Perioperative medicine (London, England) · 2026
Diabetes mellitus and the risk of postoperative visual and auditory hallucinations after cardiac surgery: insights from the VAACS study.
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Abu Khadija Haitham, Abu Hamdeh Nizar, Darwish Abdalaziz, Najajra Duha, Dabash Alaa, Masu'd Mohammad, Othman Wafiq, Fraitekh Yahya Z, Kamel Mohammed Amer, Odeh Taleen, Jarrar Noureldin, Sallam Abeer, Zahran Anwar, Abu-Khazneh Omar, Majadleh Saleem, Abdallah Shymai, Heih Omar Qasem, Bali Basem, Ewidat Osama, Abdul-Hafez Hamza A, Nana Oday, Hamoudy Qassem, Alnees Mohammad
Аннотация
OBJECTIVES: Postoperative 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.
METHODS: In 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.
RESULTS: Visual 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.
CONCLUSION: Hallucinations 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.
METHODS: In 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.
RESULTS: Visual 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.
CONCLUSION: Hallucinations 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.