Malnutrition is not related with emergence delirium in older patients after noncardiac surgery

Abstract

Background Delirium is one of the most common complications in older surgical patients. Although previous studies reported that preoperative malnutrition was related with postoperative delirium (POD), there was lack of evidence to illustrate the relationship between malnutrition and emergency delirium (ED). The objective of this study was to investigate the relationship between preoperative malnutrition and ED in older patients undergoing noncardiac surgery. Methods The study was carried out in accordance with STROBE guidelines. This was a secondary analysis of a prospective cohort study. Older patients (65–90 years) who underwent noncardiac surgery under general anesthesia were enrolled in Peking University First Hospital. Results 915 patients were enrolled. The incidence of malnutrition was 53.6 % (490/915). The incidence of emergency delirium was 41.8 % (205/490) in malnutrition group and 31.5 % (134/425) in control group, P < 0.001. After adjusting confounding factors (i.e., age, cognitive impairment, American Society of Anesthesiologists classification (ASA), duration of surgery, pain score, low body temperature and allogeneic blood transfusion), malnutrition was not associated with increased risk of emergency delirium (OR = 1.055, 95 % CI 0.767–1.452, P = 0.742). Conclusions Malnutrition was common in older patients undergoing non-cardiac surgery, but it’s not related with emergence delirium after adjusted for confounders. Trial registration Chinese Clinical Trial Registry (http://www.chictr.org.cn) (ChiCTR-OOC-17,012,734).

Predisposing and Precipitating Factors Associated With Delirium

“…Studies were conducted in 40 different countries, with the plurality in the United States (86 studies [27.3%]), followed by China (48 studies [15.2%]) and the Netherlands (24 studies [7.6%]). Most studies were prospective cohort studies (296 studies…”

“…A list of included studies with number of participants and NOS score is included in eTable in Supplement 1). There were 138 studies (43.8%) that excluded participants due to a language barrier (participants were excluded if they did not speak the same language that delirium assessors used).…”

“…A total of 33 predisposing factors were identified. Advanced age and cognitive impairment or dementia were identified in the most studies and participants; 112 studies with 50 418 participants (among whom 9147 patients had delirium) identified age and 130 studies with 42 124 participants (among whom 9617 patients had delirium) identified cognitive impairment or dementia as factors. The following predisposing factors were variably defined across studies: functional impairment, cardiovascular disease, central nervous system disorders, and psychiatric disorders.…”

Predictive value of the geriatric nutrition risk index for postoperative delirium in elderly patients undergoing cardiac surgery

“…14,15,17 However, a recent study revealed contradictory findings. 16 In their multivariate logistic analysis, Zhang et al 16 determined that malnutrition was not associated with POD. The inconsistent findings may be partly explained by the variability in the types of surgeries and malnutrition screening tools that they employed.…”

“…Some studies have suggested that malnutrition may be a risk factor for POD, but the evidence is inconclusive 14–17 . Malnutrition is common among the elderly, especially those hospitalized or with a chronic illness 18,19 .…”