Efficacy of Intervention for Prevention of Postoperative Delirium after Spine Surgery

Abstract

Introduction Delirium after spine surgery is an important complication; identification of risk factors associated with postoperative delirium (PD) is essential for reducing its incidence. Prophylactic intervention for PD has been reported to be effective. This study aimed to identify risk factors for PD and determine the efficacy of a prevention program using a delirium risk scoring system for PD after spine surgery. Methods This study was conducted in two stages. First, 294 patients (167 males, 127 females) who underwent spine surgery from 2013 to 2014 were assessed to examine the incidence and risk factors of PD and to establish a novel PD screening tool (Group A). Second, preoperative intervention was performed on 265 patients who underwent surgery from 2016 to 2017 (Group B) for the purpose of preventing PD using a delirium risk scoring system. Outcomes, including PD incidence and rates of adverse events, were compared between Group A and Group B. Results A logistic regression analysis revealed that psychiatric disorders (odds ratio [OR] = 10.3, P < 0.001), benzodiazepine use (OR = 4.9, P < 0.001), age > 70 years (OR = 4.2, P < 0.001), hearing loss (OR = 3.7, P = 0.001), and admission to intensive care unit (ICU) (OR = 3.7, P = 0.006) were independent risk factors associated with PD. Based on these results, we established a novel delirium screening tool after spine surgery. PD incidence was significantly higher in Group A than in Group B (22% vs. 13%, P = 0.0008). The occurrence of dangerous behavioral symptoms was significantly higher in Group A than in Group B (66% vs. 40%, P = 0.02). The catheter problem tended to be higher in Group A than in Group B (19% vs. 9%, P = 0.245). Conclusions In this study, psychiatric disorders, benzodiazepine use, age > 70 years, hearing loss, and admission to ICU were independent risk factors associated with PD. With the introduction of the delirium risk score, the onset of delirium was delayed, and adverse outcomes of delirium were reduced.

Evidence‐based strategies to reduce the incidence of postoperative delirium: a narrative review

“…The patients and their families who received an individualised education session, critical care tour and information leaflet had a lower incidence of postoperative delirium compared with those patients receiving standard care (10% vs. 24%; p = 0.038) [27]. Similarly, multi‐component interventions for the prevention of delirium may include an educational facet [28]. The potential benefit of educational interventions is reflected in the recent expert consensus paper by Peden et al.…”

“…The strongest evidence for pharmacological delirium prevention involves medication avoidance, specifically benzodiazepines, with a two-to five-fold increased incidence of delirium in patients given peri-operative benzodiazepines [28,30].…”

“…This educational approach has been examined in 133 surgical patients without pre-existing cognitive impairment who had cardiac surgery using cardiopulmonary bypass. The patients and their families who received an individualised education session, critical care tour and information leaflet had a lower incidence of postoperative delirium compared with those patients receiving standard care (10% vs. 24%; p = 0.038)[27].Similarly, multi-component interventions for the prevention of delirium may include an educational facet[28]. The potential benefit of educational interventions is reflected in the recent expert consensus paper by Peden et al[29] This endorses offering patients and their families education about the risk of developing delirium, the risk of a delayed return to cognitive baseline and techniques to reduce delirium incidence.Pharmacological interventionsA review of strategies to prevent postoperative delirium would not be complete without a discussion of pharmacological interventions, despite the lack of conclusive evidence in support of pharmacological prophylaxis to prevent delirium.…”

Benzodiazepines and Related Drugs in Orthopaedics

“…In the elderly, benzodiazepines and z-drugs have been shown to increase the risk of hip fractures, which may be related to sedation, cognitive reduction, or impaired balance, or possibly to decreased bone density [35][36][37] . Studies have shown that patients with a history of benzodiazepine use were at a greater risk for delirium after hip fractures 38 , spine surgery 39 , or total joint arthroplasty 7 . In patients having total knee arthroplasty specifically, benzodiazepines can be associated with an increased risk of revision surgery, fractures, and delirium 40 .…”

Association between preoperative on‐site CCU visits and postoperative delirium in patients undergoing cardiac surgery: A retrospective cohort study

“…Secondly, it can help patients psychologically prepare for surgery. Through systematic and professional delirium 28 and that electroconvulsive therapy could also delay delirium. 29 However, the impact of preoperative visits on POD has yet to be investigated.…”