Background Postoperative delirium in older patients results in worse outcomes and increased costs. The prevalence and predictors of postoperative delirium in patients undergoing major colorectal surgery are not clear. Objectives To determine the prevalence and predictors of postoperative delirium in older patients after major colorectal surgery. Methods Patients older than 50 years, without preexisting cognitive impairment, were recruited before surgery. These patients were assessed after surgery for delirium daily for 3 days by using the Confusion Assessment Method. Regression analysis was used to determine independent predictors of postoperative delirium. Results Patients (n = 118) had a mean age of 71.81 years, and approximately half were women (54%). Most participants (64%) were married, and comorbid conditions were common. Delirium developed in 35% of the patients in the 3 days after surgery and in 21% in the first 24 hours. New cases of delirium were identified on each of the 3 days after surgery, and a few patients (7%) had delirium for the entire 3 days. Odds for delirium in the first 24 hours were increased for patients who had early admission (odds ratio [OR] = 4.48; P = .06) and decreased for patients who were married (OR = 0.25; P = .01). Odds for delirium in the first 3 days after surgery were increased for men (OR = 4.27; P = .02), older patients (OR = 1.05; P = .04), and patients who stayed overnight in the critical care unit (OR = 2.97; P = .06). Conclusions Postoperative delirium is common and persistent in older patients in the first 3 days after colorectal surgery.

The majority of people undergoing valve replacement for rheumatic heart disease have good outcomes. Mortality and morbidity rates at 1 and 5 years, particularly for female patients, are cause for concern and indicate a need for evaluation of resources toward systematic long-term postoperative surveillance and medical management.

Background: Fiji has one of the world's highest rates of rheumatic heart disease (RHD). The associated valve deterioration and dysfunction results in significant mortality and morbidity. Volunteer surgical teams conduct valve replacements (VR) but rarely publish their outcomes. This study aims to evaluate the early and late mortality, and major adverse valve-related events (MAVE), after VR for RHD in Fiji, performed by the Sydney Adventist Hospital coordinated Operation Open Heart team.Methods: Patients (n = 131) were treated from 2001 to 2011. Complete data on 120 (92%) patients was extracted from medical records at hospitals (n = 7) and out-patient clinics (n = 18) and through familial network searching.Results: Patients' age at the time of surgery was 25.52 yrs (SD 11.84 range 6-52 yrs), and the majority were female (61%) and indigenous Fijian (71%). Valves replaced were isolated-mitral (53%), isolated-aortic (18%) and multiple (29%) valves. Almost all patients (97%) had a mechanical prosthesis. The median time since surgery was 2.5 years (range 0.16-10 years). The cumulative mortality rate at 30 and 60 days, and 1 and 5 years, was 1.6%, 5%, 10% and 18% respectively. The cumulative MAVE rate at 30 and 60 days, and 1 and 5 years was 8%, 8%, 18% and 27% respectively. After adjusting for age and valves being replaced, males were much less likely to die (Odds ratio .25, 95% confidence interval .08-.81).Conclusions: High level of follow-up allows accurate comparison of outcomes to developing countries and indicates comparable benefits; outcomes for women need further investigation.

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