Remaining confounding factors to confirm the role of intraoperative hyperglycemia in postoperative delirium

Kinoshita, Hiroyuki; Sato, Tsunehisa; Nakajima, Yoshiyuki

doi:10.23736/s0375-9393.20.14432-8

Cited by 5 publications

(9 citation statements)

References 5 publications

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“…Postoperative delirium adversely affects patient outcomes, leading to higher mortality rates [1], cognitive and functional decline [2], prolonged hospital stays, and increased healthcare costs. Despite clinical diagnosis using established manuals such as the DSM-V and ICD-10, there is a need for simpler and faster screening tools such as the CAM and delirium observation screening scales, albeit with lower sensitivity compared to expert assessments [3][4][5][6][7][8]. Various risk factors, including age, cognitive impairment, comorbidities, and medication use, contribute to postoperative delirium [9,10].…”

Section: Discussionmentioning

confidence: 99%

“…Delirium is currently diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) or the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Faster and simpler delirium screening tools were described, including the confusion assessment method (CAM) [3][4][5], the delirium observation screening scale, delirium symptom interview, and the NEECHAM confusion scale [6], with low sensitivity (about 30%) compared with an expert delirium assessment (that is, by a psychiatrist, geriatrician, or neurologist) [7,8]. However, diagnostic disagreement may be typical among experts and disciplines.…”

Section: Introductionmentioning

confidence: 99%

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The Efficacy of Low-Dose Risperidone Treatment for Post-Surgical Delirium in Elderly Orthopedic Patients

Raphael,

Edna,

Irina

et al. 2023

Medicina

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Background: Delirium is an acute and typically reversible failure of essential cognitive and attentional functions and is a growing public health concern, with an incidence of 20–50% in patients older than 65 after major surgery and 61% in patients undergoing hip fracture surgery. Numerous treatment strategies have been examined with no conclusive results. The purpose of this study is to assess the efficacy of a three-day low-dose risperidone treatment protocol, 0.5 mg BID, in treating delirium in elderly hospitalized orthopedic surgery department patients. Methods: This study is a prospective non-randomized study involving the senior patient population, older than 65, in an Orthopedic Surgery Department in 2019 and 2020. Delirium was diagnosed by a confusion assessment method (CAM) questionnaire. A three-day 0.5 mg risperidone BID treatment protocol was initiated following diagnosis. Patient data collected included age, gender, chronic diseases, type of surgery and anesthesia and delirium characteristics. Results: The delirium study group included 47 patients with an average age of 84.4 years (±8.6), of whom 53.2% were females. Delirium incidence was 3.7% in all patients older than 65 (1759 patients) and 9.3% in the proximal femoral fracture group. We did not correlate electrolyte imbalance, anemia, polypharmacy and chronic diseases to delirium onset characteristics. Following the three-day low-dose risperidone treatment protocol, 0.5 mg BID, 14.9% of the patients showed CAM score normalization after one day of treatment, and 93.6% within two days. Conclusions: We found our rigid three-day low-dose risperidone treatment protocol, 0.5 mg BID, efficacious in fast delirium resolution, without side effects.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Efficacy of Low-Dose Risperidone Treatment for Post-Surgical Delirium in Elderly Orthopedic Patients

Raphael,

Edna,

Irina

et al. 2023

Medicina

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“…1,2 However, due to the aging population, patients frequently present with multiple medical comorbidities, which may increase the likelihood of complications after surgery. 1,2 Postoperative delirium (POD) represents a significant and common complication, particularly among elderly population with reported incidence rates ranging from 10 to 70% [3][4][5][6] , depending on the surgical procedure and studied…”

Section: Introductionmentioning

confidence: 99%

“…Notably, vascular, cardiac and orthopedic surgeries especially urgent or semi-urgent repair of hip fractures exhibit a higher occurrence of POD. [6][7][8] The etiology of POD is multifactorial, stemming from patientrelated factors such as advanced age or coexisting medical conditions, operative factors such as prolonged operative time or severe blood loss, and environmental factors such as staying in the ICU, where patients may have difficulty recognizing the time or being in an unfamiliar place. Some of these factors can be preventable, but others cannot.…”

Section: Introductionmentioning

confidence: 99%

“…POD contributes to unfavorable outcomes, including prolonged hospitalization, increased costs of care, higher rates of morbidities and mortality, as well as, compromised functional and cognitive recovery. 4,6,[8][9][10] Patients may develop post-operative cognitive dysfunction 11 , leading to permanent brain damage if POD is not detected early.…”

Section: Introductionmentioning

confidence: 99%

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Effect of a Single-dose Dexmedetomidine on Postoperative Delirium and Intraoperative Hemodynamic Outcomes in Elderly Hip Surgery; A Randomized Controlled Trial Dexmedetomidine for Postoperative Delirium

Choovongkomol,

Sinchai,

Choovongkomol

2024

Siriraj Med J

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Objective: Postoperative delirium (POD) is common in elderly patients. The growing evidences suggesting the potential benefits of dexmedetomidine (DEX) infusion in reducing POD. However, the administration of a singledose DEX remains controversial. This study aims to investigate the effect of a single-dose DEX on POD in elderlypatients undergoing hip surgery. Materials and Methods: This prospective, randomized, double-blinded trial enrolled patients aged over 65 years who underwent hip surgery under spinal anesthesia. Patients were assigned to either the DEX (received intravenous DEX 0.3-0.5 μg/kg after incision), or the normal saline solution (NSS). Delirium assessments were conducted at the post anesthetic care unit (PACU) and at 24, 48 and 72 hours postoperatively using the Confusion AssessmentMethod (CAM). Results: A total of 200 patients were randomized, with 100 in the DEX and 100 in the NSS. The incidence of POD was significantly lower in the DEX compared to the NSS (P < 0.001, RR 0.45, 95%CI: 0.28, 0.73). This difference remained significant at each postoperative assessment time point. There was no significant difference in sedation score and perioperative hemodynamics, except for a slightly lower intraoperative heart rate (P=0.015) and systolic blood pressure (P=0.029) observed at the PACU in the DEX, but these differences were not clinically significant. Additionally, the length of stay after surgery in the DEX was significantly shorter compare to the NSS (P=0.006). Conclusion: A single-dose dexmedetomidine can reduce the incidence of POD within 72 hours postoperatively in elderly patients undergoing hip surgery without compromising intraoperative hemodynamic stability.

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Associations between depression symptom burden and delirium risk: a prospective cohort study

Gaba,

Li,

Zheng

et al. 2023

Preprint

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BACKGROUND AND OBJECTIVES: Delirium and depression are increasingly common in aging. There is considerable clinical overlap, including shared symptoms and comorbid conditions, including Alzheimer disease (AD), functional decline, and mortality. Despite this, the long–term relationship between depression and delirium remains unclear. This study assessed the associations of depression symptom burden and its trajectory with delirium risk in a 12–year prospective study of older individuals during hospitalization. RESEARCH DESIGN AND METHODS: 319,141 UK biobank participants between 2006–2010 (mean 58y [range 37–74, SD=8], 54% female) reported frequency (0–3) of four depressive symptoms (mood, disinterest, tenseness, or lethargy) in the preceding 2 weeks, and aggregated into a depressive symptom burden score (0–12). New–onset delirium was obtained from hospitalization records during 12y median follow–up. 40,451 (mean age 57 ± 8; range 40–74y) had repeat assessment on average 8y after their first. Cox proportional hazard models examined whether depression symptom burden and trajectory predicted incident delirium during hospitalization. RESULTS: 5,753 (15 per 1000) newly developed delirium during follow–up. Increased risk for delirium was seen for mild (aggregated scores 1–2, hazards ratio, HR=1.16, [95% confidence interval 1.08–1.25], p<0.001), modest (scores 3–5, 1.30 [1.19 –1.43], p<0.001) and severe (scores ≥ 5, 1.38 [1.24 –1.55], p<0.001) depressive symptoms, versus none in the fully adjusted model. These findings were independent of the number of hospitalizations and consistent across hospitalization settings (e.g., surgical, medical, or critical care) and specialty (e.g., neuropsychiatric, cardiorespiratory or other). Worsening depression symptoms (≥1 point increase), compared to no change/improved score, were associated with an additional 39% increased risk (1.39 [1.03–1.88], p=0.03) independent of baseline depression burden. The association was strongest in those over 65y at baseline (p for interaction <0.001). DISCUSSION AND IMPLICATIONS: Depression symptom burden and worsening trajectory predicted delirium risk during hospitalization. Increased awareness of subclinical depression symptoms may be warranted for delirium prevention.

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Remaining confounding factors to confirm the role of intraoperative hyperglycemia in postoperative delirium

Cited by 5 publications

References 5 publications

The Efficacy of Low-Dose Risperidone Treatment for Post-Surgical Delirium in Elderly Orthopedic Patients

The Efficacy of Low-Dose Risperidone Treatment for Post-Surgical Delirium in Elderly Orthopedic Patients

Effect of a Single-dose Dexmedetomidine on Postoperative Delirium and Intraoperative Hemodynamic Outcomes in Elderly Hip Surgery; A Randomized Controlled Trial Dexmedetomidine for Postoperative Delirium

Associations between depression symptom burden and delirium risk: a prospective cohort study

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