Incidence Of Delirium In Elderly Patients Research Articles

The Potential Value of Prehabilitation for Preventing Delirium in Elective Surgery for Aneurysms of the Abdominal Aorta.

Delirium is a common and serious postoperative complication in elderly patients undergoing abdominal aortic aneurysm (AAA) repair and is associated with a variety of adverse outcomes. Multimodal prehabilitation aims to identify and minimize potential risk factors for delirium and improve overall health. The aim of this study is to investigate the effect of multimodal prehabilitation on delirium incidence in elderly patients undergoing elective repair for AAA. A single-centre cohort analysis was performed in the Netherlands for patients aged ≥70 years, undergoing elective repair for AAA (open surgery and endovascular aortic repair). Prehabilitation was gradually introduced between 2016 and 2019 and offered as standard care from 2019. The program was constructed to optimize overall health and included delirium risk assessment, home-based tailor-made exercises by a physical therapist, nutritional optimization by a dietician, iron infusion in case of anaemia and a comprehensive geriatric assessment by a geriatrician in case of frailty. The primary outcome was incidence of delirium within 30 days after surgery. A total of 81 control and 123 prehabilitation patients were included. A reduction in incidence of delirium was found (11.1% in the control group to 4.9% in the prehabilitation group), with too small numbers to reach statistical significance (p=0.09). Also, patients in the prehabilitation group had a small, non-significant decreased length of hospital stay (4 days) compared to the control group (5 days) (p=0.07). Although no significant differences were found, we carefully conclude that this study provides some support for implementing multimodal prehabilitation for delirium prevention in elderly patients undergoing AAA repair. Further research with larger cohorts is necessary to identify and select patients that would most benefit from prehabilitation.

Effect of reducing-opioids consumption on postoperative delirium incidence in elderly patients after gastric cancer surgery

Objective: To evaluate the effect of reducing-opioids on postoperative delirium (POD) incidence in elderly patients with gastric cancer surgery. Methods: From July 2016 to September 2021, 130 elderly patients undergoing scheduled gastric cancer surgery in Zhejiang Cancer Hospital were selected and divided into conventional opioid general anesthesia group (group A) and reducing-opioids general anesthesia group (group B) according to random number table. Postoperative analgesic pump formula: group A: 0.2% ropivacaine and 1 μg/ml sufentanil solution; Group B: 0.2% ropivacaine solution. POD assessment was performed once daily between 8 am and 8 pm for 3 days after surgery. The primary outcome measures were POD incidence 3 days after surgery, and the secondary outcome measures included anaesthesia related adverse events 3 days after surgery, such as nausea and vomiting, postoperative fever and fatigue. Results: Among the 130 patients, 7 patients were excluded because they did not comply with the POD test after operation. Finally, 123 elderly patients completed the study. There were 59 cases in group A, aged (73±5) years, including 45 males, and 64 cases in group B, aged (71±6) years, including 56 males. The incidence of total POD 3 days after surgery in group A and B was 30.5% (18/59) and 18.8% (12/64), respectively, with no statistical significance (P>0.05). However, POD incidence at 48 and 72 h after operation in group A [27.1% (16/59) and 16.9% (10/59)] was higher than that in group B [10.9% (8/64) and 4.7% (3/64), both P<0.05]. The incidence of nausea and vomiting in group A was higher than that in group B [15.3% (9/59) vs 1.6% (1/64), P<0.05]. Conclusion: Reducing-opioids consumption have no effect on the incidence of total POD 3 d after gastric cancer surgery in elderly patients, but can reduce the risk of POD 48-72 h after surgery.

A randomized control trial comparing prophylactic dexmedetomidine versus clonidine on rates and duration of delirium in older adult patients undergoing coronary artery bypass grafting.

Postoperative delirium occurs in 20-50% of elderly patients undergoing cardiac surgery and increases morbidity and mortality. We investigated whether prophylactic dexmedetomidine could reduce delirium incidence in elderly patients after coronary artery bypass grafting (CABG), compared with clonidine. Prospective observational trial. Academic university hospital. Patients (60-70 years old) who underwent CABG and received either dexmedetomidine or clonidine infusion postoperatively. Patients were randomly allocated to dexmedetomidine or clonidine groups. In the dexmedetomidine group, patients received an initial infusion of 0.7-1.2 μg/kg/h; sedation and analgesia were evaluated after 45-60 min. If the Richmond assessment sedation score (RASS) increased from +1 to +4, the infusion rate was increased by 0.1-0.2 μg/kg/h every 30 min, up to 1-1.4 μg/kg body-weight/h. Dexmedetomidine infusion was not discontinued pre-extubation; thereafter, infusion was reduced by 0.1 μg/kg/h until 0.2 μg/kg/h. The maximum infusion duration was 72 h. In the clonidine group, patients received an initial infusion of 0.5 μg/kg, followed by 1-2 μg/kg/h, if the RASS changed from +1 to +4. This was continued throughout mechanical ventilation. Patients were followed up to 5 days post-surgery. Delirium incidence, extubation time, lengths of intensive care unit (ICU) and hospital stay, need for inotropic support or vasopressors, mean arterial blood pressure and heart rate, hospital mortality rate, total postoperative morphine dose, number of patients receiving haloperidol, and adverse events were recorded. Two-hundred-and-eighty-six patients (dexmedetomidine, 144; clonidine, 142) were studied. Dexmedetomidine was associated with lower risk and duration of delirium, shorter mechanical ventilation duration and ICU stay, lower mortality rate, and lower morphine consumption than the clonidine group. Dexmedetomidine significantly decreased heart rates after ICU admission. Postoperative infusion of dexmedetomidine provides a feasible option for postoperative control of delirium after CABG in adult patients.

Multimodal prehabilitation to reduce the incidence of delirium and other adverse events in elderly patients undergoing elective major abdominal surgery: An uncontrolled before-and-after study

BackgroundDelirium is a common and serious complication in elderly patients undergoing major abdominal surgery, with significant adverse outcomes. Successful strategies or therapies to reduce the incidence of delirium are scarce. The objective of this study was to assess the role of prehabilitation in reducing the incidence of delirium in elderly patients.MethodsA single-center uncontrolled before-and-after study was conducted, including patients aged 70 years or older who underwent elective abdominal surgery for colorectal carcinoma or an abdominal aortic aneurysm between January 2013 and October 2015 (control group) and between November 2015 and June 2018 (prehabilitation group). The prehabilitation group received interventions to improve patients’ physical health, nutritional status, factors of frailty and preoperative anaemia prior to surgery. The primary outcome was incidence of delirium, diagnosed with the DSM-V criteria or the confusion assessment method. Secondary outcomes were additional complications, length of stay, unplanned ICU admission, length of ICU stay, readmission rate, institutionalization, and in-hospital or 30-day mortality.ResultA total of 360 control patients and 267 prehabilitation patients were included in the final analysis. The mean number of prehabilitation days was 39 days. The prehabilitation group had a higher burden of comorbidities and was more physically and visually impaired at baseline. At adjusted logistic regression analysis, delirium incidence was reduced significantly from 11.7 to 8.2% (OR 0.56; 95% CI 0.32–0.98; P = 0.043). No statistically significant effects were seen on secondary outcomes.ConclusionCurrent prehabilitation program is feasible and safe, and can reduce delirium incidence in elderly patients undergoing elective major abdominal surgery. This program merits further evaluation.Trial registrationDutch Trial Registration, NTR5932.

Influence of Parecoxib combined with Morphine on delirium incidence in elderly patients

Objectives To investigate the influence of multimodel analgesia of Parecoxib combined with Morphine on delirium in elderly patients. Methods Patients aged 60-85 years scheduled for thoracic surgery, general surgery or orthopedic surgery were randomized into Parecoxib combined with Morphine group(PM group)or Morphine alone group(M group). All patients in two groups received the same regimen of Morphine for patient controlled intravenous analgesia(PCIA)after operation.Patients in PM group received the first dose of Parecoxib 40 mg at the end of surgery, and then received parecoxib 40 mg per dose at 12-hour interval until postoperative 72 hours.Patients in M group received normal saline instead of Parecoxib.Incidence rate of delirium was evaluated during 1st to 5th postoperative day(confusion assessment method for the intensive are unit). The visual analogue score(VAS), daily morphine consumption, presence of nausea and vomiting(PONV), Blood urea nitrogen, serum creatinine, alanine aminotransferase, aspartate aminotransferase, prothrombin time, activated partial throboplastin time, and international normallized ratios on 1st to 3rd postoperative day were recorded and compared between the two groups. Results The delirium incidence during 5 days after operation was 4.3%(11/257)in PM group, and 6.8%(17/250)in morphine alone group(P>0.05). From 1st to 3rd postoperative day, PM group versus M group showed that VAS was lower(P<0.01), consumption of Morphine was lower(P<0.05), incidence of PONV was lower(P<0.05). Conclusions Parecoxib combined with morphine used in the elderly patients improves postoperative analgesia, reduces morphine consumption and incidence of PONV, but has no significant effect on delirium incidence. Key words: Abortifacient agents, nonsteroidal; Delirium; Analgesia