• Amritha Soundhar, Reshmi Udesh, Amol Mehta, John Schindler, Vinodh Jeevanantham, Thomas Gleason, and Parthasarathy D Thirumala.
• Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA.
• J. Cardiothorac. Vasc. Anesth. 2017 Dec 1; 31 (6): 1977-1984.

ObjectiveTo investigate the risk factors for postoperative delirium and the impact of delirium on mortality and morbidity following transcatheter aortic valve implantation (TAVI).DesignPatients who underwent TAVI were identified using the International Classification of Diseases, 9th revision clinical modification codes from the National Inpatient Sample database. Statistical analysis of preoperative and perioperative risk factors was done to identify the independent risk factors for delirium after TAVI.SettingMulti-institutional.ParticipantsPatients who underwent TAVI from 2012 to 2013.InterventionsTAVI.Measurements And Main ResultsOver the period of 2 years (2012-2013), 7,566 patients underwent TAVI. The incidence of delirium post-TAVI was 4.57% (345). Age >85 (odds ratio [OR] 1.03; 95% confidence interval [CI] 1.01-1.05; p = 0.003), electrolyte abnormalities (OR 1.83; 95% CI 1.17-2.87; p = 0.008), prior neurologic illness (OR 1.67; 95% CI 1.10-3.15; p = 0.01), and weight loss in the hospital (OR 1.77; 95% CI 1.05-2.99; p = 0.03) were independent risk factors for postoperative delirium (POD). Unilateral or bilateral carotid stenosis did not predispose to the development of delirium. POD was an independent risk factor for procedural morbidity (OR 3.29; 95% CI 2.05-5.28; p < 0.001). POD did not increase the risk of in-house mortality after TAVI.ConclusionAge of >85, electrolyte disturbance, pre-existing neurologic disease and weight loss were found to be independent risk factors for delirium. POD was associated significantly with morbidity. Owing to a significant increase in the morbidity, a thorough screening protocol and effective strategies to predict, prevent, and treat postoperative delirium would reduce the cost associated with TAVI.Copyright © 2017 Elsevier Inc. All rights reserved.

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