Postoperative Delirium After Colorectal Surgery in Older Patients

Abstract

Background Postoperative delirium in older patients results in worse outcomes and increased costs. The prevalence and predictors of postoperative delirium in patients undergoing major colorectal surgery are not clear. Objectives To determine the prevalence and predictors of postoperative delirium in older patients after major colorectal surgery. Methods Patients older than 50 years, without preexisting cognitive impairment, were recruited before surgery. These patients were assessed after surgery for delirium daily for 3 days by using the Confusion Assessment Method. Regression analysis was used to determine independent predictors of postoperative delirium. Results Patients (n = 118) had a mean age of 71.81 years, and approximately half were women (54%). Most participants (64%) were married, and comorbid conditions were common. Delirium developed in 35% of the patients in the 3 days after surgery and in 21% in the first 24 hours. New cases of delirium were identified on each of the 3 days after surgery, and a few patients (7%) had delirium for the entire 3 days. Odds for delirium in the first 24 hours were increased for patients who had early admission (odds ratio [OR] = 4.48; P = .06) and decreased for patients who were married (OR = 0.25; P = .01). Odds for delirium in the first 3 days after surgery were increased for men (OR = 4.27; P = .02), older patients (OR = 1.05; P = .04), and patients who stayed overnight in the critical care unit (OR = 2.97; P = .06). Conclusions Postoperative delirium is common and persistent in older patients in the first 3 days after colorectal surgery.

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

“…Postoperative delirium occurs at an incidence rate of 15-35% following gastrointestinal (GI) surgery in the elderly [1][2][3] . Symptoms of postoperative delirium include visual hallucinations, auditory hallucinations, disorientation, aggression and poriomania.…”

Can postoperative or preemptive epidural analgesia effect on the incidence of postoperative delirium after major abdominal surgery?

“…[13] The incidence is approximately 87% in old patients requiring intensive care. Linda et al [14] found that in 35% postoperative colorectal operative patients aged ≥50 years, at least one episode of delirium was observed within the first 3 days after surgery; it was observed within the first 24 h in 21% patients and on the second (9%) and third (7%) day in some patients. In the present study, the incidence of POD was 9.09% in the Group A patients and 7.2% in the Group B patients, which is contrary to findings in the literature.…”

“…[15] This test is not specific to POD, but it could give significant results when applied on the third day after surgery. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] In young patients, cognitive deficits were observed in tests applied on the second day after surgery. [17] It was argued that postoperative mental state tests should be applied 1 week after major surgery at the earliest to eliminate anesthetic substances and metabolites.…”

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

“…Although varying incidence rates have been reported, it has been stated to occur in 37% of hospitalised patients [25][26][27]. In a study by Sharma et al [28] of elderly patients (mean age, 77 ± 1 years) who underwent surgery for a hip fracture under general anaesthesia, recovery room delirium was determined at a prevalence of 45% and the extent of the high risk group (ASA III) with preoperative dementia was reported to be related to postoperative delirium.…”