Postoperative Delirium in Severely Burned Patients Undergoing Early Escharotomy

Abstract

The aim of this study is to investigate the incidence, related risk factors, and outcomes of postoperative delirium (POD) in severely burned patients undergoing early escharotomy. This study included 385 severely burned patients (injured <1 week; TBSA, 31-50% or 11-20%; American Society of Anesthesiologists physical status, II-IV) aged 18 to 65 years, who underwent early escharotomy between October 2014 and December 2015, and were selected by cluster sampling. The authors excluded patients with preoperative delirium or diagnosed dementia, depression, or cognitive dysfunction. Preoperative, perioperative, intraoperative, and postoperative information, such as demographic characteristics, vital signs, and health history were collected. The Confusion Assessment Method was used once daily for 5 days after surgery to identify POD. Stepwise binary logistic regression analysis was used to identify the risk factors for POD, t-tests, and χ tests were performed to compare the outcomes of patients with and without the condition. Fifty-six (14.55%) of the patients in the sample were diagnosed with POD. Stepwise binary logistic regression showed that the significant risk factors for POD in severely burned patients undergoing early escharotomy were advanced age (>50 years old), a history of alcohol consumption (>3/week), high American Society of Anesthesiologists classification (III or IV), time between injury and surgery (>2 days), number of previous escharotomies (>2), combined intravenous and inhalation anesthesia, no bispectral index applied, long duration surgery (>180 min), and intraoperative hypotension (mean arterial pressure < 55 mm Hg). On the basis of the different odds ratios, the authors established a weighted model. When the score of a patient's weighted odds ratios is more than 6, the incidence of POD increased significantly (P < .05). When the score of a patient's weighted odds ratios is more than 6, the incidence of POD increased significantly (P < .05). Further, POD was associated with more postoperative complications, including hepatic and renal function impairment and hypernatremia, as well as prolonged hospitalization, increased medical costs, and higher mortality.

Investigating Association between Intraoperative Hypotension and Postoperative Neurocognitive Disorders in Non-Cardiac Surgery: A Comprehensive Review

“…In two studies [ 41 , 49 ] IOH was defined as an absolute decrease in SBP < 90 mmHg. In the next three articles, MAP < 55 mmHg [ 50 ], MAP < 60 mmHg [ 45 ] and MAP < 65 mmHg [ 52 ], respectively, were applied as the cut-off points for IOH. In another two studies, the definition of IOH as a percentage decrease of MAP by 30% compared to the baseline [ 46 , 51 ] was adopted.…”

“…In 2017, Guo et al [ 50 ], basing on data from 385 patients with a mean age of 48 ± 13 years undergoing escharotomy, designed a predictive model to assess the probability of POD. One of the variables included in the model was IOH, defined as MAP drop <55 mmHg (OR = 27.07; 95%CI 7.13–102.83, p < 0.05).…”

A Survey of Electronic Health Record (EHR) Variables Associated with Postoperative Delirium: A Systematic Review

“…Six of the studies investigated age by using cutoffs as a risk factor. Four of these found significant cutoffs: one at 50 years [15], one at 60 years [16], one at 65 years [17], and one at 70 years-old [18]. The two studies that did not find significance used 65 years [19] and 80 years-old [20] as cutoffs.…”

“…Seven studies assessed a history of alcohol consumption as a predictor for delirium, three of which found a significant association between the two variables. The populations in the studies where alcohol is a significant predictor were comprised of liver transplant [24], severe burn [15], and major general surgery patients [23] (Table 2).…”

“…Intraoperative blood loss has also been shown as a predictor for development of POD in two population subsets: elderly patients receiving total hip arthroplasty (THA) procedures and severely burned patients undergoing early escharotomies [15,31]. Large volume blood loss can lead to intraoperative hypotension and an increased need for blood transfusions, both of which have been shown to be predictors for POD [15,31] (Table 5).…”