Postoperative Delirium after Urological Surgery: A Literature Review

Abstract

Purpose: We aimed to thoroughly search and identify studies referring to risk factors associated with postoperative delirium (POD) in patients undergoing open as well as en-doscopic urological surgery. Methods: The review after a systematic literature search included 5 studies. Results: The incidence of POD was reported to be between 7.8 and 30% depending on the type of the urologic surgery, while in the majority of the studies the onset happened on the first postoperative day and the symptoms lasted 3 ± 0.8 days. Seventeen different risk factors for POD were identified and presented in detail. Conclusion: The Mini-Mental State Examination score and older age were significantly associated with the development of POD. However, the Confusion Assessment Method is very well validated against the diagnosis of delirium from the specialists.

High ASA Physical Status and Low Serum Uric Acid to Creatinine Ratio are Independent Risk Factors for Postoperative Delirium Among Older Adults Undergoing Urinary Calculi Surgery

“…POD, a common and serious trouble in the clinical environment, occurs in 7–35% of older adults after urological surgery, which often results in various negative outcomes and seriously hinders the postoperative recovery of patients. 2 , 3 However, POD can be prevented, with its potential risk factors identification being the first step. Several previous studies investigated the incidence of POD and related risk factors in radical cystectomy and TURB in recent years.…”

“…Meanwhile, the reported POD incidence ranged from 7% to 35% in urological surgery according to a previous literature review. 2 Therefore, we assumed that the prevalence of POD (π) following urinary calculi surgery was 10%, with a relative error ε of 20%, an allowable error E of 5%, and a confidence interval (1–α) of 95%. The sample size was calculated as approximately 166.…”

“…It was reported that the POD incidence was 29% in radical cystectomy, 21% in transurethral resection of the prostate (TURP), and 10% in transurethral resection of bladder tumor (TURBT). 2 In addition, POD can result in various adverse consequences, such as prolonged hospital stays, higher risk of dementia, as well as increased mortality. 3 , 4 Therefore, it is imperative to explore effective strategies for preventing and treating POD.…”

Antipsychotic Drugs in Prevention of Postoperative Delirium—What Is Known in 2020?

“…The incidence of delirium varies from several percent in patients hospitalized in general wards up to 80% in patients with multi-organ failure treated in intensive care units (ICU) [ 4 , 5 ]. Hypoactive delirium in the most frequent form, accounting for almost half of all delirium cases and may not be recognized even in 80% of patients, due to the coexistence of dementia or use of sedative drugs, which cannot always be discontinued in the ICU [ 6 , 7 ].…”

“…Altered level of consciousness (4) ICDSC [11] • Altered level of consciousness Total scores of ≥12-diagnosis of delirium Table 1. Criteria for the diagnosis of delirium in scientific research.…”