Evidence map›Paper›PMID 42449454›Full record

ArticlePerioperative medicine (London, England)2026

Diabetes mellitus and the risk of postoperative visual and auditory hallucinations after cardiac surgery: insights from the VAACS study.

Haitham Abu Khadija, Nizar Abu Hamdeh, Abdalaziz Darwish, Duha Najajra, Alaa Dabash, Mohammad Masu'd, Wafiq Othman, Yahya Z Fraitekh, Mohammed Amer Kamel, Taleen Odeh and 13 more

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Article in Perioperative medicine (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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4 · The record

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5 · Who and what money

Authors and funding

23 authors.

Haitham Abu KhadijaHeart Center, Kaplan Medical Center, Rehovot, Affiliated with the Hebrew University, Jerusalem, Israel.
Nizar Abu HamdehDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, Palestine.
Abdalaziz DarwishDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, Palestine.
Duha NajajraDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, Palestine.
Alaa DabashDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, Palestine.
Mohammad Masu'dDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, Palestine.
Wafiq OthmanDepartment of Anesthesia, An-Najah National University Hospital, Nablus, Palestine.
Yahya Z FraitekhPalestinian Clinical Research Center, Bethlehem, Palestine.
Mohammed Amer KamelPalestinian Clinical Research Center, Bethlehem, Palestine.
Taleen OdehDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, Palestine.
Noureldin JarrarDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, Palestine.
Abeer SallamDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, Palestine.
Anwar ZahranDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, Palestine.
Omar Abu-KhaznehDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, Palestine.
Saleem MajadlehDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, Palestine.
Shymai AbdallahDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, Palestine.
Omar Qasem HeihPalestinian Clinical Research Center, Bethlehem, Palestine.
Basem BaliDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, Palestine.
Osama EwidatDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, Palestine.
Hamza A Abdul-HafezDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, Palestine.
Oday NanaDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, Palestine.
Qassem HamoudyDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, Palestine.
Mohammad AlneesPalestinian Clinical Research Center, Bethlehem, Palestine. a2011z2012z2013@gmail.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesPostoperative hallucinations are underrecognized neuropsychiatric complications of cardiac surgery. Glycemic control may influence their occurrence, particularly in patients with diabetes. This study aimed to estimate the incidence of visual and auditory hallucinations in diabetic and non-diabetic patients after cardiac surgery, and to identify factors independently associated with hallucinations within each group.

methodsIn this prospective multicenter cohort, hallucinations were assessed daily for 7 days using the Questionnaire for Psychotic Experiences. Cox regression identified predictors within diabetic and non-diabetic cohorts.

resultsVisual hallucinations occurred in 12.0% of diabetic and 11.2% of non-diabetic patients, while auditory hallucinations occurred in 7.9% and 6.0%, respectively, with no statistically significant between-group difference. Among diabetic patients, elevated preoperative HbA1c independently predicted both visual hallucinations (adjusted HR 1.29; 95% CI, 1.05-1.59) and auditory hallucinations (adjusted HR 1.37; 95% CI, 1.07-1.76). Higher preoperative blood glucose was also independently associated with increased risk of visual hallucinations (adjusted HR 1.011; 95% CI, 1.002-1.020) and auditory hallucinations (adjusted HR 1.013; 95% CI, 1.003-1.024). Morphine use showed an inverse association with auditory hallucinations in diabetic patients, although this did not reach statistical significance after adjustment (adjusted HR 0.57; 95% CI, 0.29-1.12). Longer postoperative mechanical ventilation was inversely associated with auditory hallucinations in diabetic patients (adjusted HR 0.80; 95% CI, 0.71-0.91), although this finding should be interpreted cautiously because hallucination assessment began only after extubation. Among non-diabetic patients, hemodialysis dependence independently predicted visual hallucinations (adjusted HR 6.99; 95% CI, 1.59-30.61), while critical preoperative state (adjusted HR 2.70; 95% CI, 1.23-5.93) and higher EuroSCORE II (adjusted HR 1.10; 95% CI, 1.05-1.15) independently predicted auditory hallucinations.

conclusionHallucinations affect a notable prportion of patients after cardiac surgery. Higher preoperative HbA1c and blood glucose were associated with postoperative hallucination risk, particularly in diabetic patients. These findings identify dysglycemia as a clinically relevant risk marker, but do not establish that short-term glycemic optimization would directly prevent hallucinations.

Indexed as

Cardiac surgeryDiabetes mellitusPostoperative hallucinations

Identifiers

PMID42449454

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