Clinical Characteristics and Potentially Harmful Behaviors in Patients with Delirium After Cardiac Surgery

Abstract

Objective: To describe selected clinical characteristics and behavioral manifestations associated with risks of harm to patients and healthcare workers among patients with delirium after cardiac surgery. Subjects and Methods: A prospective descriptive study was conducted in adult patients aged ≥18 years who underwent cardiac surgery and were treated in the Postoperative Cardiac Intensive Care Unit from June to December 2025. Sedation and level of consciousness were assessed using the Richmond Agitation-Sedation Scale (RASS), and delirium was screened using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Patients with RASS scores of −4 or −5 were reassessed when their level of consciousness permitted evaluation. Postoperative delirium was identified by acute onset or fluctuating course, inattention, and either disorganized thinking or altered level of consciousness. Potentially dangerous behaviors toward patients and healthcare workers were recorded during follow-up. Results: A total of 38 patients with postoperative delirium after cardiac surgery were included. The mean age was 60.35 ± 10.84 years, and 73.7% were female. The mean time to onset of postoperative delirium was 25.47 ± 26.76 hours after admission to the intensive care unit; 36.8% of cases occurred on postoperative day 0 and 47.4% on postoperative day 1. The condition lasted 1 day in 60.5% of patients and 2 days in 26.3%. Hyperactive delirium was the predominant clinical subtype, with no mixed subtype identified. With 36.84% patients had prolonging the duration of mechanical ventilation beyond the initial plan due to postoperative delirium. The most common potentially harmful behaviors toward patients were self-removal of intravenous lines (21.1%), removal of nasogastric tubes (13.2%), striking the head or limbs (13.2%), removal of urinary catheters (10.5%), and self-extubation (5.3%). Behaviors posing risks to healthcare workers and caregivers included verbal abuse or insults (57.9%), spitting (39.5%), scratching, pinching, or biting (26.3%), and hitting or kicking (15.8%). Haloperidol was administered to 92.1% of patients, while physical restraint was used in 94.7%. Conclusion: Postoperative delirium occurred predominantly within the first 24–48 hours and was mainly characterized by hyperactive manifestations. It was associated with substantial risks to both patients and healthcare workers, particularly through self-removal of therapeutic devices, agitation, and aggressive behaviors. It is important for ensuring patient and healthcare-worker safety in the postoperative cardiac intensive care setting.