Evidence map›Paper›PMID 36792460›Full record

ArticleJournal of cardiothoracic and vascular anesthesia2023

The Association Between Enhanced Recovery After Cardiac Surgery-Guided Analgesics and Postoperative Delirium.

Christina Anne Jelly, Jacob C Clifton, Frederic T Billings, Antonio Hernandez, Andrew J Schaffer, Matthew E Shotwell, Robert E Freundlich

Open access · greenAbstract read
In one paragraph

Article in Journal of cardiothoracic and vascular anesthesia, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
4.1field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it, 19 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 1 country.

Christina Anne JellyDepartment of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN.
Jacob C CliftonDepartment of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN. Electronic address: jacob.c.clifton@vumc.org.
Frederic T BillingsDepartment of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
Antonio HernandezDepartment of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN.
Andrew J SchafferSchool of Medicine, Vanderbilt University, Nashville, TN.
Matthew E ShotwellDepartment of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
Robert E FreundlichDepartment of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN.
Vanderbilt University Medical Center · USVanderbilt University · US

Funding

Vanderbilt Institute for Clinical and Translational Research (VICTR) -Identifying correlates of functional immunity in SARS-CoV-2 convalescent plasmaUL1TR002243 · NCATS · VANDERBILT UNIVERSITY MEDICAL CENTER · PI Paul A. Harris, Wesley H Self · 2017 to 2026
$130.7M
Hyper-oxygenation, oxidative stress, and kidney injury following cardiac surgeryR01GM112871 · NIGMS · VANDERBILT UNIVERSITY MEDICAL CENTER · PI BILLINGS, FREDERIC TREMAINE · 2015 to 2019
$1.8M
Reducing Reintubation Risk in High-Risk Cardiac Surgery Patients with High-Flow Nasal Cannula -the "I-CAN" studyK23HL148640 · NHLBI · VANDERBILT UNIVERSITY MEDICAL CENTER · PI FREUNDLICH, ROBERT EDWARD · 2020 to 2024
$867k
NCATS NIH HHS UL1 TR002243NHLBI NIH HHS K23 HL148640NIGMS NIH HHS R01 GM112871
6 · The paper itself

Abstract

objectivesDelirium is a common postoperative complication associated with death and long-term cognitive impairment. The authors studied the association between opioid-sparing anesthetics, incorporating Enhanced Recovery After Cardiac Surgery (ERACS)-guided analgesics and postoperative delirium.

designThe authors performed a retrospective review of nonemergent coronary, valve, or ascending aorta surgery patients.

settingA tertiary academic medical institution.

participantsThe study authors analyzed a dataset of elective adult cardiac surgical patients. All patients ≥18 years undergoing elective cardiac surgery from November 2, 2017 until February 2, 2021 were eligible for inclusion.

interventionsThe ERACS-guided multimodal pain regimen included preoperative oral acetaminophen and gabapentin, and intraoperative intravenous lidocaine, ketamine, and dexmedetomidine. MEASUREMENTS AND MAIN

resultsDelirium was measured by bedside nurses using the Confusion Assessment Method for the intensive care unit (ICU). Delirium occurred in 220 of the 1,675 patients (13.7%). The use of any component of the multimodal pain regimen was not associated with delirium (odds ratio [OR]: 0.85 [95% CI: 0.63-1.16]). Individually, acetaminophen was associated with reduced odds of delirium (OR: 0.60 [95% CI: 0.37-0.95]). Gabapentin (OR: 1.36 [95% CI: 0.97-2.21]), lidocaine (OR: 0.86 [95% CI: 0.53-1.37]), ketamine (OR: 1.15 [95% CI: 0.72-1.83]), and dexmedetomidine (OR: 0.79 [95% CI: 0.46-1.31]) were not individually associated with postoperative delirium. Individual ERACS elements were associated with secondary outcomes of hospital length of stay, ICU duration, postoperative opioid administration, and postoperative intubation duration.

conclusionsThe use of an opioid-sparing perioperative ERACS pain regimen was not associated with reduced postoperative delirium, opioid consumption, or additional poor outcomes. Individually, acetaminophen was associated with reduced delirium.

Indexed as

Cardiac Surgical ProceduresDexmedetomidineEmergence DeliriumKetamineAcetaminophenAdultAnalgesicsAnalgesics, OpioidGabapentinHumansLidocainePostoperative PainAcetaminophenAnalgesicsAnalgesics, OpioidDexmedetomidineGabapentinKetamineLidocainecardiacdeliriumEnhanced Recovery After Cardiac Surgery (ERACS)multimodal analgesiapain

Identifiers

PMID36792460
PMCPMC10065906
OpenAlexW4313731237

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.