Postoperative Delirium and Postoperative Cognitive Dysfunction

Abstract

Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Postoperative delirium and postoperative cognitive dysfunction share risk factors and may co-occur, but their relationship is not well established. The primary goals of this study were to describe the prevalence of postoperative cognitive dysfunction and to investigate its association with in-hospital delirium. The authors hypothesized that delirium would be a significant risk factor for postoperative cognitive dysfunction during follow-up. Methods This study used data from an observational study of cognitive outcomes after major noncardiac surgery, the Successful Aging after Elective Surgery study. Postoperative delirium was evaluated each hospital day with confusion assessment method–based interviews supplemented by chart reviews. Postoperative cognitive dysfunction was determined using methods adapted from the International Study of Postoperative Cognitive Dysfunction. Associations between delirium and postoperative cognitive dysfunction were examined at 1, 2, and 6 months. Results One hundred thirty-four of 560 participants (24%) developed delirium during hospitalization. Slightly fewer than half (47%, 256 of 548) met the International Study of Postoperative Cognitive Dysfunction-defined threshold for postoperative cognitive dysfunction at 1 month, but this proportion decreased at 2 months (23%, 123 of 536) and 6 months (16%, 85 of 528). At each follow-up, the level of agreement between delirium and postoperative cognitive dysfunction was poor (kappa less than .08) and correlations were small (r less than .16). The relative risk of postoperative cognitive dysfunction was significantly elevated for patients with a history of postoperative delirium at 1 month (relative risk = 1.34; 95% CI, 1.07–1.67), but not 2 months (relative risk = 1.08; 95% CI, 0.72–1.64), or 6 months (relative risk = 1.21; 95% CI, 0.71–2.09). Conclusions Delirium significantly increased the risk of postoperative cognitive dysfunction in the first postoperative month; this relationship did not hold in longer-term follow-up. At each evaluation, postoperative cognitive dysfunction was more common among patients without delirium. Postoperative delirium and postoperative cognitive dysfunction may be distinct manifestations of perioperative neurocognitive deficits.

Metabolomic and Lipidomic Profiling of Preoperative CSF in Elderly Hip Fracture Patients With Postoperative Delirium

“…A total of 110 adults were recruited in this study (Figure 1). Patients were excluded if they: (Daiello et al, 2019) had a past medical history of neurological disease such as delirium, schizophrenia, dementia, or stroke [with regard to dementia, it was screened if Mini Mental State Examination (MMSE) scores of ≤ 17 for illiterate patients, ≤ 20 for patients with 1-6 years of education, or ≤ 24 for patients with 7 or more years of education] (Li et al, 2016;Vutskits and Xie, 2016) were unable to read or write or cooperate; (Eckenhoff et al, 2020) had a history of drug or alcohol abuse. Eighty participants (15 POD vs. 65 Non-POD) completed the study.…”

“…Patients over 65 years of age are the largest consumers of procedural care, and postoperative delirium (POD) is one of the most common complications experienced by elderly patients during the postoperative period (Daiello et al, 2019). POD is an acute neuropsychiatric syndrome occurring in the hours to days after anesthesia and surgery (Vutskits and Xie, 2016), which can elicit durable deficits in executive function, memory, attention, and other cognitive domains (Eckenhoff et al, 2020).…”

Post-operative analgesia following hip surgery: A single injection of 0.25% bupivacaine through posterior lumbar plexus block using a neurostimulator

“…For patients infected with hepatitis B or female patients receiving lumbar plexus blocks and sciatic nerve blocks, the authors recommended that combined ultrasound and nerve stimulator guidance should be used to improve the safety, and the use of ultrasound did not improve the quality of deep nerve block [22]. In this study be- [23]. In the present study with centenary patients, the incidence of delirium in the immediate postoperative period was 11.4%.…”

The Glymphatic System: A Potential Pathophysiological Focus for Perioperative Neurocognitive Disorder

“…5 Patients, especially elderly patients, suffered cognitive decline after many kinds of surgery, but because of differences in assessment tools and methods, the reported incidence of POCD varied greatly. Following the 2018 recommended change to PND, when the diagnosis process and method were given, 2 Daiello et al 6 found that Hu Z. et al: Glymphatic system and PND Explor Res Hypothesis Med postoperative delirium and postoperative cognitive dysfunction may be distinct manifestations of perioperative neurocognitive deficits.…”