Acute confusional state in the elderly following hip surgery: incidence, risk factors and complications

P, Galanakis; Bickel, Horst; Gradinger, R.; Gumppenberg, S. von; Förstl, Hans

doi:10.1002/gps.327

Cited by 212 publications

(177 citation statements)

References 45 publications

Supporting

Mentioning

159

Contrasting

Unclassified

Order By: Relevance

“…This fact suggests that intensive postoperative management of pain, blood sugar levels, and patient discomfort should be conducted as soon as the patient leaves the operating room and should be sustained until at least postoperative day 3. The factors associated with the development of POD in our study were similar to those identified in previous reports [1][2][3][4]7,[13][14][15][16][17][18]27) . Surprisingly, we could not obtain any significant relationship between brain surgery and POD, regardless of disease category or surgery, such as performed on microscope or by naked-eye.…”

Section: Incidence and Risk Factors Of Podsupporting

confidence: 90%

“…Preoperative factors included male, older age (＞65 years), patients already suffering dementia or delirium regardless of underlying conditions, history of alcohol abuse (＞10 yr), abnormal serum level of sodium (＜130 or ＞150 mmol/L), potassium (＜3.0 or ＞6.0 mmol/L), and glucose (fasting ＜60 or postprandial 2hr ＞300 mg/dL), and co-morbidities of more than 2 diseases with or without diabetes 7,19,22) . Operative factors included location of surgery (brain, spine, or peripheral nervous system), type of surgery (emergency vs. elective), type of anesthesia (general vs. local, neuroleptic or regional) and duration of surgical procedures.…”

Section: Assessment Of Risk Factorsmentioning

confidence: 99%

“…The incidence of POD varies between 5.1% and 52.5% in elderly patients undergoing major surgery, and certain procedures such as hip fracture or aortic surgery having higher risk of POD 4,5,7,8,21,22,27) . Because there has been practically no neurosurgical literature on the incidence of POD, we could not compare the 21.4% incidence in our study with that from similar studies.…”

Section: Incidence and Risk Factors Of Podmentioning

confidence: 99%

See 2 more Smart Citations

Incidence and Risk Factors of Acute Postoperative Delirium in Geriatric Neurosurgical Patients

Kim

et al. 2008

J Korean Neurosurg Soc

View full text Add to dashboard Cite

Objective : Postoperative delirium (POD) is characterized by an acute change in cognitive function and can result in longer hospital stays, higher morbidity rates, and more frequent discharges to long-term care facilities. In this study, we investigated the incidence and risk factors of POD in 224 patients older than 70 years of age, who had undergone a neurosurgical operation in the last two years. Methods : Data related to preoperative factors (male gender, >70 years, previous dementia or delirium, alcohol abuse, serum levels of sodium, potassium and glucose, and co-morbidities), perioperative factors (type of surgery and anesthesia, and duration of surgery) and postoperative data (length of stay in recovery room, severity of pain and use of opioid analgesics) were retrospectively collected and statistically analyzed. Results : POD appeared in 48 patients (21.4%) by postoperative day 3. When we excluded 26 patients with previous dementia or delirium, 17 spontaneously recovered by postoperative day 14, while 5 patients recovered by postoperative 2 months with medication, among 22 patients with newly developed POD. The univariate risk factors for POD included previously dementic or delirious patients, abnormal preoperative serum glucose level, pre-existent diabetes, the use of local anesthesia for the operation, longer operation time (>3.2 hr) or recovery room stay (>90 min), and severe pain (VAS>6.8) requiring opioid treatment (p<0.05). Backward regression analysis revealed that previously dementic patients with diabetes, the operation being performed under local anesthesia, and severe postoperative pain treated with opioids were independent risk factors for POD. Conclusion : Our study shows that control of blood glucose levels and management of pain during local anesthesia and in the immediate postoperative period can reduce unexpected POD and help preventing unexpected medicolegal problems and economic burdens.

show abstract

Section: Incidence and Risk Factors Of Podsupporting

confidence: 90%

Section: Assessment Of Risk Factorsmentioning

confidence: 99%

Section: Incidence and Risk Factors Of Podmentioning

confidence: 99%

See 1 more Smart Citation

Incidence and Risk Factors of Acute Postoperative Delirium in Geriatric Neurosurgical Patients

Kim

et al. 2008

J Korean Neurosurg Soc

View full text Add to dashboard Cite

show abstract

“…For example, careful reviews of prescribed drugs, laboratory testing, and identification of frail patients should be completed. This should make it possible to prevent delirium and treat patients [16,27]. Specific screening should be incorporated in admission evaluation.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of delirium in elderly patients with hip fracture

Suwanpasu

Grinslade

et al. 2014

Asian Biomedicine

View full text Add to dashboard Cite

Background: Delirium is a leading cause of death and disability in the elderly with hip fracture. Identifying reliable risk factors for delirium is critical to support optimal outcomes for prevention and reducing delirium. Objective: To quantify the reported factors associated to delirium for patients with hip fracture. Methods: Electronic databases were searched (including Medline, Pub Med, CINAHL, EMBASE, Evidence Based Medicine Reviews, Cochrane Review, Web of Science, and PsycINFO) to identify all studies, published in English language that evaluated the risk factors of delirium hospitalized people with hip fracture. Two reviewers independently assessed methodology quality and extracted relevant data. The data from the included studies were summarized, and pooled estimates were calculated for 12 risk factors. Results: Thirty-seven studies were included in the review and 25 in the meta-analysis. The incidence of delirium was 32.4% (95% confidence interval [CI] = 25.9%-39.5%). Six predisposing and four precipitating factors predicted delirium among older patients with hip fracture confirmed. The predisposing factors included advanced age (ES = 1.06, 95% CI = 1.03-1.09), male sex (ES = 1.34, 95% CI = 1.08-1.68), impairment of cognition (ES = 2.91, 95% CI = 1.91-4.42), and function (ES = 1.75, 95% CI = 1.39-2.2), comorbidity (ES = 1.59, 95% CI = 1.30-1.96), and health problems (ES = 2.64, 95% CI = 2.04-3.42). Precipitating factors were hypo-or hypernatremia (ES = 1.73, 95% CI = 1.14-2.64), depression (ES = 4.07, 95% CI = 1.95-8.49), more than three prescribed drugs (ES = 1.28, 95% CI = 1.10-1.49), and drugs including opioids (ES = 2.13, 95% CI = 1.42-3.18) and anticholinergic agents (ES = 2.10, 95% CI = 1.60-2.75). Conclusion:This meta-analysis result provides evidence that these risk factors have a significant impact on delirium in elders with hip fracture during hospitalization. Developing formal screening, and effective preventive and management strategies for delirium is important.

show abstract

“…20 Other than the stress of surgery, the risk factors for delirium in surgical patients most likely do not differ substantially from those in nonsurgical patients. 17 However, advanced age, 8,18,19,[21][22][23][24] preexisting impaired cognition, 8,21,22,[25][26][27] use of psychotropic medications, 22,25,26,28 and impaired functional status and sensory deficits 8,21,27,29 are recognized as predisposing factors for postoperative delirium. A diverse array of precipitating factors for delirium have also been identified in surgical patients, including impaired oxygenation, 2,30 abnormal hematological and/or biochemical status, 25,26,[30][31][32] blood loss and replacement, 19,32 and intravenous infusions.…”

mentioning

confidence: 99%

Postoperative Delirium After Colorectal Surgery in Older Patients

Mangnall¹,

Gallagher²,

Stein‐Parbury³

2010

American Journal of Critical Care

View full text Add to dashboard Cite

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.

show abstract

Acute confusional state in the elderly following hip surgery: incidence, risk factors and complications

Abstract: ACS is common among elderly hip surgery patients. The occurrence of ACS is influenced by several predisposing and precipitating factors. Further knowledge of these risk factors will contribute to the early identification of high risk patients and to the development of preventive measures.

Cited by 212 publications

References 45 publications

Incidence and Risk Factors of Acute Postoperative Delirium in Geriatric Neurosurgical Patients

Incidence and Risk Factors of Acute Postoperative Delirium in Geriatric Neurosurgical Patients

Risk factors of delirium in elderly patients with hip fracture

Postoperative Delirium After Colorectal Surgery in Older Patients

Contact Info

Product

Resources

About