Delirium in an Enhanced Recovery After Cardiac Surgery Cohort

Background Postoperative care with ERAS programs resulted in a reduction in the incidence of postoperative delirium (POD). This study aims to evaluate the incidence of POD, describe the postoperative course of patients managed exclusively within an ERAS pathway after cardiac surgery, and explore potential factors associated with the occurrence of delirium. Methods We enrolled patients managed within an ERAS program in cardiac surgery. The primary outcome was the incidence of delirium. Secondary outcomes included the impact of POD on the postoperative course and perioperative factors associated with its occurrence. Results Among 500 patients included POD occurred in 30 patients (6%). Patients with POD were older (70 vs. 64years, p = 0.006), had a lower BMI. Patients with POD experienced significantly more postoperative complications, longer ICU (3 vs. 1 days, p < 0.001) and hospital stays. In multivariable analysis, older age, lower BMI and ICU readmission were associated with POD, whereas early extubation and opioid discontinuation before postoperative day 3 were associated with lower odds of POD. Conclusion POD remains a persistent complication despite implementation of a mature ERAS pathway and is associated with a more complex postoperative recovery. Exploratory analyses identified early extubation and shorter postoperative opioid exposure as potentially modifiable perioperative factors.