Incidence of and risk factors for postoperative delirium in older adult patients undergoing noncardiac surgery: a prospective study

Arissara Iamaroon,Onuma Chaiwat,Patumporn Sura-Arunsumrit,Nichakarn Rewuri,Nattikan Wiwatnodom,Titima Wongviriyawong

doi:10.1186/s12877-020-1449-8

Arissara Iamaroon, Onuma Chaiwat + Show 4 more

Open Access

https://doi.org/10.1186/s12877-020-1449-8

Copy DOI

Journal: BMC Geriatrics	Publication Date: Feb 3, 2020
Citations: 50	License type: open-access

Affiliation: Siriraj Hospital, Mahidol University

Abstract

BackgroundTo identify the incidence of, risk factors for, and outcomes associated with postoperative delirium (POD) in older adult patients who underwent noncardiac surgery.MethodsThis prospective study recruited patients aged ≥ 60 years who were scheduled to undergo noncardiac surgery at Siriraj Hospital (Bangkok, Thailand). Functional and cognitive statuses were assessed preoperatively using Barthel Index (BI) and the modified Informant Questionnaire on Cognitive Decline in the Elderly, respectively. POD was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition criteria. Incidence of POD was reported. Univariate and multivariate analyses were used to identify risk factors for POD.ResultsOf the 249 included patients, 29 (11.6%) developed POD. Most patients (61.3%) developed delirium on postoperative day 1. Univariate analysis showed age ≥ 75 years, BI score ≤ 70, pre-existing dementia, preoperative use of opioid or benzodiazepine, preoperative infection, and hematocrit < 30% to be significantly associated with POD. Multivariate logistic analysis revealed pre-existing dementia (adjusted risk ratio [RR]: 3.95, 95% confidence interval [CI]: 1.91–8.17; p < 0.001) and age ≥ 75 years (adjusted RR: 2.54, 95% CI: 1.11–5.80; p = 0.027) to be independent risk factors for POD. Median length of hospital stay was 10 (range: 3–36) days for patients with POD versus 6 (range: 2–76) days for those without delirium (p < 0.001).ConclusionsPOD remains a common surgical complication, with an incidence of 11.6%. Patients with pre-existing dementia and age ≥ 75 years are the most vulnerable high-risk group. A multidisciplinary team consisting of anesthesiologists and geriatricians should implement perioperative care to prevent and manage POD.

Highlights

To identify the incidence of, risk factors for, and outcomes associated with postoperative delirium (POD) in older adult patients who underwent noncardiac surgery
Only preexisting dementia and age ≥ 75 years remained significantly associated with POD in patients undergoing noncardiac surgery (Table 3)
Delirium superimposed on dementia (DSD) is the term used for delirium that occurs in patients with preexisting dementia [28]

Summary

Introduction

To identify the incidence of, risk factors for, and outcomes associated with postoperative delirium (POD) in older adult patients who underwent noncardiac surgery. Delirium is a common postoperative complication that occurs in 5 to 52% of older adult patients after noncardiac surgery [1, 2]. The development of delirium following surgery has some significant potential effects on patient outcomes; POD is often underdiagnosed. Some studies reported that more than 50% of Iamaroon et al BMC Geriatrics (2020) 20:40 patients with delirium were undiagnosed by medical teams [11,12,13]. Clinical studies of incidence and risk factors associated with POD may provide additional useful clues to the optimal perioperative care of older adult surgical patients at risk for delirium. Risk identification may help clinicians provide patient-specific management during the perioperative period

Objectives

Methods

Results

Discussion

Conclusion