Incidence of and risk factors for postoperative delirium in older adult patients undergoing noncardiac surgery: a prospective study

Abstract

Background: To identify the incidence of, risk factors for, and outcomes associated with postoperative delirium (POD) in older adult patients who underwent noncardiac surgery. Methods: This prospective study recruited patients aged ≥ 60 years who were scheduled to undergo noncardiac surgery at Siriraj Hospital (Bangkok, Thailand). Functional and cognitive statuses were assessed preoperatively using Barthel Index (BI) and the modified Informant Questionnaire on Cognitive Decline in the Elderly, respectively. POD was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition criteria. Incidence of POD was reported. Univariate and multivariate analyses were used to identify risk factors for POD. Results: Of the 249 included patients, 29 (11.6%) developed POD. Most patients (61.3%) developed delirium on postoperative day 1. Univariate analysis showed age ≥ 75 years, BI score ≤ 70, pre-existing dementia, preoperative use of opioid or benzodiazepine, preoperative infection, and hematocrit < 30% to be significantly associated with POD. Multivariate logistic analysis revealed pre-existing dementia (adjusted risk ratio [RR]: 3.95, 95% confidence interval [CI]: 1.91-8.17; p < 0.001) and age ≥ 75 years (adjusted RR: 2.54, 95% CI: 1.11-5.80; p = 0.027) to be independent risk factors for POD. Median length of hospital stay was 10 (range: 3-36) days for patients with POD versus 6 (range: 2-76) days for those without delirium (p < 0.001). Conclusions: POD remains a common surgical complication, with an incidence of 11.6%. Patients with pre-existing dementia and age ≥ 75 years are the most vulnerable high-risk group. A multidisciplinary team consisting of anesthesiologists and geriatricians should implement perioperative care to prevent and manage POD.

Critical clinical situations in adult patients with Mucopolysaccharidoses (MPS)

“…Postoperative delirium is associated with a poor prognosis, and has been associated with baseline cognitive function, and cardiac and emergency surgeries, so it should be kept in mind when monitoring adult MPS patients post-surgery (41). Postoperative cognition may also be affected by the use of some sedatives (42), analgesia in some populations (43), dehydration (44), preoperative infection (45), and some AEDs (46). In MPS additional care should be taken to ensure that the patient is appropriately assessed, and that post-operative cognitive changes do not impact further on any pre-existing neurocognitive deficits.…”

Effects of electroencephalography and regional cerebral oxygen saturation monitoring on perioperative neurocognitive disorders: a systematic review and meta-analysis

“…Its incidence rate ranges from 10 to 50% in general population. In high-risk patients, the incidence rate could reach as high as 50-70% [2][3][4]. PND is associated with several poor prognosis, such as higher mortality, long-term cognitive decline, dementia, re-admission and prolonged length of hospitalization.…”

Critical clinical situations in adult patients with Mucopolysaccharidoses (MPS)

“…Postoperative delirium is associated with a poor prognosis, and has been associated with baseline cognitive function, and cardiac and emergency surgeries, so it should be kept in mind when monitoring adult MPS patients post-surgery [41]. Postoperative cognition may also be affected by the use of some sedatives [42], analgesia in some populations [43], dehydration [44], preoperative infection [45], and some AEDs [46]. In MPS additional care should be taken to ensure that the patient is appropriately assessed, and that post-operative cognitive changes do not impact further on any preexisting neurocognitive deficits.…”