Anesthesia and Postoperative Delirium in Older Adults Undergoing Hip Surgery

Slor, Chantal J.; Jonghe, Jos F. M. de; Vreeswijk, Ralph; Groot, Erwin R.; Ploeg, Tjeerd van der; Gool, Willem A. van; Eikelenboom, Piet; Snoeck, M.M.J.; Schmand, Ben; Kalisvaart, Kees J.

doi:10.1111/j.1532-5415.2011.03452.x

Cited by 48 publications

(43 citation statements)

References 32 publications

(43 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although previous studies report a better outcome for patients who are operated under spinal analgesia [23,24], a more recent study did not show a difference in delirium risk for patients who were operated under regional or general anesthesia [25]. In this study there was no association between type of anesthesia and complications or mortality either.…”

Section: Discussioncontrasting

confidence: 77%

The development of a comprehensive multidisciplinary care pathway for patients with a hip fracture: design and results of a clinical trial

Flikweert

Izaks

Knobben

et al. 2014

BMC Musculoskelet Disord

View full text Add to dashboard Cite

BackgroundHip fractures frequently occur in older persons and severely decrease life expectancy and independence. Several care pathways have been developed to lower the risk of negative outcomes but most pathways are limited to only one aspect of care. The aim of this study was therefore to develop a comprehensive care pathway for older persons with a hip fracture and to conduct a preliminary analysis of its effect.MethodsA comprehensive multidisciplinary care pathway for patients aged 60 years or older with a hip fracture was developed by a multidisciplinary team. The new care pathway was evaluated in a clinical trial with historical controls. The data of the intervention group were collected prospectively. The intervention group included all patients with a hip fracture who were admitted to University Medical Center Groningen between 1 July 2009 and 1 July 2011. The data of the control group were collected retrospectively. The control group comprised all patients with a hip fracture who were admitted between 1 January 2006 and 1 January 2008. The groups were compared with the independent sample t-test, the Mann–Whitney U-test or the Chi-squared test (Phi test). The effect of the intervention on fasting time and length of stay was adjusted by linear regression analysis for differences between the intervention and control group.ResultsThe intervention group included 256 persons (women, 68%; mean age (SD), 78 (9) years) and the control group 145 persons (women, 72%; mean age (SD), 80 (10) years). Median preoperative fasting time and median length of hospital stay were significantly lower in the intervention group: 9 vs. 17 hours (p < 0.001), and 7 vs. 11 days (p < 0.001), respectively. A similar result was found after adjustment for age, gender, living condition and American Society of Anesthesiologists (ASA) classification. In-hospital mortality was also lower in the intervention group: 2% vs. 6% (p < 0.05). There were no statistically significant differences in other outcome measures.ConclusionsThe new comprehensive care pathway was associated with a significant decrease in preoperative fasting time and length of hospital stay.

show abstract

Section: Discussioncontrasting

confidence: 77%

The development of a comprehensive multidisciplinary care pathway for patients with a hip fracture: design and results of a clinical trial

Flikweert

Izaks

Knobben

et al. 2014

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…91 However, a recent meta-analysis did not find an increased risk of general versus regional anaesthesia for POD, 92 and a recent large prospective cohort study of elderly patients undergoing hip surgery did not find an independent association between benzodiazepines, opioids, anticholinergics or general anaesthetics (vs. regional) and POD. 93 With regard to specific general anaesthetic agents, no difference in POD or long-term cognitive dysfunction (3 months) was found between desflurane and propofol, but patients anaesthetized with propofol had a higher incidence of early cognitive dysfunction (days 3–7). 94 In a small prospective study of cardiac surgery patients, sevoflurane was associated with worse early (day 3 and 6) neurocognitive function and higher S100 beta protein (a marker of brain injury) than either isoflurane or desflurane.…”

Section: Risk Factors For Podmentioning

confidence: 91%

Epidemiology and risk factors for delirium across hospital settings

Vasilevskis

Han

Hughes

et al. 2012

Best Practice & Research Clinical Anaesthesiology

296

221

View full text Add to dashboard Cite

Delirium is one of the most common causes of acute end-organ dysfunction across hospital settings, occurring in as high as 80% of critically ill patients that require intensive care unit (ICU) care. The implications of this acute form of brain injury are profound. Across many hospital settings (emergency department, general medical ward, postoperative and ICU), a patient who experiences delirium is more likely to experience increased short- and long-term mortality, decreases in long-term cognitive function, increases in hospital length of stay and increased complications of hospital care. With the development of reliable setting-specific delirium-screening instruments, researchers have been able to highlight the predisposing and potentially modifiable risk factors that place patients at highest risk. Among the large number of risk factors discovered, administration of potent sedative medications, most notably benzodiazepines, is most consistently and strongly associated with an increased burden of delirium. Alternatively, in both the hospital and ICU, delirium can be prevented with the application of protocols that include early mobility/exercise. Future studies must work to understand the epidemiology across settings and focus upon modifiable risk factors that can be integrated into existing delirium prevention and treatment protocols.

show abstract

“…A high incidence of delirium is seen in older patients undergoing surgery for hip fracture. Contrary to popular belief, there is little evidence that general anesthesia is associated with delirium after surgery [66]. The most important predisposing factor for delirium in these patients is preexisting cognitive decline or dementia.…”

Section: Clinical Evidencementioning

confidence: 97%

Whether, when and how chronic inflammation increases the risk of developing late-onset Alzheimer's disease

Eikelenboom

Hoozemans

Veerhuis

et al. 2012

Alzheimer's Research & Therapy

Self Cite

View full text Add to dashboard Cite

Neuropathological studies have revealed the presence of a broad variety of inflammation-related proteins (complement factors, acute-phase proteins, pro-inflammatory cytokines) in Alzheimer's disease (AD) brains. These constituents of innate immunity are involved in several crucial pathogenic events of the underlying pathological cascade in AD, and recent studies have shown that innate immunity is involved in the etiology of late-onset AD. Genome-wide association studies have demonstrated gene loci that are linked to the complement system. Neuropathological and experimental studies indicate that fibrillar amyloid-β (Aβ) can activate the innate immunity-related CD14 and Toll-like receptor signaling pathways of glial cells for pro-inflammatory cytokine production. The production capacity of this pathway is under genetic control and offspring with a parental history of late-onset AD have a higher production capacity for pro-inflammatory cytokines. The activation of microglia by fibrillar Aβ deposits in the early preclinical stages of AD can make the brain susceptible later on for a second immune challenge leading to enhanced production of pro-inflammatory cytokines. An example of a second immune challenge could be systemic inflammation in patients with preclinical AD. Prospective epidemiological studies show that elevated serum levels of acute phase reactants can be considered as a risk factor for AD. Clinical studies suggest that peripheral inflammation increases the risk of dementia, especially in patients with preexistent cognitive impairment, and accelerates further deterioration in demented patients. The view that peripheral inflammation can increase the risk of dementia in older people provides scope for prevention.

show abstract

Anesthesia and Postoperative Delirium in Older Adults Undergoing Hip Surgery

Cited by 48 publications

References 32 publications

The development of a comprehensive multidisciplinary care pathway for patients with a hip fracture: design and results of a clinical trial

The development of a comprehensive multidisciplinary care pathway for patients with a hip fracture: design and results of a clinical trial

Epidemiology and risk factors for delirium across hospital settings

Whether, when and how chronic inflammation increases the risk of developing late-onset Alzheimer's disease

Contact Info

Product

Resources

About