Postoperative delirium in elderly patients after major abdominal surgery

Olin, Kemal; Eriksdotter, Maria; Jansson, Anders; Herrington, Margery K.; Kristiansson, Marianne; Permert, Johan

doi:10.1002/bjs.5053

Cited by 134 publications

(108 citation statements)

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“…17 Postoperative delirium occurs most often in the first 3 days after surgery, and most cases develop in the first day. 18,19 However, the time of onset and the duration of postoperative delirium are poorly understood; most published studies of hospitalized patients indicate the prevalence of delirium with no reference to the length of hospital stay or incidence. 20 Other than the stress of surgery, the risk factors for delirium in surgical patients most likely do not differ substantially from those in nonsurgical patients.…”

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confidence: 99%

“…17 However, advanced age, 8,18,19,[21][22][23][24] preexisting impaired cognition, 8,21,22,[25][26][27] use of psychotropic medications, 22,25,26,28 and impaired functional status and sensory deficits 8,21,27,29 are recognized as predisposing factors for postoperative delirium. A diverse array of precipitating factors for delirium have also been identified in surgical patients, including impaired oxygenation, 2,30 abnormal hematological and/or biochemical status, 25,26,[30][31][32] blood loss and replacement, 19,32 and intravenous infusions. 19,25,26,33 These factors also vary according to the type of surgery undertaken.…”

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confidence: 99%

“…A diverse array of precipitating factors for delirium have also been identified in surgical patients, including impaired oxygenation, 2,30 abnormal hematological and/or biochemical status, 25,26,[30][31][32] blood loss and replacement, 19,32 and intravenous infusions. 19,25,26,33 These factors also vary according to the type of surgery undertaken. For example, precipitating factors for postoperative delirium in cardiothoracic surgical patients include admission to the intensive care unit and invasive monitoring, 34,35 cardiopulmonary bypass, 36,37 and hypothermic states.…”

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Postoperative Delirium After Colorectal Surgery in Older Patients

Mangnall¹,

Gallagher²,

Stein‐Parbury³

2010

American Journal of Critical Care

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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.

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Postoperative Delirium After Colorectal Surgery in Older Patients

Mangnall¹,

Gallagher²,

Stein‐Parbury³

2010

American Journal of Critical Care

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“…Delirium is an acute and fluctuating alteration of mental state of reduced awareness and disturbance of attention. POD (Post Operative Delirium) often starts in the recovery room and occurs up to 5 days after surgery [3][4][5]. One investigation [4] found that many patients with POD on the peripheral ward already had POD in the recovery room.…”

Section: Post Operative Deliriummentioning

confidence: 99%

Untitled

2017

JACCOA

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Postoperative delirium (POD) is a common and serious adverse event in the elderly patient and is associated with significant morbidity and mortality. A new treatment for POD by intravenous Intralipid injection in the recovery room is first suggested in the medical literature.Keywords: Postoperative delirium; Postoperative cognitive dysfunction; Intralipid Post Operative DeliriumDelirium is defined by either the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) [1] or by the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD 10, Table 3) [2]. Delirium is an acute and fluctuating alteration of mental state of reduced awareness and disturbance of attention. POD (Post Operative Delirium) often starts in the recovery room and occurs up to 5 days after surgery [3][4][5]. One investigation [4] found that many patients with POD on the peripheral ward already had POD in the recovery room.More than 230 million surgical procedures are performed each year worldwide, of which more than 80 million are in Europe [6][7][8]. In Europe, the in-hospital mortality rate up to a maximum of 60 days is 3% after elective surgery and nearly 10% after emergency surgery [7]. In addition to mortality, postoperative cognitive impairments such as POD and postoperative cognitive dysfunction (POCD) impose a huge burden on individuals and society [9]. The incidence of POD is dependent on perioperative and intraoperative risk factors [10]. Therefore, the incidence of POD varies within a broad range [11,12]. For example, a metaanalysis of 26 studies of POD reported an incidence of 4.0 to 53.3% in hip fracture patients and 3.6 to 28.3% in elective patients [13].Delirium is one of the most common complications following hip fracture surgery in older people. This study identified pre-and peri-operative factors associated with the development of postoperative delirium following hip fracture surgery.Published and unpublished literature were searched to identify all evidence reporting variables on patient characteristics, onadmission, intra-operative and post-operative management assessing incident delirium in older people following hip fracture surgery. Pooled odds ratio (OR) and mean difference of those who experienced delirium compared to those who did not were calculated for each variable. Evidence was assessed using the Downs and Black appraisal tool and interpreted using the GRADE approach.A total of 6704 people (2090 people with postoperative delirium) from 32 studies were analyzed. There was moderate evidence of nearly a two-times greater probability of post-operative-delirium for those aged 80 years and over (OR: 1.77; 95% CI: 1.09, 2.87), whether patients lived in a care institution pre-admission (OR: 2.65; 95% CI: 1.79, 3.92), and a six-times greater probability of developing post-operative delirium with a pre-admission diagnosis of dementia (OR: 6.07, 95% CI: 4.84, 7.62). There was no association with intra-operative variables and probability of deliri...

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“…Postoperative delirium is associated with a poor outcome, including increased length of stay (LOS) in hospital and in the intensive care unit (ICU) or Post Anesthesia Care Unit (PACU), frequent medical complications, increased costs of care, and increased mortality [1][2][3][4][5][6][7][8] .…”

Section: Introductionmentioning

confidence: 99%