Risk Factors for Delirium after Spine Surgery: An Age-Matched Analysis

Abstract

Study DesignA retrospective cohort study.PurposeTo investigate the risk factors for postoperative delirium after spine surgery, excluding older age, which has already been established as a strong risk factor.Overview of LiteratureMore than 30 risk factors have been reported for delirium after spine surgery, making it challenging to identify which factors should be prioritized. We hypothesized that risk factors could not be prioritized to date because the factor of older age is very strong and influenced other factors. To eliminate the influence of older age, we performed an age-matched group comparison analysis for the investigation of other risk factors.MethodsThis study involved 532 patients who underwent spine surgery. Two patients of the same age without delirium (delirium negative group) were matched to each patient with delirium (delirium positive group). Differences in suspected risk factors for post-operative delirium between the two groups identified from previous reports were analyzed using univariate analysis. Multivariate analysis was performed for factors that showed a significant difference between the two groups in the univariate analysis.ResultsFifty-nine (11.1%) of 532 patients developed postoperative delirium after spine surgery. Large amounts of intraoperative bleeding, low preoperative concentration of serum Na, high postoperative (day after surgery) serum level of C-reactive protein, low hematocrit level, low concentration of albumin, and high body temperature were detected as significant risk factors in the univariate analysis. Large amounts of intraoperative bleeding remained a risk factor for postoperative delirium in the multivariate analysis.ConclusionsWe should pay attention to and take precautions against the occurrence of postoperative delirium after spine surgery in patients of older age or those who experience severe intraoperative bleeding.

Incidence and Risk Factors for Postoperative Delirium in Patients Undergoing Spine Surgery: A Systematic Review and Meta-Analysis

“…However, diabetes mellitus, history of surgery, and cerebral vascular diseases were not found to be related to developing delirium, which was consistent with the previous meta-analysis [47]. For the cardiovascular comorbidity, the pooled result of 10 studies [8, 11, 15, 23, 26, 30, 31, 34, 43, 45] showed no significance (OR 0.81; 95% CI 0.34–1.29) with low heterogeneity ( I 2 0%) (Figure 4(a)). Only one study found cardiovascular comorbidity as a risk factor for delirium [11].…”

Preoperative risk factors for delirium in patients aged ≥75 years undergoing spinal surgery: a retrospective study

“…It is speculated that direct brain damage from stroke may increase the risk of postoperative delirium 13,21 ; however, this factor cannot be controlled preoperatively. We also found that preoperative hyponatremia was a significant risk factor for postoperative delirium, and Morino et al 22 reported the same finding in an age-matched analysis. Moreover, Halladay et al 23 identified the following delirium-screening targets: preexisting cognitive impairment, infection, and a sodium concentration of <135 or >145 mEq/L.…”

“…We also found that preoperative hyponatremia was a significant risk factor for postoperative delirium, and Morino et al. 22 reported the same finding in an age-matched analysis. Moreover, Halladay et al.…”

Postoperative Delirium after Spine Surgery: A Single-Center Age-Matched Study

“…We think this might be related to the inflammatory response associated with delirium. Cerejeira et al 7) reported that the cerebral effect of systemic inflammation during the perioperative period may be aggravated by the anticholinergic effects of drugs administrated during this phase and be responsible for postoperative delirium 16) . In the present study, abnormal postoperative Cl levels were related to postoperative delirium.…”

“…The fixed risk factors include advanced age, pre-existing psychiatric disease, and the presence of multiple comorbidities. Among these, old age is the most strongly identified risk factor 16) . A number of reviews regarding postoperative delirium in general surgery, hip fracture surgery, and cardiovascular surgery have been reported 5,25,30) .…”