Delirium in fast-track colonic surgery

Kurbegovic, Sorel; Andersen, Jens T.; Krenk, Lene; Kehlet, Henrik

doi:10.1007/s00423-015-1297-8

Cited by 22 publications

(8 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The observed 21% occurrence of ED and 9% occurrence of POD during the first four postoperative days for our entire cohort is similar to the overall 5%–30% findings of ED/POD from recent specific studies in liver resection 4 . Our findings are based on a well‐implemented ERAS liver resection program 6 but contrast with reports of POD after other ERAS procedures with a low occurrence of less than 3% 25,26 . This can potentially be explained by the use of the more sensitive 3D‐CAM assessment tool, especially for hypoactive delirium.…”

Section: Discussioncontrasting

confidence: 88%

High‐dose preoperative glucocorticoid for prevention of emergence and postoperative delirium in liver resection: A double‐blinded randomized clinical trial substudy

Awada

Steinthorsdottir

Schultz

et al. 2022

Acta Anaesthesiol Scand

Self Cite

View full text Add to dashboard Cite

Background: Emergence delirium (ED) and postoperative delirium (POD) are associated with increased morbidity and mortality and occur in up to one-third of patients undergoing major non-cardiac surgery, where the underlying pathogenesis is multifactorial, including increased inflammation. We aimed to assess the effect of preoperative high-versus low-dose glucocorticoid on the occurrence of ED and POD. Methods: This was a substudy from a randomized, double-blinded clinical trial. Patients ≥18 years, undergoing open liver resection were randomized 1:1 to high-dose (HD, 10 mg/kg methylprednisolone) or low-dose (LD, 8 mg dexamethasone) glucocorticoid and assessed for ED and POD for a maximum of 4 days during hospitalization. The 3-min Diagnostic Interview for CAM-defined delirium (3D-CAM) was used for assessment, 15 and 90 min after arrival in the post-anesthesia care unit (PACU), and subsequently once daily in the ward. Results: Fifty-three patients were included in this secondary substudy (26 HD-group and 27 LD-group). ED occurred in n = 5 HD versus n = 6 LD patients 15 min after PACU arrival. At 90 min after PACU arrival, 4 patients had ED, all from LD-group, and resulted in significantly longer PACU admission, 273 versus 178 min in ED versus Non-ED patients. During the first 4 days in the ward, n = 5 patients had at least one occurrence of POD, all from LD-group. Conclusions:The primary finding of the current substudy was a lower occurrence of ED/POD in the PACU 90 min after arrival and during the first four postoperative days in patients receiving high-dose glucocorticoid compared with patients receiving low-dose glucocorticoid. The two study groups were not evenly balanced concerning known explanatory factors, i.e., age and size of surgery, which calls for larger studies to elucidate the matter.

show abstract

Section: Discussioncontrasting

confidence: 88%

High‐dose preoperative glucocorticoid for prevention of emergence and postoperative delirium in liver resection: A double‐blinded randomized clinical trial substudy

Awada

Steinthorsdottir

Schultz

et al. 2022

Acta Anaesthesiol Scand

Self Cite

View full text Add to dashboard Cite

show abstract

“…Interestingly, the postoperative complication rate was 26%, lower than the rates reported in the other procedure-specific studies [ 13 , 32 , 33 ]. The present findings confirmed the effectiveness of FTS in accelerating patient recovery and home discharge, even in vulnerable oncogeriatric patients.…”

Section: Discussioncontrasting

confidence: 63%

“…Moreover, the fast-track setup in colonic oncogeriatric surgery was correlated with a shorter length of hospital stay and reduced incidence of POD (2.8%) [ 32 ]. Recently, a subanalysis of the randomized clinical trial of Jia et al [ 13 ] on patients over 80 years has indicated the protective role of FTS on postoperative complications, including delirium, in both elderly and oldest old patients [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…In relation to these other studies, the heterogeneity associated with elderly populations and delirium assessment methodology may account for the wide range of these reported series. In particular, the findings of Kurbegovic et al[ 32 ] were retrospective in nature, and there was no systematic geriatric assessment of patients’ clinical vulnerability. Similarly, the study of Jia et al [ 13 ], despite the lower incidence of POD (3.4%) in patients submitted to FTS, did not include focused geriatric assessment of frailty.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Delirium, Frailty, and Fast-Track Surgery in Oncogeriatrics: Is There a Link?

Monacelli

Signori

Prefumo

et al. 2018

Dement Geriatr Cogn Disord Extra

View full text Add to dashboard Cite

Background/Aims: Postoperative delirium (POD) is more frequent in elderly patients undergoing major cancer surgery. The interplay between individual clinical vulnerability and a series of perioperative factors seems to play a relevant role. Surgery is the first-line treatment option for cancer, and fast-track surgery (FTS) has been documented to decrease postoperative complications. The study sought to assess, after comprehensive geriatric assessment (CGA) and frailty stratification (Rockwood 40 items index), which perioperative parameters were predictive of POD development in elderly patients undergoing FTS for colorectal cancer. Methods: A total of 107 consecutive subjects admitted for elective colorectal FTS were enrolled. All patients underwent CGA, frailly stratification, Timed up & go (TUG) test, 4AT test for delirium screening, anesthesiologists physical status classification, and Dindo-Clavien classification. Results: The incidence of POD was 12.3%. Patients’ prevalent clinical phenotype was pre-frail. The multivariate analysis indicated physical performance (TUG in seconds) as the most significant predictor of POD for each second of increase. Conclusions: Only few procedure-specific studies have examined the impact of FTS for colorectal cancer on POD. This is the first study to investigate the risk factors for POD, in a vulnerable octogenarian oncogeriatric population submitted to FTS surgery and frailty stratification.

show abstract

“…We believe that preventive measures and early detection with appropriate management for delirium would lead to a decrease in the incidence of delirium. The implementation of enhanced recovery strategies after surgery will be one of the helpful concepts [47,48] . In addition, further determination of the optimal cutoff value of the CACI score as suggested in this study may help in early detection as well.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Delirium in Patients after Pancreaticoduodenectomy

Ito¹,

Abe

Handa³

et al. 2016

Dig Surg

View full text Add to dashboard Cite

Background/Aims: Postoperative delirium (POD) is one of the most common complications after various types of surgery. The aim of this study was to investigate the incidence and risk factors for delirium after pancreaticoduodenectomy (PD). Methods: This was a retrospective study of 146 consecutive patients who underwent PD between April 2007 and June 2015 at Saiseikai Yokohamashi Tobu Hospital. Results: Twenty-nine patients (19.9%) were diagnosed with delirium. Patients who were >70 years were divided into a delirium group (n = 24) and a non-delirium group (n = 41). Multivariate analysis showed that only the Charlson Age Comorbidity Index (CACI) (OR 1.8; 95% CI 1.067-3.036; p = 0.028) was an independent risk factor of delirium for patients >70 years. The receiver operating characteristic curve revealed an optimal cutoff value of 4.5 for the CACI score in all patients (sensitivity 62.1%; specificity 82.9%; area under the curve 0.782). The higher CACI score (≥5) is significantly different from the lower CACI score (p < 0.0001) with respect to POD occurrence. Conclusions: The CACI, especially in elderly patients, was associated with the incidence of POD. Therefore, utilizing this validated and practical tool preoperatively might be useful for POD.

show abstract

Delirium in fast-track colonic surgery

Abstract: These data support that an enhanced postoperative recovery program may decrease the risk and duration of PD after colonic surgery.

Cited by 22 publications

References 17 publications

High‐dose preoperative glucocorticoid for prevention of emergence and postoperative delirium in liver resection: A double‐blinded randomized clinical trial substudy

High‐dose preoperative glucocorticoid for prevention of emergence and postoperative delirium in liver resection: A double‐blinded randomized clinical trial substudy

Delirium, Frailty, and Fast-Track Surgery in Oncogeriatrics: Is There a Link?

Postoperative Delirium in Patients after Pancreaticoduodenectomy

Contact Info

Product

Resources

About