Abstract
In patients undergoing major surgery, complete handover of intraoperative anesthesia care is associated with adverse postoperative outcomes including high mortality and more major complications. The purpose of this study was to explore the association between the intraoperative complete handover between anesthesiologists and the occurrence of postoperative delirium. This was a secondary analysis of the database of a previously published clinical trial. Seven hundred patients aged 65 years or older, who were admitted to the intensive care unit after noncardiac surgery, were included. Delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit twice daily during the first 7 postoperative days. Other postoperative outcomes were also monitored. The association between the intraoperative complete handover of anesthesia care and the development of postoperative delirium was analyzed with a logistic regression model. Of the 700 enrolled patients, 111 (15.9%) developed postoperative delirium within 7 days. After correction for confounding factors, intraoperative complete handover between anesthesiologists was associated with an increased risk of postoperative delirium (OR 1.787, 95% CI 1.012–3.155, P = 0.046). Patients with intraoperative complete handover also had higher incidence of non-delirium complications (P = 0.003) and stayed longer in hospital after surgery (P = 0.002). For elderly patients admitted to the intensive care unit after noncardiac surgery, intraoperative complete handover of anesthesia care was associated with an increased risk of postoperative delirium. Chinese Clinical Trial Registry (http://www.chictr.org.cn): ChiCTR-TRC-10000802.
Highlights
Delirium is an acutely occurring cerebral dysfunction characterized with transient and fluctuating disturbances in attention, consciousness and cognition
Compared with patients without completed handover of anesthesia care, those with complete handover were younger (P = 0.001), suffered less hypertension before surgery (P = 0.045), underwent longer anesthesia and surgery and more major or complex surgery (P = 0.006), lost more blood but received more fluid infusion and blood transfusion during surgery, and received more mechanical ventilation as well as propofol sedation during intensive care unit (ICU) stay after surgery (Tables 1, 2)
Apart from complete handover of anesthesia care, univariate analyses identified nine other factors that were associated with the risk of delirium development after surgery, including age, body mass index (BMI), previous stroke, preoperative albumin < 30 g/L, intraoperative etomidate, ICU admission with intubation, prophylactic dexmedetomidine, postoperative propofol within 7 days, and pathologically diagnosed cancer (Online Resource 2)
Summary
Delirium is an acutely occurring cerebral dysfunction characterized with transient and fluctuating disturbances in attention, consciousness and cognition. With the aging population and the increasing number of surgical cases [10, 11], intraoperative handover of anesthesia care is inevitable in some cases due to personal problem, such as fatigue or illness, or department commitments [12]. Studies showed that a high proportion of intraoperative handover between anesthesiologists is insufficient [14], and that complete handover of anesthesia care is associated with worse outcomes, including increased all-cause death and major complications within 30 days after surgery [13]. The impact of anesthesia handover on postoperative delirium remains unclear
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