Postoperative Course After Emergency Colorectal Surgery for Secondary Peritonitis in the Elderly Is Often Complicated by Delirium

Abstract

Postoperative delirium, morbidity, and mortality in our elderly patients with secondary perionitis of colorectal origin is described. This is a chart-based retrospective analysis of 63 patients who were operated on at the University Hospital Basel from April 2001 to May 2004. Postoperative delirium occurred in 33%. Overall morbidity was 71.4%. Surgery-related morbidity was 43.4%. Mortality was 14.4%. There was no statistical significance between delirium, morbidity and mortality (P = 0.279 and P = 0.364). There was no statistically significant correlation between the analyzed scores (American Society of Anesthesiologists classification, Mannheimer Peritonitis Index, Acute Physiology and Chronic Health Evaluation score II, physiological and operative surgical severity and enumeration of morbidity and mortality score' or short 'cr-POSSUM') and postoperative delirium, morbidity or mortality. Postoperative delirium occurred in one-third of the patients, who seem to have a trend to higher morbidity. Even if the different scores already had proven to be predictive in terms of morbidity and mortality, they do not help the risk stratification of postoperative delirium, morbidity, or mortality in our collective population.

Postoperative delirium in elderly after elective and acute colorectal surgery: A prospective cohort study

“…Ansaloni et al reported a lower incidence of delirium (18%) after acute surgery whilst other reported delirium rates in 33% in elderly patients (>70 years) with secondary peritonitis [12,23]. The wide range in these reported series may be explained by variations in included patient populations and the application of other diagnostic tools and procedure.…”

“…Older patients undergoing acute abdominal surgery are also at risk for postoperative delirium [12]. However, to our knowledge the incidence of postoperative delirium and the associated morbidity and mortality after emergency colon surgery in the elderly has not been reported yet.…”

Emergency Surgery and Male Gender Are Risk Factors of Postoperative Delirium After General or Gastrointestinal Surgery in Elderly Patients: A Multicenter Cohort Study

“…Postoperative delirium (PD) is an acute, fluctuating disorder of attention and cognition [1]. It is one of the most common serious postoperative complications in elderly patients, with a reported incidence of 9.0-13.2% in gastrointestinal and general surgery [2][3][4][5], 33% in colorectal emergency surgery [6], 9.1-28.6% in orthopedic surgery [7][8][9], and 23.0-32.0% in cardiovascular surgery [10,11]. In addition to being subjectively uncomfortable, PD is associated with accidental removal of drains or catheters, worsened treatment compliance, exhaustion of medical staff, and medical accidents such as falls.…”

“…PD is also associated with impaired treatment outcomes, including impaired activities of daily living [7], prolonged hospitalization [2,3,5] and intensive care unit stays [2], elevated morbidity [2,3,6] and mortality [9,12,13] and increased hospital costs [2].…”

Incidence and predictors of postoperative delirium in the older acute care surgery population: a prospective study

“…6 The incidence of delirium has been noted to be as high as 60% in all inpatients and 7%−35% within the general surgery population. [6][7][8][9][10][11] The consequences of delirium result in substantial health care expenditure owing to a prolonged hospital stay and increased disability, necessitating escalated levels of care at discharge. [12][13][14][15] Delirium is also associated with increased mortality rates during the hospital stay and substantially increased overall 6-month and 1-year mortality rates.…”