• Abdullah M Al-Qudah, Ta'aniOmar AlOACenter of Clinical Neurophysiology, Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA., Parthasarathy D Thirumala, Ibrahim Sultan, Shyam Visweswaran, Neelesh Nadkarni, Victoria Kiselevskaya, Donald J Crammond, Jeffrey Balzer, Katherine M Anetakis, Varun Shandal, Kathirvel Subramaniam, Balachundhar Subramanium, and Senthilkumar Sadhasivam.
• Center of Clinical Neurophysiology, Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
• J. Cardiothorac. Vasc. Anesth. 2024 Feb 1; 38 (2): 526533526-533.

ObjectivePostoperative delirium (POD) can occur in up to 50% of older patients undergoing cardiovascular surgery, resulting in hospitalization and significant morbidity and mortality. This study aimed to determine whether intraoperative neurophysiologic monitoring (IONM) modalities can be used to predict delirium in patients undergoing cardiovascular surgery.DesignAdult patients undergoing cardiovascular surgery with IONM between 2019 and 2021 were reviewed retrospectively. Delirium was assessed multiple times using the Intensive Care Delirium Screening Checklist (ICDSC). Patients with an ICDSC score ≥4 were considered to have POD. Significant IONM changes were evaluated based on a visual review of electroencephalography (EEG) and somatosensory evoked potentials data and documentation of significant changes during surgery.SettingUniversity of Pittsburgh Medical Center hospitals.ParticipantsPatients 18 years old and older undergoing cardiovascular surgery with IONM monitoring.Measurements And Main ResultsOf the 578 patients undergoing cardiovascular surgery with IONM, 126 had POD (21.8%). Significant IONM changes were noted in 134 patients, of whom 49 patients had delirium (36.6%). In contrast, 444 patients had no IONM changes during surgery, of whom 77 (17.3%) patients had POD. Upon multivariate analysis, IONM changes were associated with POD (odds ratio 2.12; 95% CI 1.31-3.44; p < 0.001). Additionally, baseline EEG abnormalities were associated with POD (p = 0.002).ConclusionSignificant IONM changes are associated with an increased risk of POD in patients undergoing cardiovascular surgery. These findings offer a basis for future research and analysis of EEG and somatosensory evoked potential monitoring to predict, detect, and prevent POD.Copyright © 2023 Elsevier Inc. All rights reserved.

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