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BACKGROUND: Intraoperative burst-suppression is associated with postoperative delirium. Whether this association is causal remains unclear. Therefore, we investigated whether burst-suppression during cardiopulmonary bypass (CPB) mediates the effects of known delirium risk factors on postoperative delirium. METHODS: This was a retrospective cohort observational sub-study of the Minimizing ICU Neurological Dysfunction with Dexmedetomidine-induced Sleep trial. We analyzed data from patients over 60 years old undergoing cardiac surgery (n = 159). Univariate and multivariable regression analyses were performed to assess for associations and enable causal inference. Delirium risk factors were evaluated using the abbreviated Montreal Cognitive Assessment, and Patient-Reported Outcomes Measurement Information System questionnaires for applied cognition, physical function, global health, sleep, and pain. We also analyzed electroencephalogram data (n = 141). RESULTS: The incidence of delirium in patients with CPB burst-suppression was 25% (15/60) compared to 6% (5/81) in patients without CPB burst-suppression. In univariate analyses, age (OR:1.08 [95% CI: 1.03, 1.14], P=0.002), lowest CPB temperature (OR:0.79 [0.66, 0.94], P=0.010), alpha power (OR:0.65 [0.54, 0.80], P |
