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

Raats, Jelle W; Steunenberg, Stijn L.; Crolla, Rogier M. P. H.; Wijsman, Jan H.; Slaa, Alexander te; Laan, Lijckle van der

doi:10.1016/j.ijsu.2015.04.080

Cited by 48 publications

(32 citation statements)

References 24 publications

(18 reference statements)

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“…This makes it difficult to differentiate between delirium, dementia, depression or other reasons for agitation or sedation and does not reflect the real incidence of postoperative delirium in our population. Prospective measurement with validated scales in elective elderly surgical CRC patients reveals incidence rates of postoperative delirium of 11–31% . Comparable articles report variable rates of surgical site infections in older age groups, although the mean incidence is similar to our findings .…”

Section: Discussionsupporting

confidence: 83%

Postoperative complications in individuals aged 70 and over undergoing elective surgery for colorectal cancer

et al. 2017

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Section: Discussionsupporting

confidence: 83%

Postoperative complications in individuals aged 70 and over undergoing elective surgery for colorectal cancer

et al. 2017

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“…For example, there is no difference in the ICU stay between the delirium or non-delirium patients of abdominal disease, the possible reason for consideration is that the patients with abdominal diseases included in this study were all surgical patients and showed transient delirium, which reversal quickly and has no affection on ICU stay. It is in contrast to what has been demonstrated in Raats et al's study [37] which show that high incidence of delirium was found in abdominal surgery patients. Delirium was associated with adverse outcomes including higher hospital stay, mortality and discharge to a nursing home.…”

Section: Discussioncontrasting

confidence: 91%

ICU delirium:what is different between the type of diseases?

Feng

Yu-hang

et al. 2020

Preprint

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Background: Delirium is an acute neurological disorder that is quite common complication in intensive care unit (ICU) patients. However, there are no studies to focus on risk factors vary from disease to disease. The purpose of our study was to identify the risk factors and prognosis of delirium in patients with different disease types. Method: We conducted an observed study of consecutive patients from September to November 2016, who underwent surgical operation or with poor conservative treatment were admitted to the ICU. The patients were screened for delirium by using the diagnostic tools of Richmond Agitation Sedation Scale (RASS score) and the Confusion Assessment Method ICU (CAM-ICU). Results: A total of 406 patients met the inclusion criteria in our study. The overall incidence of ICU delirium was 45.8% (186/406), the delirium was highest in patients with brain disease (68%), followed by pulmonary disease (63%) and sepsis/shock (49%). The risk factors are different for different types of disease, for heart and vascular disease subgroup, only sleep quality (OR=0.236, p＜0.001) was independent risk factor for delirium. For abdominal disease subgroup, age (OR=2.514, p=0.002), vasoactive drugs (OR=13.799, p=0.002), and sleep quality (OR=0.114, p＜0.001) were risk factors for the delirium. And for sepsis and septic shock subgroup, age(OR=1.100, p=0.022), APACHE II scores(OR=1.255, p＜0.001) and sleep quality (OR=0.090, p=0.034) were risk factors for the delirium. ICU delirium is associated with worse outcomes including ICU stays(P<0.001) and 28-day mortality(P=0.001). The difference of ICU stays between delirium and non-delirium groups in the subgroup of heart and vascular disease(P<0.001), pulmonary disease(P=0.011), sepsis/septic shock(P<0.001) and cerebral disease(P=0.011) were consistent with the general population. But subgroup of sepsis/septic shock was the only one whom has the significant difference in the 28-day mortality (P=0.006) between delirium and non-delirium groups. Conclusion: The incidence and risk factors of delirium varied greatly with the type of disease. Age and sleep quality were independent risk factors for the development of delirium in most subgroup diseases. The prognosis of delirium was different in different disease types, among them, patients with sepsis/septic shock associated delirium have the worst prognosis.

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“…However, surgeons have little knowledge of the assessment and management of preoperatively identifiable age-related factors that affect outcomes. Frailty, poor functional status, cognitive impairment and postoperative delirium in older people have all been shown to be associated with prolonged postoperative stay, adverse postoperative outcomes, [13][14][15][16][17] and postoperative discharge to a higher level of care. 18 The prevalence and severity of postoperative complications in an older surgical patient has also been shown to have a negative effect on the time take to return to baseline functional status.…”

Section: Preoperative Carementioning

confidence: 99%

Surgery in the older person: Training needs for the provision of multidisciplinary care

Pearce

Bunni

McCarthy

et al. 2016

annals

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INTRODUCTION Many older surgical patients are exposed to high risks of morbidity and mortality when undergoing both elective and emergency surgery. METHODS We provide an overview of perioperative care teams and the educational opportunities available to surgeons who undertake surgery in the older person. FINDINGS The number of older people undergoing surgery is increasing at a rate faster than the proportion of older people in the overall population. Management of the older surgical patient throughout the surgical pathway forms part of the Specialty Training Curriculum for Geriatric Medicine. While 'surgery in childhood' continues to form part of the general surgical higher training syllabus, surgery in the later years of life does not. There are limited postgraduate courses and training opportunities currently available to surgeons in this field. There is clear societal need to address perioperative care for older surgical patients, which has proved successful in some centers. Moreover, surgical trainees support the inclusion of geriatric medicine issues into their training. CONCLUSIONS The ageing population requires a multidisciplinary perioperative approach, with dedicated and appropriately trained clinicians and allied health care professionals to improve outcomes.

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

Abstract: High incidence of delirium was found in both acute and elective colorectal surgery. Delirium was associated with adverse outcomes.

Cited by 48 publications

References 24 publications

Postoperative complications in individuals aged 70 and over undergoing elective surgery for colorectal cancer

Postoperative complications in individuals aged 70 and over undergoing elective surgery for colorectal cancer

ICU delirium:what is different between the type of diseases?

Surgery in the older person: Training needs for the provision of multidisciplinary care

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