Preoperative risk factors for postoperative delirium

Litaker, David; Locala, Joseph A.; Franco, Kathleen; Bronson, David L.; Tannous, Ziad

doi:10.1016/s0163-8343(01)00117-7

Cited by 280 publications

(198 citation statements)

References 38 publications

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“…[17][18][19] A representative riskprediction model designed for an unselected population of non-cardiac surgical patients is detailed in Table 1. 18 In a recent systematic review assessing the available medical and surgical risk-prediction models, several common themes were identified among the variety of predictor variables reported; the rapidity and severity of the physical insult and the patient's comorbidities appear as the key features predicting delirium following surgery.…”

Section: Predictorsmentioning

confidence: 99%

“…[17][18][19] Le tableau 1 présente de façon détaillée un modèle représentatif de prédiction du risque conçu pour une population non sélectionnée de patients subissant une chirurgie non cardiaque. 18 Dans une synthèse systématique récente évaluant les modèles de prédiction du risque médical et chirurgical, plusieurs thèmes communs ont été identifiés parmi les différentes variables prédictives décrites; la rapidité et la gravité de la lésion physique, ainsi que les comorbidités du patient semblent être les caractéristiques essentielles pour prédire la survenue d'un delirium après l'intervention chirurgicale.…”

Section: é Léments Prédictifsunclassified

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Postoperative delirium: risk factors and management: Continuing Professional Development

Chaput

Bryson

2012

Can J Anesth/J Can Anesth

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Purpose Postoperative delirium often remains undiagnosed and therefore untreated. The purpose of this continuing professional development module is to identify patients at high risk of developing delirium following noncardiac surgery and to provide tools to aid in the diagnosis of delirium at the bedside. Optimal prevention and treatment strategies are recommended. Principal findings Delirium is characterized by an acute onset and a fluctuating course, inattention, disorganized thinking and an altered level of consciousness, and occurs in up to 40% of patients in the perioperative period. The pathophysiology of delirium is multifactorial, but it is believed to be related to inflammation, altered neurotransmission, and stress in the patient who has had surgery. Acetylcholine and dopamine appear to play a significant role. There is an increased risk of a poor outcome in patients who develop delirium, including a longer hospital stay and death. Surgical and patient factors play a significant role in predicting who will subsequently develop delirium. Prevention is much more effective than treatment in the management of delirium. The most effective prevention strategies include proactive geriatric assessment and care of the patient on a geriatrics surgical ward as well as prophylactic low-dose antipsychotic agents. From an anesthetic perspective, evidence in some surgical populations would support the use of regional techniques and minimal sedation. If delirium develops, treatment with lowdose oral antipsychotics appears to be most effective.Conclusions Delirium is a serious condition that must be recognized early and treated promptly to minimize deleterious outcomes. In order to institute prevention strategies and treat the condition effectively when it occurs, the anesthesiologist must be vigilant in identifying patients at risk and in screening for this condition. Objectives of this Continuing Professional Development (CPD) module:After reading this module, the reader should be able to:1. Define delirium in the context of other cognitive changes following non-cardiac surgery. 2. Understand the incidence and adverse outcomes associated with delirium. 3. List predisposing and precipitating factors of postoperative delirium and identify the patient at risk. 4. Explain the underlying pathophysiologic mechanisms believed to be implicated in causing delirium. 5. Formulate an anesthetic plan that minimizes the risk of developing postoperative delirium. 6. Devise a management plan to treat postoperative delirium most effectively while minimizing the adverse effects of treatment.Like other Western nations, Canada's population is aging rapidly. Over the past 50 years, the proportion of Canadians over the age of 65 has risen from 7.7% to 13.7%. A Statistics Canada estimates that the proportion of seniors will double 123Can J Anesth/J Can Anesth (2012) 59:304-320 DOI 10.1007 yet again by 2036 and will represent 23-25% of Canada's population. B This rapid demographic shift will impact anesthesiologists and hospitals ...

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Section: Predictorsmentioning

confidence: 99%

Section: é Léments Prédictifsunclassified

Postoperative delirium: risk factors and management: Continuing Professional Development

Chaput

Bryson

2012

Can J Anesth/J Can Anesth

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“…Overall, surgical patients who consumed more alcohol were at significantly greater risk of post-operative delirium. Despite variation in sample characteristics and alcohol assessment instruments, alcohol use or misuse was significantly associated with a 2 to 6 fold increase in the odds of post-operative delirium in three of four studies [26,28,36]. The other showed a trend toward an association [32].…”

Section: Associations Between Alcohol Use or Misuse And Surgical Outcmentioning

confidence: 86%

“…Twenty two of these studies reported alcohol use/misuse prevalence ( Table 1) and 19 evaluated alcohol-related post-operative complications ( Table 2). Seven of the 27 studies described alcohol use or misuse in mixed samples of patients undergoing different types of non-cardiac surgeries [22][23][24][25][26][27][28], and three of those seven used data from the Veterans Affairs (VA) National Surgical Quality Improvement Program (NSQIP) [22][23][24]. One other study described and compared the prevalence of alcohol misuse across different surgical subspecialties [29], and one study was limited to vascular or thoracic patients admitted to ICU post-operatively [30].…”

Section: Studies Meeting Inclusion Criteria For Reviewmentioning

confidence: 99%

“…While 12 studies used assessments based on interviews or self-report questionnaires, 10 were based on clinical information abstracted from the medical record, and four studies did not state the source of the alcohol data. Measures varied from dichotomous measures of lifetime or current alcohol use [23,24,35], screening questionnaires for lifetime alcohol use disorders such as the CAGE and Short Michigan Alcoholism Screening Test (SMAST) [29,48], categorization based on drinking over 2 or 3 drinks per day or over 6 drinks a week, judgments that alcohol use was associated with an injury [34], DSM criteria for alcohol use disorders or binge drinking [48], and self-reported history of alcohol abuse [28] or alcohol use impacting health [26]. A major limitation of studies identified was the lack of description of how alcohol use/misuse was assessed and the timeframe of the alcohol measure (Tables 1 and 2), so that it was often unclear if patients who were categorized as at-risk due to drinking continued to drink at the time of surgery.…”

Section: Strengths and Limitations Of Identified Studiesmentioning

confidence: 99%

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Alcohol Misuse Prevalence and Associations with Post-Operative Complications in US Surgical Patients: A Review

Harris¹,

Frey²,

DeBenedetti³

et al. 2009

TOSJ

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Abstract:We conducted a standardized review of research on the prevalence of alcohol use or misuse (including alcohol use disorders), and the association of alcohol use or misuse with post-operative surgical complications among US patients. Twenty seven studies that included a preoperative measure of alcohol use or misuse and included at least 50 US surgical patients were identified using a standardized search strategy (1950( -April 2007. Twenty-two of the studies reported prevalence of alcohol use or misuse, which was highest in major otolaryngology surgeries (mostly for cancer and injuries: 22-88.5%) and thoracic surgery (lung transplant and cancer resections: 29-33%) and ranged from 8-28% in the remaining studies. Nineteen studies examined the association between pre-operative alcohol consumption and post-operative complications suggesting positive associations between alcohol use or misuse and risk for post-operative delirium, pneumonia, cognitive decline, overall complications, and death. Most identified studies had methodological limitations, especially the widespread use of drinking assessment methods that cannot distinguish alcohol use from misuse.

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Characteristics Associated With Delirium in Older Patients in a Medical Intensive Care Unit

Pisani¹

2007

Arch Intern Med

233

162

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Background: Delirium is a highly prevalent disorder among older patients in the intensive care unit. Methods: We performed a prospective cohort study of 304 patients 60 years or older admitted from September 5, 2002, through September 30, 2004, to a 14-bed ICU in an urban university teaching hospital. The main outcome measure was ICU delirium that developed within 48 hours of ICU admission. Patients were assessed for delirium with the Confusion Assessment Method for the ICU and medical record review. Risk factors for delirium were assessed on ICU admission by interview with proxies and medical record review. A model was developed using multivariate logistic regression and internally validated with bootstrapping methods. Results: Delirium occurred in 214 study participants (70.4%) within the first 48 hours of ICU admission. In METHODS Study participants were 304 consecutive patients 60 years or older who were admitted to the medical ICU at Yale-New Haven Hospital,

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Preoperative risk factors for postoperative delirium

Cited by 280 publications

References 38 publications

Postoperative delirium: risk factors and management: Continuing Professional Development

Postoperative delirium: risk factors and management: Continuing Professional Development

Alcohol Misuse Prevalence and Associations with Post-Operative Complications in US Surgical Patients: A Review

Characteristics Associated With Delirium in Older Patients in a Medical Intensive Care Unit

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