Risk factors of post-operative delirium after elective vascular surgery in the elderly: A systematic review

Raats, Jelle W; Lange, D; Laan, Lijckle van der

doi:10.1016/j.ijsu.2016.09.001

Cited by 73 publications

(76 citation statements)

References 36 publications

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“…Delirium is characterized by acute confusion with changes in perception, attention, cognition, and sensation in complex mental status [5]. The mental status of the patient is suddenly changed to be insensitive toward time, places, and individuals [6].…”

Section: Definitions Of the Characteristics Of Elderly Deliriummentioning

confidence: 99%

“…Demographic and physical factors are age, gender, hospitalized days, institutionalization, trauma history, surgery, heart and lung illness, hypertension, diabetes, chronic kidney failure, gastrointestinal diseases, urinary and genital illness, metabolic disorders, central nervous system illness, peripheral vascular disease, stroke, dementia, malnutrition, fever, low albumin, low oxygen, dehydration, electronic imbalance, azotemia, infection, convulsion, and multiple or pain medications [1,2,4,5,[7][8][9][11][12][13][14][15][16][17][18]. Specifically, 3% to 5% of elderly people who have had hip and knee surgeries would experience acute confusion or delirium for a specific period.…”

Section: Related Factors Of Elderly Deliriummentioning

confidence: 99%

“…Therefore, insufficient pre-surgery assessments and post-surgery complications are factors related to elderly delirium [6,19]. The functional, cognitive, psychosocial, and other factors are decreases in energy, activities of daily living and instrumental activities of daily living, and cognition, as well as increases in sleep disturbances, depression, social isolation, long-term bed rests, environmental overstimulus, catheter use, and need for restraint [2,5,[7][8][9][10]14,16,17].…”

Section: Related Factors Of Elderly Deliriummentioning

confidence: 99%

“…The assessment scales [1,2,4,5,[7][8][9][10][11][12][14][15][16] used to measure elderly delirium include medical diagnosis systems such as DSM-III-R, DSM-IV, and DSM-IV-TR, as well as cognitive assessment scales such as the short portable mental status questionnaire (SPMSQ) [20], the minimental status examination (MMSE) [21], the confusion assessment method-ICU (CAM-ICU) [22,23], the Groningen Frailty Indicator (GFI) [24] and Hasegawa's Dementia Scale-Revised (HDS-R) [25].…”

Section: Assessment Scales Of Elderly Deliriummentioning

confidence: 99%

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Integrate Literature Review of Delirium on the Elders

Chen¹,

Ku²

2017

J Gerontol Geriatr Res

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Delirium is a common problem for elderly hospitalized patients and those transferred from one place to another. The risk of delirium increases considerably with age. This article provides an integrated review of the literature on delirium in elderly patients; on the basis of this review, the characteristics of elderly delirium can be defined as follows: acute confusion with fluctuating changes in consciousness, orientation, attention, perceptions, emotion, thinking, sleeping patterns, and behaviors, which could develop and disappear in a short period. The related factors of elderly delirium include demographic and physical factors, as well as cognitive, functional, psychosocial, and other factors. Furthermore, scales for assessing elderly delirium include the short portable mental status questionnaire, mini-mental status examination, Confusion Assessment Method-ICU (CAM-ICU), delirium observation screening scale, NEECHAM Confusion Scale, Groningen Frailty Indicator, and Hasegawa's Dementia Scale-Revised. Although the CAM-ICU has the least items and affords the fastest assessment, it lacks the items to measure orientation, perceptions, emotions, sleeping patterns, and behaviors, which are the characteristics of elderly delirium identified in the integrated literature review. Based on the literature review findings, the authors recommend that future studies should develop a comprehensive delirium assessment scale for elderly patients, including the related factors and defining characteristics, thus enabling health care professionals to care for and manage delirium problems effectively and efficiently. Moreover, the authors suggest developing an assessment scale to distinguish between the three problems (delirium, dementia, and depression) and reduce misdiagnosis rates, which would result in reduced hospitalization times, death rates, cost to the health care system, and patients being transferred to nursing homes.©

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Section: Definitions Of the Characteristics Of Elderly Deliriummentioning

confidence: 99%

Section: Related Factors Of Elderly Deliriummentioning

confidence: 99%

Section: Related Factors Of Elderly Deliriummentioning

confidence: 99%

Section: Assessment Scales Of Elderly Deliriummentioning

confidence: 99%

See 2 more Smart Citations

Integrate Literature Review of Delirium on the Elders

Chen¹,

Ku²

2017

J Gerontol Geriatr Res

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“…The leading risk factors consistently identified in this systematic review were advanced age and cognitive impairment. Multi-disciplinary specialist-led interventions in the preoperative phase could decrease incidence and severity of delirium and should be focused on identified highrisk patients [16].…”

mentioning

confidence: 99%

Untitled

2017

JACCOA

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Postoperative delirium (POD) is a common and serious adverse event in the elderly patient and is associated with significant morbidity and mortality. A new treatment for POD by intravenous Intralipid injection in the recovery room is first suggested in the medical literature.Keywords: Postoperative delirium; Postoperative cognitive dysfunction; Intralipid Post Operative DeliriumDelirium is defined by either the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) [1] or by the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD 10, Table 3) [2]. Delirium is an acute and fluctuating alteration of mental state of reduced awareness and disturbance of attention. POD (Post Operative Delirium) often starts in the recovery room and occurs up to 5 days after surgery [3][4][5]. One investigation [4] found that many patients with POD on the peripheral ward already had POD in the recovery room.More than 230 million surgical procedures are performed each year worldwide, of which more than 80 million are in Europe [6][7][8]. In Europe, the in-hospital mortality rate up to a maximum of 60 days is 3% after elective surgery and nearly 10% after emergency surgery [7]. In addition to mortality, postoperative cognitive impairments such as POD and postoperative cognitive dysfunction (POCD) impose a huge burden on individuals and society [9]. The incidence of POD is dependent on perioperative and intraoperative risk factors [10]. Therefore, the incidence of POD varies within a broad range [11,12]. For example, a metaanalysis of 26 studies of POD reported an incidence of 4.0 to 53.3% in hip fracture patients and 3.6 to 28.3% in elective patients [13].Delirium is one of the most common complications following hip fracture surgery in older people. This study identified pre-and peri-operative factors associated with the development of postoperative delirium following hip fracture surgery.Published and unpublished literature were searched to identify all evidence reporting variables on patient characteristics, onadmission, intra-operative and post-operative management assessing incident delirium in older people following hip fracture surgery. Pooled odds ratio (OR) and mean difference of those who experienced delirium compared to those who did not were calculated for each variable. Evidence was assessed using the Downs and Black appraisal tool and interpreted using the GRADE approach.A total of 6704 people (2090 people with postoperative delirium) from 32 studies were analyzed. There was moderate evidence of nearly a two-times greater probability of post-operative-delirium for those aged 80 years and over (OR: 1.77; 95% CI: 1.09, 2.87), whether patients lived in a care institution pre-admission (OR: 2.65; 95% CI: 1.79, 3.92), and a six-times greater probability of developing post-operative delirium with a pre-admission diagnosis of dementia (OR: 6.07, 95% CI: 4.84, 7.62). There was no association with intra-operative variables and probability of deliri...

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Randomized clinical trial of intraoperative dexmedetomidine to prevent delirium in the elderly undergoing major non-cardiac surgery

Li¹,

Wang²,

Mu³

et al. 2020

British Journal of Surgery

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Background Delirium is common in elderly patients after surgery and is associated with poor outcomes. This study aimed to investigate the impact of intraoperative dexmedetomidine on the incidence of delirium in elderly patients undergoing major surgery. Methods This was a randomized double‐blind placebo‐controlled trial. Elderly patients (aged 60 years or more) scheduled to undergo major non‐cardiac surgery were randomized into two groups. Patients in the intervention group received a loading dose of dexmedetomidine 0·6 μg/kg 10 min before induction of anaesthesia followed by a continuous infusion (0·5 μg per kg per h) until 1 h before the end of surgery. Patients in the control group received volume‐matched normal saline in the same schedule. The primary outcome was the incidence of delirium during the first 5 days after surgery. Delirium was assessed with the Confusion Assessment Method (CAM) for non‐ventilated patients and CAM for the Intensive Care Unit for ventilated patients. Results In total, 309 patients who received dexmedetomidine and 310 control patients were included in the intention‐to‐treat analysis. The incidence of delirium within 5 days of surgery was lower with dexmedetomidine treatment: 5·5 per cent (17 of 309) versus 10·3 per cent (32 of 310) in the control group (relative risk (RR) 0·53, 95 per cent c.i. 0·30 to 0·94; P = 0·026). The overall incidence of complications at 30 days was also lower after dexmedetomidine (19·4 per cent (60 of 309) versus 26·1 per cent (81 of 310) for controls; RR 0·74, 0·55 to 0·99, P = 0·047). Conclusion Intraoperative dexmedetomidine halved the risk of delirium in the elderly after major non‐cardiac surgery. Registration number: ChiCTR‐IPR‐15007654 ( http://www.chictr.org.cn).

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Risk factors of post-operative delirium after elective vascular surgery in the elderly: A systematic review

Cited by 73 publications

References 36 publications

Integrate Literature Review of Delirium on the Elders

Integrate Literature Review of Delirium on the Elders

Untitled

Randomized clinical trial of intraoperative dexmedetomidine to prevent delirium in the elderly undergoing major non-cardiac surgery

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