Postoperative Delirium

Abstract

Delirium is a global impairment of upper brain functions caused by an organic substrate. It is frequently observed in the postoperative period, particularly in elderly people. Vascular and orthopedic surgery and long-duration surgery are associated with a higher incidence of postoperative delirium. When it occurs, postoperative delirium makes patient management much more difficult, increases costs, and, above all, causes severe discomfort to the patient. Delirium is also associated with higher postoperative mortality and morbidity, and with delayed functional recovery, but it is still unclear whether worse prognosis is directly caused by delirium or results from the neurological damage of which delirium is simply a symptom. Drug therapy should be part of a complex approach to prevent and treat this complication. Neuroleptics like haloperidol and droperidol, and benzodiazepines are usually employed in order to control symptoms like agitation, restlessness, and altered perceptions. Atypical neuroleptics, like risperidone, have not yet been studied in postoperative delirium, although some case reports in which they were successfully used have been published. Physiostigmine is effective in delirium caused by anticholinergic syndrome; vitamins may be useful in alcoholics; melatonin use has been suggested in order to prevent and treat delirium by normalizing sleep-wake cycle alterations. Environmental interventions are often costless and may be very useful to prevent and treat postoperative delirium in patients at risk.

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

“…This fact suggests that intensive postoperative management of pain, blood sugar levels, and patient discomfort should be conducted as soon as the patient leaves the operating room and should be sustained until at least postoperative day 3. The factors associated with the development of POD in our study were similar to those identified in previous reports [1][2][3][4]7,[13][14][15][16][17][18]27) . Surprisingly, we could not obtain any significant relationship between brain surgery and POD, regardless of disease category or surgery, such as performed on microscope or by naked-eye.…”

“…Moreover, as the population becomes older as a whole, the incidence of POD is also likely to increase accordingly, as proven by previous literature 1,4) . In this study, we investigated the real incidence and risk factors of POD in elderly neurosurgical patients.…”

“…The incidence of POD varies between 5.1% and 52.5% in elderly patients undergoing major surgery, and certain procedures such as hip fracture or aortic surgery having higher risk of POD 4,5,7,8,21,22,27) . Because there has been practically no neurosurgical literature on the incidence of POD, we could not compare the 21.4% incidence in our study with that from similar studies.…”

“…In our cohort, 72.9% of patients exhibited POD on postoperative day 1, 22.9% on postoperative day 2, and the remainder on postoperative day 3. POD usually occurs by the third postoperative day and becomes worse at night 4,18,23) . This fact suggests that intensive postoperative management of pain, blood sugar levels, and patient discomfort should be conducted as soon as the patient leaves the operating room and should be sustained until at least postoperative day 3.…”

“…According to these reports, POD is associated with greater cost, longer length of hospital stays or institutionalization, more frequent discharge to long-term care facilities, additional complications aside from POD, poor recovery, and mortality 8,19,26) . Although reversible in nature, POD precedes with some cognitive deficits remaining for up to months after surgery, particularly in the elderly 4,21) . The main differences between POD and dementia are the potential for reversibility, length of morbidity, and presence of an initiating event.…”