Role of Intraoperative Neuromonitoring to Predict Postoperative Delirium in Cardiovascular Surgery

Postoperative delirium (POD) can occur in up to 50% of elderly patients undergoing cardiovascular surgery, resulting in hospitalization and significant morbidity and mortality. This study aims to determine whether intraoperative neurophysiological monitoring (IONM) modalities can be used to predict delirium in patients undergoing cardiovascular surgery. Adults patients undergoing cardiovascular surgery with IONM between 2019 and 2021 were retrospectively reviewed. Delirium was assessed multiple times using the Intensive Care Delirium Screening Checklist (ICDSC). Patients with an ICDSC score equal to or greater than 4 were considered to have POD. Significant IONM changes were evaluated based on a visual review of EEG and SSEP data and documentation of significant changes during surgery. University of Pittsburgh Medical Center (UPMC) hospitals. Patients ≥ 18 years old undergoing cardiovascular surgery with IONM monitoring. Of the 578 patients undergoing cardiovascular surgery with IONM, 126 had POD (21.8%). Significant IONM changes were noted in 134 patients, of which 49 patients had delirium (36.6%). In contrast, 444 patients had no IONM changes during surgery, of which 77 (17.3%) patients had POD. Upon multivariable analysis, IONM changes were associated with POD, OR: 2.12 (95% CI 1.31-3.44, p-value: <0.001). Additionally, baseline EEG abnormalities were associated with POD (p-value: 0.002). Significant IONM changes are associated with an increased risk of POD in patients undergoing cardiovascular surgery. Our findings offer basis for future research and analysis of EEG and SSEP monitoring to predict, detect, and prevent POD.