Early Diagnosis Of Postoperative Delirium In Patients Who Underwent General Surgery

Abstract

Objective: Postoperative delirium (POD) is a common postoperative complication. This study aimed to diagnose POD early primarily in patients who underwent General Surgery. This study also aimed to shorten the duration of hospital stays, prevent re-hospitalization after discharge and decrease the rates of morbidity/mortality through investigating the relationship with the characteristics of the patients/surgery/anesthesia in patients diagnosed with postoperative delirium in an early period. Material and Methods: Data of 303 patients at the age of 18 and above who were operated by General Surgery Clinic between March 2018 and May 2018, who were followed up by the Department of Anesthesiology and Reanimation for preoperative, intraoperative and postoperative periods and who received general anesthesia were included in the study.Patients’ demographic data, occupation, educational status, income level, additional diseases, ASA (American Society of Anesthesia) score, previous surgeries, history of a psychiatric or neurological disease, history of alcohol, cigarette, or drug use, and memory problems were recorded. Mini Mental State Examination (MMSE) was used to identify preoperative mental levels of the patients. Diagnosis of the patient, name, duration and features of the surgery to be performed, whether the surgery was urgent or elective, drugs used, type of catheterization (artery, central, foley or nasogastric), Hb value, intraoperative vital findings, and duration of postoperative discharge were recorded. The diagnosis of POD in patients was evaluated with Confusion Assessment Method (CAM). Results: POD developed in 2-6% (8 patients) of the patients. A significant relationship was recorded between the diagnosis of POD and age and additional diseases (ASA score). Results showed that the risk of delirium decreased as the education levels of the patients increased. A significant relationship was recorded between delirium and only midazolam among anesthetic agents used. A significant relationship was recorded among hypercarbia that developed during the surgery, invasive procedures, prolonged duration of surgery and hospitalizations in Intensive Care Units and Post-Anesthesia Care Units.Conclusion: The rate of POD (2.6%) and risk factors determined for POD within the first three days in our study were in compliance with literature. Diagnosing POD with CAM in an early postoperative period was advantageous. The treatment planning of the patients for POD could be done in the early period. By doing this, increase in mortality, morbidity and cost as a result of missing the diagnosis of POD was prevented.