Measures of Executive Function and Depression Predict Postoperative Delirium (original) (raw)
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Measures of Executive Function and Depression Identify Patients at Risk for Postoperative Delirium
Anesthesiology, 2009
Background: Postoperative delirium is associated with increased morbidity and mortality. Preexisting cognitive impairment and depression have been frequently cited as important risk factors for this complication. This prospective cohort study was designed to determine whether individuals who perform poorly on preoperative cognitive tests and/or exhibited depressive symptoms would be at high risk for the development of postoperative delirium.
Executive Function and Depression as Independent Risk Factors for Postoperative Delirium
Anesthesiology, 2009
Background: Postoperative delirium has been associated with greater complications, medical cost, and increased mortality during hospitalization. Recent evidence suggests that preoperative executive dysfunction and depression may predict postoperative delirium; however, the combined effect of these risk factors remains unknown. This study examined the association among preoperative executive function, depressive symptoms, and established clinical predictors of postoperative delirium among 998 consecutive patients undergoing major noncardiac surgery.
International Journal of Geriatric Psychiatry, 2019
ObjectivesDelirium is an important postoperative complication, yet predictive risk factors for postoperative delirium severity remain elusive. We hypothesized that the NSQIP risk calculation for serious complications (NSQIP‐SC) or risk of death (NSQIP‐D), and cognitive tests of executive function (Trail Making Tests A and B [TMTA and TMTB]), would be predictive of postoperative delirium severity. Further, we demonstrate how advanced statistical techniques can be used to identify candidate predictors.Methods/DesignData from an ongoing perioperative prospective cohort study of 100 adults (65 y old or older) undergoing noncardiac surgery were analyzed. In addition to NSQIP‐SC, NSQIP‐D, TMTA, and TMTB, participant age, sex, American Society of Anesthesiologists (ASA) score, tobacco use, surgery type, depression, Framingham risk score, and preoperative blood pressure were collected. The Delirium Rating Scale‐R‐98 (DRS) measured delirium severity; the Confusion Assessment Method (CAM) ide...
Cognitive Trajectories after Postoperative Delirium Paper Reviewed
2012
BACKGROUND Delirium is common after cardiac surgery and may be associated with long-term changes in cognitive function. We examined postoperative delirium and the cognitive trajectory during the first year after cardiac surgery. METHODS We enrolled 225 patients 60 years of age or older who were planning to undergo coronary-artery bypass grafting or valve replacement. Patients were assessed preoperatively, daily during hospitalization beginning on postoperative day 2, and at 1, 6, and 12 months after surgery. Cognitive function was assessed with the use of the Mini-Mental State Examination (MMSE; score range, 0 to 30, with lower scores indicating poorer performance). Delirium was diagnosed with the use of the Confusion Assessment Method. We examined performance on the MMSE in the first year after surgery, controlling for demographic characteristics, coexisting conditions, hospital, and surgery type. RESULTS The 103 participants (46%) in whom delirium developed postoperatively had lower preoperative mean MMSE scores than those in whom delirium did not develop (25.8 vs. 26.9, P<0.001). In adjusted models, those with delirium had a larger drop in cognitive function (as measured by the MMSE score) 2 days after surgery than did those without delirium (7.7 points vs. 2.1, P<0.001) and had significantly lower postoperative cognitive function than those without delirium, both at 1 month (mean MMSE score, 24.1 vs. 27.4; P<0.001) and at 1 year (25.2 vs. 27.2, P<0.001) after surgery. With adjustment for baseline differences, the between-group difference in mean MMSE scores was significant 30 days after surgery (P<0.001) but not at 6 or 12 months (P = 0.056 for both). A higher percentage of patients with delirium than those without delirium had not returned to their preoperative baseline level at 6 months (40% vs. 24%, P = 0.01), but the difference was not significant at 12 months (31% vs. 20%, P = 0.055). CONCLUSIONS Delirium is associated with a significant decline in cognitive ability during the first year after cardiac surgery, with a trajectory characterized by an initial decline and prolonged impairment. (Funded by the Harvard Older Americans Independence Center and others.)
Geriatrics
Postoperative delirium (POD) is an acute alteration of mental state, characterized by reduced awareness and attention, occurring up to five postoperative days after recovery from anesthesia. Several original studies and reviews have identified possible perioperative POD risk factors; however, there is no comprehensive review of the preoperative risk factors in patients diagnosed with POD using only validated diagnostic scales. The aim of this systematic review was to report the preoperative risk factors associated with an increased incidence of POD in patients undergoing non-cardiac and non-brain surgery. The reviewed studies included original research papers that used at least one validated diagnostic scale to identify POD occurrence for more than 24 h. A total of 6475 references were retrieved from the database search, with only 260 of them being suitable for further review. Out of the 260 reviewed studies, only 165 that used a validated POD scale reported one or more preoperative...
Preoperative Risk Assessment for Delirium After Noncardiac Surgery: A Systematic Review
Journal of the American Geriatrics Society, 2000
Delirium is a common postoperative complication in older adults associated with adverse events including functional decline, longer lengths of stay, and risk of institutionalization. The purpose of this article is to systematically review preoperative risk factors associated with delirium following noncardiac surgery.
Risk Factors for Early Delirium after Surgery
2019
Background: Although unrecognized, early postoperative delirium and cognitive dysfunction in the Intensive Care Unit (ICU) are relatively common. Aim: The present study has proposed to identify the risk factors for delirium and their early incidence after surgery, with a view to implementing a screening list for delirium in ICU (ICDSL). Method: 722 patients undergoing abdominal surgery, with general anesthesia, were prospectively monitored for the development of postoperative delirium during Intensive Care Unit (ICU) stay. Results: The incidence of postoperative delirium was 8.03% (58 cases). No statistically relevant prolongation predictors for delirium were found. The duration of surgery was double, thus significantly higher in the delirium group (2.5 ± 1 vs 1 ± 0.87 hours). Patients in the delusion group were transfused with blood products, had episodes of intraoperative cardiocirculatory decline, underwent protracted mechanical ventilation (averaging 1.15 hours longer), and the ...
British Journal of Surgery, 2010
Background: This study evaluated the incidence of postoperative delirium (POD) in elderly patients undergoing general surgery, the risk factors associated with POD, and its impact on hospital stay and mortality. Methods: Patients aged over 65 years who had emergency or elective operations were eligible for this case-control study. Risk factors significantly associated with POD using univariable analysis were entered into multivariable analysis, to establish those independently associated with POD. Results: A total of 351 patients (357 admissions) were enrolled in the study. The incidence of POD was 13•2 per cent (17•9 per cent for emergency operations). Independent variables associated with POD were: age above 75 years, co-morbidity, preoperative cognitive impairment, psychopathological symptoms and abnormal glycaemic control. Median length of hospital stay was 21 (range 1-75) days for patients with POD versus 8 (range 1-79) days for control patients (P < 0•001). The hospital mortality rate was 19 and 8•4 per cent respectively (P = 0•021). Conclusion: The incidence of POD is high in elderly patients for both emergency and elective surgery, leading to an increase in hospital stay and perioperative mortality. To minimize POD, associated risk factors of co-morbidity, cognitive impairment, psychopathology and abnormal glycaemic control must be identified and treated.
Risk factors for Delirium after major surgery
Annals of Clinical and Analytical Medicine, 2021
Aim: The high prevalence of delirium in surgical clinics and risk factors need to be determined for evidence-based practices to prevent the adverse effects it causes in the early period. This study aimed to determine the development of delirium and associated risk factors in patients over 65 years of age after major surgical intervention. Material and Method: This study was conducted as a descriptive and relation-seeker type study and it was held between September 2018-April 2019. Ageappropriate criteria for a total of 100 patients aged ≥65 who created the climb sample were used. The study used the Delirium Screening Scale (Nu-DESC) as data collection tools, Surgeon Before-During-Post-intervention Risk Factors Evaluation Form and a Mini-Mental Test. The SPPS 25.0 statistics package program was used to evaluate the data. Results: Delirium was more common in men aged 75 years and over who were using multiple drugs, long anesthesia duration, high serum cytokine levels, low hemoglobin and albumin levels, and the results were statistically significant (p<0.05). Discussion: Evidence-based effective treatment protocols for delirium after major surgery and risk factors for preventive interventions should be determined. When designing future delirium prevention strategies or in future etiological studies, they should focus on delirium-prone patients based on these risk factors.