Abstract

BackgroundAlthough postoperative delirium is a frequent complication of surgery, little is known about risk factors for delirium occurring in the post-anaesthesia care unit (PACU). The aim of this study was to determine pre- and intraoperative risk factors for the development of recovery room delirium (RRD) in patients undergoing elective non-cardiovascular surgery.MethodsRRD was diagnosed according to the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). We collected perioperative data in 228 patients undergoing elective non-cardiovascular surgery under general anaesthesia and performed univariate and multivariate logistic regression to identify risk factors related to RRD. PACU and postoperative events were recorded to assess the outcome of RRD.ResultsFifty-seven patients (25%) developed RRD. On multivariate analysis, maintenance of anaesthesia with inhalation anaesthetic agents (OR = 6.294, 95% CI 1.4–28.8, corrected p = 0.03), malignant primary disease (OR = 3.464, 95% CI = 1.396–8.592, corrected p = 0.018), American Society of Anaesthesiologists Physical Status (ASA-PS) III–V (OR = 3.389, 95% CI = 1.401–8.201, corrected p = 0.018), elevated serum total or direct bilirubin (OR = 2.535, 95% CI = 1.006–6.388, corrected p = 0.049), and invasive surgery (OR = 2.431, 95% CI = 1.103–5.357, corrected p = 0.035) were identified as independent risk factors for RRD. RRD was associated with higher healthcare costs (31,428 yuan [17,872–43,674] versus 16,555 yuan [12,618–27,788], corrected p = 0.002), a longer median hospital stay (17 days [12–23.5] versus 11 days [9–17], corrected p = 0.002), and a longer postoperative stay (11 days [7–15] versus 7 days [5–10], corrected p = 0.002]).ConclusionsIdentifying patients at high odds for RRD preoperatively would enable the formation of more timely postoperative delirium management programmes.

Highlights

  • Delirium is an acute brain organ dysfunction characterized by changes in level of consciousness, inattention, and disorganized thinking

  • Identifying patients at high odds for recovery room delirium (RRD) preoperatively would enable the formation of more timely postoperative delirium management programmes (Munk et al 2016)

  • We used the Confusion Assessment Method (CAM)-ICU to investigate the proportion of and risk factors associated with RRD in post-anaesthesia care unit (PACU) after elective non-cardiovascular surgery under general anaesthesia

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Summary

Introduction

Delirium is an acute brain organ dysfunction characterized by changes in level of consciousness, inattention, and disorganized thinking. Identifying patients at high odds for RRD preoperatively would enable the formation of more timely postoperative delirium management programmes (Munk et al 2016). In this prospective study, we used the CAM-ICU to investigate the proportion of and risk factors associated with RRD in PACU after elective non-cardiovascular surgery under general anaesthesia. The aim of this study was to determine preand intraoperative risk factors for the development of recovery room delirium (RRD) in patients undergoing elective non-cardiovascular surgery

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