Post Operative Delirium: A Rare Complication in Orthognathic Surgery

Abstract

Delirium is described by the Diagnostic and Statistical Manual of Mental Disorders as an acute condition of fluctuating consciousness impacting one’s ability to focus with abnormal attention and is accompanied by cognitive changes and perceptual disturbances as the result of a general medical condition. Post-operative delirium is a known complication seen as a sequela in various types of surgery that has a positive correlation with increased risk for extended hospital stay, increasing costs, and agitation causing difficulty with patient compliance and comfort. Special attention for this condition has been given to patients undergoing cardiac surgery (incidence 10-60%), major orthopedic surgery (incidence 4-53%), head and neck cancer surgery (incidence 26.3%), and more generally among elderly patients (13.2-17.9%), but should be a recognized complication in various other populations. POD may be seen in a hyperactive form, a hypoactive form, and a mixed form. Because of this variability in presentation, post-operative delirium can often go misdiagnosed or unnoticed all together. Several resources have been developed, particularly in the ICU setting, to identify delirium (CAM, CAM-ICU), but these still lack accuracy and have some shortcomings differentiating types of post-operative delirium. No standard labs or imaging studies have been found effective at identifying or assessing post-operative delirium to date, only to rule out other acute processes. A retrospective chart review of 101 orthognathic patients was performed to see whether signs of post-operative delirium could be identified in documentation, linked to known risk factors in literature, and demonstrate a correlation with increased hospital stay.