Postoperative visual and auditory hallucinations after cardiac surgery: VAACS umbrella study.
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Abu Khadija Haitham, Abu Hamdeh Nizar, Najajra Duha, Othman Wafiq, Abdul-Hafez Hamza A, Zahran Anwar, Heih Omar, Fraitekh Yahya Z, Masu'd Mohammad, Awwad Mahdi, Filho Idiberto José Zotarelli, Zayed Alaa, Sawalha Moaath, Ismail Sara, Swidan Izzeddin, Abu-Hamda Omar, Nana Oday, Hamoudy Kasem, Bali Basem, Nairat Moaath, Al-Khdour Issa, Darwazah Ahmad, Marzouqa Bisher, Sbaih Mohammad, Shehadeh Mustafa, Bali Khalil, Alkhatib Hasan, Tamimi Helmi, Rubi Ala, Al-Aydi Nahi N, Khalaf Ro'a, Karam Saja, Atatra Aya, AbuAlrub Ibraheem, Fuqha Raya, Alhaj Zahra'a, Abubilal Lila, Abuirmaileh Wajeh, Yasini Mohammad, Dabash Alaa, Abu-Alhmam Seleen, Mhesin Deema, Bakeer Saeed, Hamdan Yazan, Ewidat Osama, Zahaika Motasem, Jboor Hanan, Ali Abdalkarim, Badran Abdalfatah, Issa Kamal, Salous Abdelrahman, Abukamleh Ghina, Hazaza Merna, Sneineh Omar Abu, Mohammad Beisan, Ayesh Hadeel, Farah Rou'a, Farah Rahaf, Abuzaina Husam, Najjar Roua, Abu-Awad Ameen, Aljuba Ayat, Shawer Balqis, Salah Omar, Shehadeh Majd, Jaber Inas, Manassra Fatima, Jaber Doha, Jayouse Batoul, Assaf Yara, Alrifai Ali, Abuhaniah Lourin, Altmaizee Maya, Darwish Abdalaziz, Alnees Mohammad
Аннотация
METHODS: We conducted a multicenter prospective cohort study (September 2022 to May 2025) across West Bank cardiac surgery centers. A total of 1332 adults (997 CABG, 335 valve) were assessed daily for 7 days postoperatively using the Questionnaire for Psychotic Experiences. Predictors of visual and auditory hallucinations evaluated with Cox proportional hazards models.
RESULTS: Visual hallucinations occurred in 11.5 % of CABG patients and 10.0 % of valve surgery patients, while auditory hallucinations were reported in 7.0 % and 5.0 %, respectively. In the CABG group, the multivariable Cox regression models stratified by hospital showed that auditory hallucinations were significantly associated with lower left ventricular ejection fraction (HR = 1.05 per 1 % decrease; 95 % CI 1.01-1.09), longer aortic cross-clamp time (HR = 1.01 per minute; 95 % CI1.0004-1.02), and immunosuppressive therapy (HR = 4.81; 95 % CI 1.13-20.53). Postoperative blood transfusion was associated with an increased risk of visual hallucinations in univariate analysis (HR = 1.87; 95 % CI 1.05-3.33), but the association became borderline after adjustment (HR = 1.97; 95 % CI 0.95-4.09). Among the valve surgery cohort, the hospital-stratified models indicated that prolonged postoperative ventilation was independently protective against visual hallucinations (adjusted HR = 0.78; 95 % CI 0.68-0.90), whereas noradrenalin use (adjusted HR = 6.07; 95 % CI 2.18-16.93) and immunosuppressive therapy (adjusted HR = 5.13; 95 % CI 1.14-23.09) markedly increased the risk. For auditory hallucinations in valve surgery patients, adrenaline exposure emerged as a significant independent predictor (adjusted HR = 3.40; 95 % CI 1.21-9.54).
CONCLUSIONS: Postoperative hallucinations affected ∼1 in 10 patients; visual hallucinations were more frequent, auditory hallucinations linked to stress and medications, with risks varying by surgery type, supporting tailored monitoring and prevention.