Risk Factors for Delirium After Spine Surgery in Extremely Elderly Patients Aged 80 Years or Older and Review of the Literature: Japan Association of Spine Surgeons with Ambition Multicenter Study

Kobayashi, Kazuyoshi; Imagama, Shiro; Ando, Kei; Ishiguro, Naoki; Yamashita, Masaomi; Eguchi, Yawara; Matsumoto, Morio; Ishii, Ken; Hikata, Tomohiro; Seki, Shoji; Terai, Hidetomi; Suzuki, Akinobu; Tamai, Katsuto; Aramomi, Masaaki; Ishikawa, Tetsuhiro; Kimura, Atsushi; Inoue, Hirokazu; Inoue, Gen; Miyagi, Masayuki; Saito, Wataru; Yamada, Kei; Hongo, Michio; Matsuoka, Yuji; Suzuki, Hidekazu; Nakano, Atsushi; Watanabe, Kazuyuki; Chikuda, Hirotaka; Ohya, Junichi; Aoki, Yasuchika; Shimizu, Masayuki; Futatsugi, Toshimasa; Mukaiyama, Keijiro; Hasegawa, Masaichi; Kiyasu, Katsuhito; Iizuka, Haku; Iizuka, Yoichi; Kobayashi, Ryuichi; Nishida, Kotaro; Kakutani, Kenichiro; Nakajima, Hideaki; Murakami, Hideki; Demura, Satoru; Kato, Satoshi; Yoshioka, Katsuhito; Namikawa, Takashi; Watanabe, Kei; Nakanishi, Kazuyoshi; Nakagawa, Yukihiro; Yoshimoto, Mitsunori; Fujiwara, Hiroyasu; Nishida, Norihiro; Imajo, Yasuaki; Yamazaki, Masashi; Sakane, Masataka; Abe, Tetsuya; Fujii, Kengo; Kaito, Takashi; Furuya, Takeo; Orita, Sumihisa; Ohtori, Seiji

doi:10.1177/2192568217700115

Cited by 47 publications

(61 citation statements)

References 65 publications

(84 reference statements)

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“…In our study, there were 8 patients (2.6%) who were diagnosed early (the rst 3 postoperative days). This rate is consistent with the reported rates of patients who were diagnosed with POD in literature (25). Moreover, the data obtained from the risk factors we investigated and the risk factors due to patients, surgery or anesthesia were consistent with literature.…”

Section: Discussionsupporting

confidence: 91%

Early Diagnosis Of Postoperative Delirium In Patients Who Underwent General Surgery

oluş¹,

Gündüz²,

Arıcı³

2020

Preprint

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Objective: Postoperative delirium (POD) is a common postoperative complication. This study aimed to diagnose POD early primarily in patients who underwent General Surgery. This study also aimed to shorten the duration of hospital stays, prevent re-hospitalization after discharge and decrease the rates of morbidity/mortality through investigating the relationship with the characteristics of the patients/surgery/anesthesia in patients diagnosed with postoperative delirium in an early period. Material and Methods: Data of 303 patients at the age of 18 and above who were operated by General Surgery Clinic between March 2018 and May 2018, who were followed up by the Department of Anesthesiology and Reanimation for preoperative, intraoperative and postoperative periods and who received general anesthesia were included in the study.Patients’ demographic data, occupation, educational status, income level, additional diseases, ASA (American Society of Anesthesia) score, previous surgeries, history of a psychiatric or neurological disease, history of alcohol, cigarette, or drug use, and memory problems were recorded. Mini Mental State Examination (MMSE) was used to identify preoperative mental levels of the patients. Diagnosis of the patient, name, duration and features of the surgery to be performed, whether the surgery was urgent or elective, drugs used, type of catheterization (artery, central, foley or nasogastric), Hb value, intraoperative vital findings, and duration of postoperative discharge were recorded. The diagnosis of POD in patients was evaluated with Confusion Assessment Method (CAM). Results: POD developed in 2-6% (8 patients) of the patients. A significant relationship was recorded between the diagnosis of POD and age and additional diseases (ASA score). Results showed that the risk of delirium decreased as the education levels of the patients increased. A significant relationship was recorded between delirium and only midazolam among anesthetic agents used. A significant relationship was recorded among hypercarbia that developed during the surgery, invasive procedures, prolonged duration of surgery and hospitalizations in Intensive Care Units and Post-Anesthesia Care Units.Conclusion: The rate of POD (2.6%) and risk factors determined for POD within the first three days in our study were in compliance with literature. Diagnosing POD with CAM in an early postoperative period was advantageous. The treatment planning of the patients for POD could be done in the early period. By doing this, increase in mortality, morbidity and cost as a result of missing the diagnosis of POD was prevented.

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Section: Discussionsupporting

confidence: 91%

Early Diagnosis Of Postoperative Delirium In Patients Who Underwent General Surgery

oluş¹,

Gündüz²,

Arıcı³

2020

Preprint

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“…The predisposing factors are the patient's basic vulnerabilities including age, antipsychotic medication use, smoking status, impaired ability to complete activities of daily living, history of delirium, weakness, and cognitive impairment 18 . Precipitating (or accelerating) factors occur during hospitalization, including massive bleeding during surgery, 19 opioid use, 19,20 or postoperative fever 21 . However, because of the heterogeneity of available studies with respect to the type of surgery, age group, and risk factors, it is difficult to draw conclusions about the most important risk factors for delirium.…”

mentioning

confidence: 99%

“…However, the study had several limitations including that researchers did not consider specific age groups or include information on a subgroup of adults older than 65 years. Moreover, a re‐analysis of the data would permit the inclusion of observational studies 19,20,23 that have become available since the publication of the meta‐analysis.…”

mentioning

confidence: 99%

Risk Factors of Postoperative Delirium in Older Adult Spine Surgery Patients: A Meta‐Analysis

Baek¹,

Kim²,

Lee³

2020

AORN Journal

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This literature review identifies factors that may place older adult patients at risk for developing delirium after spine surgery. We conducted a meta-analysis according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Using a variety of electronic databases, we identified five studies for inclusion that represent 645 patients who were 65 years or older. The pooled incidence rate of postoperative delirium was 13.0%. Factors associated with developing postoperative delirium included preoperative opioid use, cervical spine surgery versus lumbar or thoracic spine surgery, spine fusion versus simple spine surgery, hypertension, cerebrovascular disease, pulmonary disease, duration of surgery, and infused IV fluid volume. Nurses who provide perioperative care for older adult patients undergoing spine surgery should be aware of the potential risk factors of delirium to ensure patient safety. Additional research is required to clearly delineate the risk factors for postoperative delirium in older adults.

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“…11 Kobayashi et al identified that cervical lesion surgery and an EBL greater than 300 ml were significantly associated with postoperative delirium in patients 80 years or older. 17 Surgeons should pay careful attention when performing surgery in elderly patients who cannot accept a transfusion due to religious reasons and in patients with risk factors for postoperative delirium.…”

Section: Discussionmentioning

confidence: 99%

Perioperative complications of spine surgery in patients 80 years of age or older: a multicenter prospective cohort study

Watanabe

Kanayama

Takahata

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEThe number of spine surgeries performed in elderly patients is consistently increasing. However, to date the prevalence of and risk factors for perioperative complications remain unclear, especially in patients 80 years of age or older. This study had two goals: 1) determine the perioperative complications of spine surgery associated with patients 80 years of age or older; and 2) investigate the risk factors for perioperative systemic complications.METHODSIn this paper, the authors describe a multicenter prospective cohort study. Seven spine centers with board-certified spine surgeons participated in this all-case investigation. A total of 270 consecutively enrolled patients (109 males and 161 females), 80 years of age or older, underwent spine surgery between January and December 2017. Patients with trauma, infection, or tumor were excluded in this cohort. Perioperative complications were defined as adverse events that occurred intraoperatively or within 30 days postoperatively. The patients’ preoperative health status was determined using the following means of assessment: 1) the Charlson Comorbidity Index, 2) the American Society of Anesthesiologists Physical Status Classification System, 3) the Eastern Cooperative Oncology Group Performance Status (ECOG-PS), 4) the presence of sarcopenia, and 5) the Geriatric Nutritional Risk Index. Associations among patient age, preoperative health status, surgical factors (instrumentation surgery, operation time, number of spinal levels treated, and estimated blood loss), and perioperative systemic complications were analyzed.RESULTSOverall perioperative, surgical site, and minor systemic complications were observed in 20.0%, 8.1%, and 14.8% of patients, respectively. Major systemic complications, on the other hand, were not observed. The reoperation rate was low—only 4.1%. Multivariate analysis revealed that the ECOG-PS (p = 0.013), instrumentation surgery (p = 0.024), and an operation time longer than 180 minutes (p = 0.016) were associated with minor systemic complications.CONCLUSIONSTo the best of the authors’ knowledge, this is the first multicenter prospective all-case investigation of perioperative complications of spine surgery in elderly patients. Although decreased daily activity (ECOG-PS), instrumentation surgery, and longer operation time were associated with minor systemic complications, no major systemic complications were observed in these elderly patients. Thus, spine surgery can be safely performed in elderly patients 80 years of age or older.

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Risk Factors for Delirium After Spine Surgery in Extremely Elderly Patients Aged 80 Years or Older and Review of the Literature: Japan Association of Spine Surgeons with Ambition Multicenter Study

Cited by 47 publications

References 65 publications

Early Diagnosis Of Postoperative Delirium In Patients Who Underwent General Surgery

Early Diagnosis Of Postoperative Delirium In Patients Who Underwent General Surgery

Risk Factors of Postoperative Delirium in Older Adult Spine Surgery Patients: A Meta‐Analysis

Perioperative complications of spine surgery in patients 80 years of age or older: a multicenter prospective cohort study

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