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Publications

Journal Article Ahead of print

PubMed: 41507022 DOI: 10.1053/j.jvca.2025.11.036

Hyperlipidemia and Postoperative Hallucinations After Cardiac Surgery: Insights from the VAACS Cohort Study.

J Cardiothorac Vasc Anesth

Authors: Haitham Abu Khadija, Nizar Abu Hamdeh, Duha Najajra, Mohammad Masu'd, Alaa Dabash, Anwar Zahran, Basem Bali, Osama Ewidat, Mahdi Awwad, Yazan Hamdan, Lubna Kharraz, Omar Qasem Heih, Kareem Ibraheem, Osama Hroub, Omnia AbuSalah, Wafiq Othman, Sulaf Muath Daraghmeh, Issa Al-Khdour, Hasan Alkhatib, Ala Rubi, Nahi N Al-Aydi, Moath Nairat, Mohammad Khader, Omar Iyad Husni Abu Hamda, Hamza A Abdul-Hafez, Kasem Hamoudy, Oday Nana, Mohammad Alnees, Abdalaziz Darwish

Affiliations

  • Kaplan Heart Center, Kaplan Medical Center, Pasternak St. 1 Rehovot, Israel.
  • Palestinian Clinical Research Center, Bethlehem, Palestine; Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
  • Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
  • Palestinian Clinical Research Center, Bethlehem, Palestine; Faculty of Medicine, Palestine Polytechnic University, Hebron, Palestine.
  • Department of Anesthesia, An-Najah National University Hospital, Nablus, Palestine.
  • Faculty of Medicine, Arab American University, Palestine.
  • Department of Cardiothoracic Surgery, Istishari Arab Hospital, Ramallah, Palestine.
  • Department of Cardiac Surgery, Al Makassed Hospital, Jerusalem, Palestine.
  • Department of Cardiac Surgery, Consultant Cardiac Surgeon, Specialized Arab Hospital, Nablus, Palestine.
  • Specialist Cardiac Surgeon, Specialized Arab Hospital, Nablus, Palestine.
  • Department of Cardiothoracic Surgery, An-Najah National University Hospital, Nablus, Palestine.
  • Palestinian Clinical Research Center, Bethlehem, Palestine; Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; Department of Internal Medicine B, Ziv Medical Center, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
  • Kaplan Heart Center, Kaplan Medical Center, Pasternak St. 1 Rehovot, Israel; Palestinian Clinical Research Center, Bethlehem, Palestine; Harvard Medical School Postgraduate Medical Education, Global Clinical Scholars Research Training program, Boston, USA.

Abstract

OBJECTIVE

To evaluate the cumulative incidence and predictors of postoperative visual and auditory hallucinations among hyperlipidemic and normolipidemic patients undergoing cardiac surgery, with a particular focus on lipid indices, especially the low-density lipoprotein/high-density lipoprotein (LDL/HDL) ratio.

DESIGN

Multicenter, prospective cohort study with daily postoperative assessments from days 1-4 and follow-up to day 7, using Kaplan-Meier estimation and multivariable Cox proportional hazards regression.

SETTING

Ten tertiary cardiac surgery centers across the West Bank of Palestine.

PARTICIPANTS

Adults (≥18 years) undergoing coronary artery bypass grafting or valve surgery (N = 1,332), stratified as hyperlipidemic (n = 448) or normolipidemic (n = 884) according to preoperative lipid profiles. Patients with incomplete records, cognitive impairment, language barriers, or psychiatric illness were excluded.

INTERVENTIONS

None (observational study).

MEASUREMENTS AND MAIN RESULTS

Postoperative hallucinations were assessed using the validated Questionnaire for Psychotic Experiences. By day 7, visual hallucinations occurred in 11.2% of hyperlipidemic and 10.3% of normolipidemic patients, while auditory hallucinations occurred in 7.1% and 6.3%, respectively. The LDL/HDL ratio independently predicted both visual and auditory hallucinations in hyperlipidemic (visual: adjusted hazard ratio [aHR] 1.136, p = 0.016; auditory: aHR 1.146, p = 0.017) and normolipidemic (visual: aHR 1.123, p = 0.038; auditory: aHR 1.110, p = 0.047) cohorts. Longer aortic cross-clamp time increased visual hallucination risk (aHR 1.007; p = 0.015), while intraoperative fentanyl exposure reduced both visual (aHR 0.435; p = 0.011) and auditory (aHR 0.377; p = 0.023) hallucinations. A critical preoperative state predicted auditory hallucinations in hyperlipidemic patients (aHR 3.904; p = 0.001).

CONCLUSIONS

Elevated LDL/HDL ratio is a significant predictor of postoperative hallucinations. Integrating lipid profile evaluation into perioperative risk assessment may enhance neuropsychiatric outcomes following cardiac surgery.

MeSH

Anesthesia, Thoracic Surgery, Hyperlipidemias, Hallucinations, Lipoproteins, Cohort Studies, Lipoproteins, Hdl, Coronary Artery Bypass