Development of a complex intervention to prevent postoperative delirium after cardiac surgery

Summary

Delirium is a state of temporary confusion and reduced awareness of the environment. It is common after open heart surgery, affecting up to half of all patients. Although it typically clears after a few days, it is associated with longer hospital stays and an increased risk of death in the short-term, and post-traumatic stress disorder and dementia in the long-term. Delirium is distressing for patients, families and is challenging for healthcare staff to manage.

Multiple interventions have been tested to prevent delirium. Many of these have been delivered during and after surgery, including psychiatric medications, different sedatives, sleep hygiene and early mobilisation. Recent research has focused on prevention of delirium by improving physical and psychological health before surgery through brain exercises and physical activity (called "prehabilitation").

Our proposed research has several parts. First, we want to summarise all studies that have tested any intervention to prevent delirium to determine which one(s) are most effective. Second, we want to interview heart surgery patients who have / have not experienced delirium and healthcare staff looking after them to explore their views of the potential interventions (how acceptable and how easy they are to implement). Finally, we will use the information from the review and interviews to build a "logic model"; a diagram that shows how the different interventions can work together to prevent delirium and how they can be delivered. We will then apply for funding to further develop the overall intervention and test it in a large trial.

This project will utilise some of the pathways (such as patient groups) we have set up from a funded project on prehabilitation for cardiac surgery.

Progress update (May 2023)

The review is well under way. The searches are completed and all screening has taken place (double screening of 2208 abstracts). All full text articles have been identified and screened resulting in a  final batch of 112 papers.

Data extraction has taken place on 101/112  (90%) of the papers and checking of extraction has taken place on 67/112 (60%) of the papers. All extraction and checking should be complete by mid-May.

Meta-analyses and risk of bias should be completed by end of June. We have written a protocol of the study and are currently writing the methods section for the main paper. E anticipate having a first draft of the paper by the end of July 2023.

Impact

This work will lead to a high quality publication and will inform a future programme grant application.