Incidence and Risk Factors of Acute Postoperative Delirium in Geriatric Neurosurgical Patients

Abstract

Objective : Postoperative delirium (POD) is characterized by an acute change in cognitive function and can result in longer hospital stays, higher morbidity rates, and more frequent discharges to long-term care facilities. In this study, we investigated the incidence and risk factors of POD in 224 patients older than 70 years of age, who had undergone a neurosurgical operation in the last two years. Methods : Data related to preoperative factors (male gender, >70 years, previous dementia or delirium, alcohol abuse, serum levels of sodium, potassium and glucose, and co-morbidities), perioperative factors (type of surgery and anesthesia, and duration of surgery) and postoperative data (length of stay in recovery room, severity of pain and use of opioid analgesics) were retrospectively collected and statistically analyzed. Results : POD appeared in 48 patients (21.4%) by postoperative day 3. When we excluded 26 patients with previous dementia or delirium, 17 spontaneously recovered by postoperative day 14, while 5 patients recovered by postoperative 2 months with medication, among 22 patients with newly developed POD. The univariate risk factors for POD included previously dementic or delirious patients, abnormal preoperative serum glucose level, pre-existent diabetes, the use of local anesthesia for the operation, longer operation time (>3.2 hr) or recovery room stay (>90 min), and severe pain (VAS>6.8) requiring opioid treatment (p<0.05). Backward regression analysis revealed that previously dementic patients with diabetes, the operation being performed under local anesthesia, and severe postoperative pain treated with opioids were independent risk factors for POD. Conclusion : Our study shows that control of blood glucose levels and management of pain during local anesthesia and in the immediate postoperative period can reduce unexpected POD and help preventing unexpected medicolegal problems and economic burdens.

Risk Factors for Postoperative Delirium in Abdominal Surgery: A Proposal of a Postoperative Delirium Risk Score in Abdominal Surgery

“…To test this hypothesis, further basic and clinical research is 101 necessary. A low serum Na level has also been associated with the incidence of delirium in a few reports [22][23][24] . In this study, the serum Na levels on POD 3 were significantly lower in the high-risk group compared to the low-risk group.…”

Avaliação da eficácia de bupivacaína embebida em Gelfoam® no local do enxerto ósseo de crista ilíaca

“…Opioids also have a profound effect on cognitive ability. Administering smaller dosages of opioids in the geriatric population may theoretically decrease the incidence of mental status changes and may improve their rehabilitation 12 . Local anesthetic usage at the ICBG site can decrease these complications; however, this will require further prospective studies.…”

The Effects of Intrathecal Fentanyl on Sedation Depth and Postoperative Recovery Room Delirium

“…Apart from surgery, other risk factors have been defined as previously impaired cognitive state, psychotropic medications, impaired functional status and sensory failure, opioids uses, high amount of intraoperative blood loss, high amount of postoperative blood transfusion [20,21], inadequate postoperative pain control and high pain scores (VAS > 4) [20,21], and abnormal levels of serum electrolytes [22]. Preoperative fluid deficiency and dehydration have been shown to be risk factors for postoperative delirium [23,24].…”

“…The intraoperative infusion rate was adjusted for the BIS to be 70-85. After starting the propofol infusion, the haemodynamic values (MAP, HR) and SpO 2 were recorded and at 1,5,10,20,30,40,50,60,75,90,105,120, and 135 minutes. The BIS levels were measured together with the propofol infusion at 5, 10, 20, 30, 40, 50, 60, 75, 90, 105, 120, and 135 minutes.…”