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

Abstract

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.

Perioperative Care of Patients Undergoing Major Complex Spinal Instrumentation Surgery: Clinical Practice Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care

“…Preadmission evaluation has many potential benefits, including risk stratification, frailty assessment, identification of the need for postoperative resources in high-risk patients (eg, intensive care and pain services), 31 patient education regarding expectations for pain control and quality of life after the surgery, identification of patients who might benefit from prehabilitation and physiotherapy, and those at risk for postoperative delirium. [33][34][35][36] Commonly reported frailty assessment tools are the frailty index, 37 modified 5-item frailty index, 28 frailty-based score, 38 the clinical frailty scale, 39 the metastatic spinal tumor frailty index, 29,40 and the FRAIL scale. 34 It is hypothesized that the surgical procedure may improve postoperative frailty if deficits improve.…”

Risk Factors for Delirium in Elderly Patients After Lumbar Spinal Fusion

“…The wide range of the reported incidence in the literature may be partly due to different inclusion criteria such as age, the type of spine surgery, use of instrumentation, the methods used for, and the frequency of, assessing for delirium. The average reported rate of postoperative delirium in the literature appears to be greater in prospective studies compared to retrospective ones (35% vs. 11%) [3,4,[21][22][23][24] A meta-analysis including two prospective studies and three retrospective ones reported an incidence of 13%. [4] Moreover, delirium waxes and wanes 1 and even twice daily assessments as performed at our institution could have missed delirious episodes.…”

“…The average reported rate of postoperative delirium in the literature appears to be greater in prospective studies compared to retrospective ones (35% vs. 11%) [3,4,[21][22][23][24] A meta-analysis including two prospective studies and three retrospective ones reported an incidence of 13%. [4] Moreover, delirium waxes and wanes 1 and even twice daily assessments as performed at our institution could have missed delirious episodes. Therefore, given the fluctuating nature of delirium and the retrospective nature of this study, it is possible that the true incidence of postoperative delirium is higher than we observed.…”

“…Delirium is an abrupt disturbance of cognition and consciousness and is characterized by a decreased ability to sustain or shift attention, impairment of memory and executive function, and fluctuation in arousal levels. [1] The incidence of delirium after surgery has been reported to be approximately 20% in patients having spine surgery, [2][3][4] and as high as 50-80% in critically ill patients. [2][3][4] It is especially prevalent in the elderly population with almost a 15-fold increase in patients over the age of 70 years.…”

“…[1] The incidence of delirium after surgery has been reported to be approximately 20% in patients having spine surgery, [2][3][4] and as high as 50-80% in critically ill patients. [2][3][4] It is especially prevalent in the elderly population with almost a 15-fold increase in patients over the age of 70 years. [5] Postoperative delirium, with its associated high rate of other complications, functional decline, and mortality, inflicts an immense burden on patients, the healthcare industry and society.…”