Effect of preoperative pain and depressive symptoms on the risk of postoperative delirium: a prospective cohort study

Abstract

Background Preoperative pain and depression predispose patients to delirium. Our goal was to determine whether pain and depressive symptoms interact to increase delirium risk. Methods We enrolled 459 persons without dementia aged ≥70 years scheduled for elective orthopedic surgery. At baseline, participants reported their worst and average pain within seven days and current pain on a 0–10 scale. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale and chart. Delirium was assessed with the Confusion Assessment Method and chart. We examined the relationship between preoperative pain, depressive symptoms and delirium using multivariable analysis of pain and delirium stratified by presence of depressive symptoms. Findings Delirium, occurring in 23% of the sample, was significantly higher in those with depressive symptoms at baseline than those without (relative risk, RR, 1·6, 95% confidence interval, CI, 1·2–2·3). Preoperative pain was associated with an increased adjusted risk for delirium across all pain measures (RR from 1·07–1·08 per point of pain). In stratified analyses, patients with depressive symptoms had a 21% increased risk for delirium for each one-point increase in worst pain score, demonstrating a significant interaction (P=0·049). Similarly, a significant 13% increased risk for delirium was demonstrated for a one-point increase in average pain score, but the interaction did not achieve statistical significance. Interpretation Preoperative pain and depressive symptoms demonstrated increased risk for delirium independently and with substantial interaction, suggesting a cumulative impact. Thus, pain and depression are vulnerability factors for delirium that should be assessed before surgery. Funding U.S. National Institute on Aging.

A personality trait contributes to the occurrence of postoperative delirium: a prospective study

“…This may be due to the fact that age in our inclusion criteria (aged ≥ 70) was relatively high and the variation of age was relatively small. Previous studies have also documented that pain or inadequate pain control is likely to increase the risk of delirium [49], whereas our study showed that the degree of pain and the following opioid medication were not associated with the occurrence of postoperative delirium.…”

Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial

“…However, this decrease is small and, therefore, unlikely to have clinical signifi cance. Nevertheless, pain itself is a risk factor for the development of delirium, 38 so a delirium-spari ng pharmacoprophylaxis would seem to be a better strategy than increasing putative delirium-enhancing analgesic drugs to combat postoperative pain.…”

Patients prone for postoperative delirium

“…Other clinically important factors identified in prospective studies were depression [28,29], preoperative pain [29], and the complex of sleep disordered breathing, including, among others, snoring, obstructive sleep apnea syndrome, and the upper airway resistance syndrome [30]. ApoE4, a marker of Alzheimer's disease, was no risk factor in surgical patients [31,32].…”