Evaluation of the 3-Minute Diagnostic Confusion Assessment Method for Identification of Postoperative Delirium in Older Patients

Oberhaus, Jordan; Wang, Wei; Mickle, Angela; Becker, J. M.; Tedeschi, Catherine; Maybrier, Hannah; Upadhyayula, Ravi T.; Muench, Maxwell; Lin, Nan; Schmitt, Eva M.; Inouye, Sharon K.; Avidan, Michael S.

doi:10.1001/jamanetworkopen.2021.37267

Cited by 7 publications

(6 citation statements)

References 30 publications

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“…All participants received standardized perioperative care determined by their clinical treatment teams. Trained clinical research coordinators performed Confusion Assessment of Measurement (CAM) 16 , 17 in the participants on postoperative day 1 and/or 2 between 8:00 am and 12:00 noon to assess POD. Study participants who were diagnosed of POD for at least 1 of the 2 days were in the POD group, those who did not meet diagnosis for POD on either postoperative days were in the No-POD group.…”

Section: Methodsmentioning

confidence: 99%

Indole-3-Propionic acid, A Gut Microbiota Metabolite, Protects Against the Development of Postoperative Delirium

Zhou¹,

Wu²,

Wu³

et al. 2023

Annals of Surgery

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Objective: The aim was to determine preoperative gut microbiota metabolites that may be associated with postoperative delirium (POD) development in patients and further study in rodents. Summary Background Data: POD occurs in 9% to 50% of older patients undergoing anesthesia/surgery but lacks effective treatments or prevention. High-throughput metabolomics using liquid chromatography with tandem mass spectrometry has accelerated disease-related biomarkers discovery. We performed metabolomic studies in humans to identify potential metabolite biomarkers linked to POD and examined potential mechanisms in rodents. Methods: We performed a prospective observational cohort study to examine the metabolomic changes that were associated with the development of POD. Then the gut microbiota-related metabolomic changes were recapitulated by gut microbiota perturbation in rodents. POD was assessed in mice using a battery of behavioral tests including novel objective test, Y-maze test, open-field test, and buried food test. The mechanisms through which gut microbiota-related metabolomic changes influenced POD were examined using chemogenetics. Results: Indole-3-propionic acid (IPA) is a gut microbiota metabolite that belongs to the indole family. Baseline plasma levels of IPA were significantly inversely correlated with the onset of POD in 103 (17 cases) human individuals. This relationship was validated in preclinical mouse models for POD: reducing IPA levels through gut microbiota perturbation promoted POD-like behavior. More importantly, IPA administration deterred POD-like behavior. Colonization of germ-free mice with mutant Clostridium sporogenes that did not produce IPA-promoted POD-like behavior. Chemogenetic studies revealed that the protective effect of IPA in mice was mediated, in part, by peroxisome proliferator-activated receptor gamma coactivator 1-alpha in hippocampal interneurons. Conclusions: Gut microbiota-derived IPA is an important molecule implicated in the pathogenesis of POD, which could potentially be harnessed for POD prevention.

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Section: Methodsmentioning

confidence: 99%

Indole-3-Propionic acid, A Gut Microbiota Metabolite, Protects Against the Development of Postoperative Delirium

Zhou¹,

Wu²,

Wu³

et al. 2023

Annals of Surgery

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“…), self-study of instructional materials, and completion of graded 3D-CAM assessments for videotaped, simulated patient encounters. 30 Reinforcement of best practices occurred via quarterly all-staff calls.…”

Section: Discussionmentioning

confidence: 99%

“…Site staff were certified on 3D‐CAM administration by the study coordinating center prior to collecting study data; training included a 90‐min in‐person instructional session led by one co‐investigator (E.R.M. ), self‐study of instructional materials, and completion of graded 3D‐CAM assessments for videotaped, simulated patient encounters 30 . Reinforcement of best practices occurred via quarterly all‐staff calls.…”

Section: Methodsmentioning

confidence: 99%

Outcomes with spinal versus general anesthesia for patients with and without preoperative cognitive impairment: Secondary analysis of a randomized clinical trial

O'Brien

Feng

Sieber

et al. 2023

Alzheimer's & Dementia

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INTRODUCTIONThe effect of spinal versus general anesthesia on the risk of postoperative delirium or other outcomes for patients with or without cognitive impairment (including dementia) is unknown.METHODSPost hoc secondary analysis of a multicenter pragmatic trial comparing spinal versus general anesthesia for adults aged 50 years or older undergoing hip fracture surgery.RESULTSAmong patients randomized to spinal versus general anesthesia, new or worsened delirium occurred in 100/295 (33.9%) versus 107/283 (37.8%; odds ratio [OR] 0.85; 95% confidence interval [CI] 0.60 to 1.19) among persons with cognitive impairment and 70/432 (16.2%) versus 71/445 (16.0%) among persons without cognitive impairment (OR 1.02; 95% CI 0.71 to 1.47, p = 0.46 for interaction). Delirium severity, in‐hospital complications, and 60‐day functional recovery did not differ by anesthesia type in patients with or without cognitive impairment.DISCUSSIONAnesthesia type is not associated with differences in delirium and functional outcomes among persons with or without cognitive impairment.

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“…The duration of the fascia iliaca block varies depending on the administration technique and ranges from 8 hours to a median of 48 hours 14. The Confusion Assessment Method (CAM) tool was used by nursing once each 12-hour shift to assess for postoperative delirium 15–17. GPP patients had a geriatric specialized nurse practitioner (NP) after care and daily rounds attended by the hospitalist, geriatric NP, primary registered nurse, pharmacist, and case manager.…”

Section: Methodsmentioning

confidence: 99%

Geriatric Pain Protocol: Impact of Multimodal Pain Care for Elderly Orthopedic Trauma Patients

Andujo,

Yue,

McKelvey

et al. 2024

Topics in Pain Management

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Hip fractures are costly, and associated complications are the leading cause of injury-related deaths in persons 65 years or older. Uncontrolled pain leads to increased hospital length of stay (LOS), delayed physical therapy, and long-term functional impairment. The Geriatric Pain Protocol (GPP) is Cedars-Sinai's multimodal pain management solution, addressing the needs of older adult inpatients who have suffered fractures. Study participants included hip fracture patients admitted between February 1, 2019, and March 5, 2021. Inclusion criteria were patients 65 years or older with a hip fracture sustained from a ground-level fall and surgical candidate. Participants were divided into 2 categories: Geriatric Fracture Program (GFP) and non-GFP, with physician participation in the GFP being the differentiating factor. End points included postoperative pain, postoperative opioid utilization, LOS, complications, and 30-day readmission rates. The GPP decreased morphine milligram equivalent (MME) daily totals on days 1 and 2 and improved pain management compared with non-GPP patients. MMEs were lower in the GPP group than in the non-GPP group for both postoperative day 1 (POD1) (P = 0.007) and POD2 (P = 0.043); the Numerical Rating Scale (NRS) pain score on POD1 was lower in the GPP group (vs non-GPP, P = 0.013). There were no group differences in NRS POD2 pain or complications (all Ps > 0.1). The study sample (N = 453) had no significant difference between sex and LOS (all Ps > 0.3). Although not statistically significant, the 30-day readmission rate trended lower in patients treated in accordance with the GPP. Use of the GPP reduced pain levels and MME totals.

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Evaluation of the 3-Minute Diagnostic Confusion Assessment Method for Identification of Postoperative Delirium in Older Patients

Cited by 7 publications

References 30 publications

Indole-3-Propionic acid, A Gut Microbiota Metabolite, Protects Against the Development of Postoperative Delirium

Indole-3-Propionic acid, A Gut Microbiota Metabolite, Protects Against the Development of Postoperative Delirium

Outcomes with spinal versus general anesthesia for patients with and without preoperative cognitive impairment: Secondary analysis of a randomized clinical trial

Geriatric Pain Protocol: Impact of Multimodal Pain Care for Elderly Orthopedic Trauma Patients

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