Risk factors for delirium in elderly patients after lumbar spinal fusion

Gold, Colin; Ray, Emanuel; Christianson, D.W.; Park, Brian; Kournoutas, Ioannis A; Kahn, Taimur A; Perez, Eli A.; Berger, Joel I.; Sander, Katie; Igram, Cassim A.; Pugely, Andrew J.; Olinger, Catherine R; Carnahan, Ryan M.; Chen, Pei-Fu; Mueller, Rashmi N.; Hitchon, Patrick W.; Howard, Matthew A.; Banks, Matthew I.; Sanders, Robert D.; Woodroffe, Royce W.

doi:10.1016/j.clineuro.2022.107318

Cited by 12 publications

(9 citation statements)

References 40 publications

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“…As previously mentioned, ASA physical status was identified as an independent risk factor for POD. 31 , 32 In line with their results, our result demonstrated that high ASA physical status (≥3) can increase the likelihood of developing POD. ASA physical status is a preliminary assessment of the patient’s tolerance to anesthesia, mainly based on the damaged general physical condition and multiple comorbidities.…”

Section: Discussionsupporting

confidence: 89%

High ASA Physical Status and Low Serum Uric Acid to Creatinine Ratio are Independent Risk Factors for Postoperative Delirium Among Older Adults Undergoing Urinary Calculi Surgery

Liu

Gao

et al. 2023

CIA

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Purpose This study was to investigate the incidence and potential predictive factors for postoperative delirium (POD) in older people following urinary calculi surgery, and to establish the corresponding risk stratification score by the significant factors to predict the risk of POD. Patients and Methods We retrospectively analyzed the perioperative data of 195 patients aged 65 or older who underwent elective urinary calculi surgery between September 2020 and September 2022. POD was defined by chart-based method, and the serum uric acid to creatinine (SUA/Cr) ratio as well as neutrophil-to-lymphocyte ratio (NLR) were calculated, respectively. Identification of the risk factors for POD was performed by univariate and multivariate logistic regression analysis. Moreover, the risk stratification score was developed based on the regression coefficients of the associated variables. Results In 195 eligible patients following urinary calculi surgery, the median age was 69 (66–72) and 19 patients ultimately developed POD (9.7%). The results by univariate analysis showed that patients with advanced age, high American Society of Anesthesiologists (ASA) physical status (≥3) and low SUA/Cr ratio (≤3.3) were more likely to develop POD, but dexmedetomidine can significantly decrease the risk of the occurrence of POD. The multivariate analysis further indicated that high ASA physical status (≥3) and low SUA/Cr ratio (≤3.3) were independently associated with POD, and the POD incidence could obviously be elevated with the increase of risk stratification score. Moreover, patients with delirium had longer hospital stays. Conclusion POD is frequent in geriatric patients following urinary calculi surgery (9.7%). The high ASA physical status (≥3) and low SUA/Cr ratio (≤3.3) were effective predictors of POD. The corresponding risk stratification based on these factors could be beneficial to determining patients who are susceptible to POD, and thus better preventing and reducing the occurrence of POD. However, large prospective studies are needed to confirm this finding.

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Section: Discussionsupporting

confidence: 89%

High ASA Physical Status and Low Serum Uric Acid to Creatinine Ratio are Independent Risk Factors for Postoperative Delirium Among Older Adults Undergoing Urinary Calculi Surgery

Liu

Gao

et al. 2023

CIA

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“…and ultimately produce postoperative pain, which was often correlated with anxiety, depression, sleep disturbances, and postoperative cognitive dysfunction (Matsuda et al, 2019). One study by Gold et al (2022) showed that acute pain was a high-risk factor for POD in elderly patients after orthopedic surgery. Hence, early reduction of patients' postoperative pain would prevent POD to some extent, which might be related to lower levels of inflammatory factors.…”

Section: Discussionmentioning

confidence: 99%

Thoracic delirium index for predicting postoperative delirium in elderly patients following thoracic surgery: A retrospective case‐control study

Li,

Liu,

Zhang

et al. 2024

Brain and Behavior

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BackgroundPostoperative delirium (POD) is an acute neurological complication in the elderly undergoing thoracic surgery and can result in serious adverse consequences.AimsThis study aimed to identify the related risk factors for POD following thoracic surgery, primarily focusing on preoperative serum biomarkers, and further to establish a novel delirium index to better predict POD.MethodsA total of 279 patients aged ≥60 years who underwent elective thoracic surgery from August 2021 to August 2022 were enrolled in this observational study. The platelet‐to‐white blood cell ratio (PWR) was calculated as number the of platelets divided by the number of white blood cells. POD was defined by the confusion assessment method twice daily during the postoperative first 3 days. Multivariate regression analysis was performed to identify all potential variables for POD. Moreover, a novel thoracic delirium index (TDI) was developed based on the related risk factors. The accuracy of TDI and its component factors in predicting POD was determined by the curve of receiver operating characteristic (ROC).ResultsIn total, 25 of 279 patients developed POD (8.96%). Age, PWR, and average pain scores within the first 3 days after surgery were regarded as the independent risk factors for POD. Moreover, the ROC analysis showed the TDI, including age, PWR, and average pain scores within the first 3 days after surgery, can more accurately predict POD with the largest area under the curve of 0.790 and the optimal cutoff value of 9.072, respectively.ConclusionThe TDI can scientifically and effectively predict POD to provide optimal clinical guidance for older patients after thoracic surgery.

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“…In line with previous studies, 11,12 our findings support the notion that preoperative diabetes is a significant predictor of POD in elderly patients undergoing major orthopedic surgery. In contrast to recently published work which were retrospective studies without match, 29,30 the strength of the current study is its prospective matched cohort design with preoperative diabetes as the primary exposure, which minimizes confounding from age, sex, and surgery type. Another strength is the well identification of diabetes, with all diabetics confirmed with a known history or a new preoperative diagnosis, which decreased the likelihood of missed diabetes.…”

Section: Discussionmentioning

confidence: 99%

The Association of Preoperative Diabetes With Postoperative Delirium in Older Patients Undergoing Major Orthopedic Surgery: A Prospective Matched Cohort Study

Shang,

Jiang,

Fang

et al. 2024

Anesthesia &Amp; Analgesia

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BACKGROUND: Postoperative delirium (POD) is a common form of postoperative brain dysfunction, especially in the elderly. However, its risk factors remain largely to be determined. This study aimed to investigate whether (1) preoperative diabetes is associated with POD after elective orthopedic surgery and (2) intraoperative frontal alpha power is a mediator of the association between preoperative diabetes and POD. METHODS: This was a prospective matched cohort study of patients aged 60 years or more, with a preoperative diabetes who underwent elective orthopedic surgery. Nondiabetic patients were matched 1:1 to diabetic patients in terms of age, sex, and type of surgery. Primary outcome was occurrence of POD, assessed using the 3-minute Diagnostic Confusion Assessment Method (3D-CAM) once daily from 6 pm to 8 pm during the postoperative days 1–7 or until discharge. Secondary outcome was the severity of POD which was assessed for all participants using the short form of the CAM-Severity. Frontal electroencephalogram (EEG) was recorded starting before induction of anesthesia and lasting until discharge from the operating room. Intraoperative alpha power was calculated using multitaper spectral analyses. Mediation analysis was used to estimate the proportion of the association between preoperative diabetes and POD that could be explained by intraoperative alpha power. RESULTS: A total of 138 pairs of eligible patients successfully matched 1:1. After enrollment, 6 patients in the diabetes group and 4 patients in the nondiabetes group were excluded due to unavailability of raw EEG data. The final analysis included 132 participants with preoperative diabetes and 134 participants without preoperative diabetes, with a median age of 68 years and 72.6% of patients were female. The incidence of POD was 16.7% (22/132) in patients with preoperative diabetes vs 6.0% (8/134) in patients without preoperative diabetes. Preoperative diabetes was associated with increased odds of POD after adjustment of age, sex, body mass index, education level, hypertension, arrhythmia, coronary heart disease, and history of stroke (odds ratio, 3.2; 95% confidence interval [CI], 1.4–8.0; P = .009). The intraoperative alpha power accounted for an estimated 20% (95% CI, 2.6–60%; P = .021) of the association between diabetes and POD. CONCLUSIONS: This study suggests that preoperative diabetes is associated with an increased risk of POD in older patients undergoing major orthopedic surgery, and that low intraoperative alpha power partially mediates such association.

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Risk factors for delirium in elderly patients after lumbar spinal fusion

Cited by 12 publications

References 40 publications

High ASA Physical Status and Low Serum Uric Acid to Creatinine Ratio are Independent Risk Factors for Postoperative Delirium Among Older Adults Undergoing Urinary Calculi Surgery

High ASA Physical Status and Low Serum Uric Acid to Creatinine Ratio are Independent Risk Factors for Postoperative Delirium Among Older Adults Undergoing Urinary Calculi Surgery

Thoracic delirium index for predicting postoperative delirium in elderly patients following thoracic surgery: A retrospective case‐control study

The Association of Preoperative Diabetes With Postoperative Delirium in Older Patients Undergoing Major Orthopedic Surgery: A Prospective Matched Cohort Study

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