Environmental and Clinical Risk Factors for Delirium in a Neurosurgical Center: A Prospective Study

Matano, Fumihiro; Mizunari, Takayuki; Yamada, Kazutaka; Kobayashi, Shiro; Murai, Yasuo; Morita, Akio

doi:10.1016/j.wneu.2017.03.139

Cited by 25 publications

(33 citation statements)

References 38 publications

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“…Pooled analysis of studies which did not report frequency of delirium assessment resulted in an incidence of 18.0% (N = 2746; 0.18; CI 0.11-0.25), [5,7,9,11,23 [10,[46][47][48]53] in case of screening twice per day and 5.0% (n p = 958; 0.05; CI 0.00-0.28) [8,32] in case of screening three times per day. Pooled analysis of studies assessing delirium during < 3 days resulted in an incidence of 18.0% (n p = 3775; 0.18; CI 0.12-0.24) [5,7,9,11,32…”

Section: Frequency and Follow-up Of Daily Delirium Assessmentmentioning

confidence: 99%

“…Two RCTs, seven prospective and eleven retrospective cohort studies were included. Disease type for patients undergoing intracranial surgery were categorized in mixed (33.9%, n p = 1478), [4,10,21,32,39,[41][42][43][44][45][46][47][48] functional neurosurgery (26.8%, n p = 552), [11,46,[49][50][51] neurovascular (10.5%, n p = 145), [52][53][54] neuro-oncology (18.4%, n p = 1969) [5,7,55], traumatic brain injury (TBI) (4.3%, n p = 27) [56,57] and microvascular decompression (MVD) (6.2%, n p = 912) [9]. The mixed group included neurovascular, neuro-oncologic, TBI or hydrocephalus operations and functional neurosurgery (solely deep brain stimulation (DBS) in patients with Parkinson's disease).…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

“…Therefore, reported incidences vary, especially in case of hypoactive delirium 6]. Delirium is considered a severe complication in other populations, being a traumatic experience for patients and contributing to prolonged hospital stay, higher risk for re-operation, mortality and cognitive decline [7][8][9][10]. These consequences of delirium led to increased research on delirium, including in the neurosurgical population [5,7,9,11].…”

Section: Introductionmentioning

confidence: 99%

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Delirium in neurosurgery: a systematic review and meta-analysis

et al. 2021

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Delirium is a frequent occurring complication in surgical patients. Nevertheless, a scientific work-up of the clinical relevance of delirium after intracranial surgery is lacking. We conducted a systematic review (CRD42020166656) to evaluate the current diagnostic work-up, incidence, risk factors and health outcomes of delirium in this population. Five databases (Embase, Medline, Web of Science, PsycINFO, Cochrane Central) were searched from inception through March 31st, 2021. Twenty-four studies (5589 patients) were included for qualitative analysis and twenty-one studies for quantitative analysis (5083 patients). Validated delirium screening tools were used in 70% of the studies, consisting of the Confusion Assessment Method (intensive care unit) (45%), Delirium Observation Screening Scale (5%), Intensive Care Delirium Screening Checklist (10%), Neelon and Champagne Confusion Scale (5%) and Nursing Delirium Screening Scale (5%). Incidence of post-operative delirium after intracranial surgery was 19%, ranging from 12 to 26% caused by variation in clinical features and delirium assessment methods. Meta-regression for age and gender did not show a correlation with delirium. We present an overview of risk factors and health outcomes associated with the onset of delirium. Our review highlights the need of future research on delirium in neurosurgery, which should focus on optimizing diagnosis and assessing prognostic significance and management.

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Section: Frequency and Follow-up Of Daily Delirium Assessmentmentioning

confidence: 99%

Section: Study and Patient Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Delirium in neurosurgery: a systematic review and meta-analysis

et al. 2021

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“…Incidence rates of postoperative delirium after intracranial surgery vary between 4% and 44% depending on the type of surgery, such as major neurovascular reporting higher incidence rates and method of delirium assessment, such as short follow-up duration resulting in lower incidence rates. 4–13 …”

Section: Introductionmentioning

confidence: 99%

Music to prevent deliriUm during neuroSurgerY (MUSYC) Clinical trial: a study protocol for a randomised controlled trial

et al. 2021

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IntroductionDelirium is a neurocognitive disorder characterised by an acute and temporary decline of mental status affecting attention, awareness, cognition, language and visuospatial ability. The underlying pathophysiology is driven by neuroinflammation and cellular oxidative stress.Delirium is a serious complication following neurosurgical procedures with a reported incidence varying between 4% and 44% and has been associated with increased length of hospital stay, increased amount of reoperations, increased costs and mortality.Perioperative music has been reported to reduce preoperative anxiety, postoperative pain and opioid usage, and attenuates stress response caused by surgery. We hypothesize that this beneficial effect of music on a combination of delirium eliciting factors might reduce delirium incidence following neurosurgery and subsequently improve clinical outcomes.MethodsThis protocol concerns a single-centred prospective randomised controlled trial with 6 months follow-up. All adult patients undergoing a craniotomy at the Erasmus Medical Center in Rotterdam are eligible. The music group will receive recorded music through an overear headphone before, during and after surgery until postoperative day 3. Patients can choose from music playlists, offered based on music importance questionnaires administered at baseline. The control group will receive standard of clinical careDelirium is assessed by the Delirium Observation Scale and confirmed by a delirium-expert psychiatrist according to the DSM-5 criteria. Risk factors correlated with the onset of delirium, such as cognitive function at baseline, preoperative anxiety, perioperative medication use, depth of anaesthesia and postoperative pain, and delirium-related health outcomes such as length of stay, daily function, quality of life (ie, EQ-5D, EORTC questionnaires), costs and cost-effectiveness are collected.Ethics and disseminationThis study is being conducted in accordance with the Declaration of Helsinki. The Medical Ethics Review Board of Erasmus University Medical Center Rotterdam, The Netherlands, approved this protocol. Results will be disseminated via peer-reviewed scientific journals and conference presentations.Trial registration numbersNL8503 and NCT04649450.

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“…Well known risk factors for POD include increased age, cognitive impairment, substance abuse, and many others [11] , [9] . These vulnerabilities interact with intra-, peri-, and post-operative factors to result in an acutely delirious state [12] , [13] , [5] . In particular, it has been proposed that there is a direct psychotropic effect of intracranial electrodes that contributes to POD [10] .…”

Section: Introductionmentioning

confidence: 99%