Predictors Of Postoperative Delirium Research Articles

Systemic immune inflammatory index (SII) and systemic inflammatory response index (SIRI) as predictors of postoperative delirium in patients undergoing off-pump coronary artery bypass grafting (OPCABG) with cerebral infarction

ObjectivePostoperative delirium (POD) is a common complication following off-pump coronary artery bypass grafting (OPCABG) and is associated with significant morbidity. This study aims to evaluate the correlation of systemic immune inflammatory index (SII) and systemic inflammatory response index (SIRI) with postoperative delirium (POD) in patients with cerebral infarction undergoing OPCABG.MethodsThe perioperative cohort study included 321 patients who underwent OPCABG. Patients were divided into two groups based on the occurrence of POD: the delirium group (n = 113) and the non-delirium group (n = 208). Baseline characteristics, including gender, left ventricular ejection fraction (LVEF), surgery duration, hypertension, age, and smoking history were analyzed. SII and SIRI values were calculated preoperatively, and their association with POD was assessed using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were used to evaluate the predictive accuracy of SII and SIRI.ResultsStatistical differences between SII and SIRI in the two groups (P < 0.05) were observed. Multivariate analysis confirmed that SII and SIRI, age and preoperative smoking history were predictors of POD. ROC curve analysis demonstrated that SII and SIRI had considerable predictive power, with AUC values of 0.73 (0.67–0.79) for SII and 0.75 (0.69–0.81) for SIRI.ConclusionSII and SIRI were found to be associated with an increased risk of POD in patients undergoing OPCABG, but further research is needed to confirm these findings and determine their independence as risk factors.

The role of C-reactive protein as a risk marker of postoperative delirium in older hip fracture patients: a prospective cohort study.

Postoperative delirium (POD) is a common and serious neuropsychiatric syndrome that leads to higher morbidity and mortality. We investigated the association between serum C-reactive protein (CRP) and the occurrence of POD in older hip fracture patients, and whether CRP predicted POD better than a clinical model. Patients aged ≥ 75years admitted for surgical repair of an acute hip fracture were recruited. We compared serum CRP levels between patients with and without POD. Sixty patients were included, of whom 21 (35%) developed POD. Serum CRP levels were significantly higher in patients who developed delirium (p = 0.011). In a multiple regression model including clinical variables and CRP, cognitive impairment (p = 0.003) and infection (p = 0.001) were the best predictors of POD. Although higher levels of serum CRP were significantly associated with POD in older hip fracture patients, pre-existing cognitive impairment and infections were the most important risk factors for POD.

C reactive protein albumin ratio as a new predictor of postoperative delirium after cholecystectomy for acute cholecystitis

Postoperative delirium (POD) is one of the most common complications of surgery. This study aimed to identify the risk factors for POD in patients undergoing cholecystectomy for acute cholecystitis. This retrospective study included 77 patients who underwent cholecystectomy for acute cholecystitis between January 2015, and December 2020. Multiple logistic regression analysis was used to identify the factors associated with the development of delirium as the primary endpoint. Patients were divided into POD (n = 18) and non-POD (n = 59) groups and their demographic features and clinical results were compared. A significant model associated with delirium onset was predicted (Nagelkerke’s R2 = 0.382), and the significantly correlated factors were C-reactive protein/albumin ratio (CAR), Subjective Global Assessment (SGA) score, and history of psychiatric disease. The predictive value of CAR for POD was evaluated using ROC analysis; the area under the curve of CAR was 0.731, with a cutoff value of 3.69. CAR, SGA score, and a history of psychiatric disease were identified as factors associated with the development of POD in patients with acute cholecystitis. In particular, the new preoperative evaluation of CAR may be beneficial as an assessment measure of the risk factor for the development of POD.

Serum HMGB1 as a predictor for postoperative delirium in elderly patients undergoing total hip arthroplasty surgery.

Postoperative delirium (POD) is an acute mental disorder that occurs after surgery requiring general anesthesia. In animal studies, high-mobility group box 1 (HMGB1) plays a key role in mediating postoperative neuroinflammation and may have a direct impact on POD. The objective of this prospective observational study was to investigate the serum levels of HMGB1 in elderly POD patients undergoing total hip arthroplasty. This prospective observational study included 287 elderly patients who underwent total hip arthroplasty in our hospital from October 2019 to September 2022. Patients were assessed for the presence of POD using the Confusion Assessment Method (CAM) within 72 h of surgery. Serum HMGB1, interleukin (IL)-6, IL-1β, tumor necrosis factor alpha (TNF-α), and C-reactive protein (CRP) levels were measured using enzyme-linked immunosorbent assay (ELISA) before surgery, as well as at 24 h, 48 h and 72 h after surgery. Demographic and clinical data of all elderly patients were collected. The anesthesia time and surgical time in the POD group were significantly higher than those in the non-POD group. The serum levels of HMGB1, IL-6 and IL-1β in the POD group were significantly elevated compared to those in the non-POD group at all time points after surgery (p < 0.05). In addition, the serum levels of HMGB1 were positively correlated with TNF-α, IL-6 and IL-1β levels. HMGB1, IL-6 and IL-1β could be potential predictive biomarkers for the occurrence of POD in elderly patients undergoing total hip arthroplasty. Finally, we found that anesthesia time, surgical time, HMGB1, TNF-α, IL-6, and IL-1β were risk factors for POD in elderly patients undergoing total hip arthroplasty. Serum HMGB1 levels were markedly elevated in elderly POD patients undergoing total hip arthroplasty. In addition, HMGB1 could serve as a potential predictive biomarker for POD in elderly patients undergoing total hip arthroplasty.

Association between preoperative sarcopenia and postoperative delirium in older patients undergoing gastrointestinal cancer surgery.

Postoperative delirium (POD) is a usual neurological complication, often leading to poor prognoses. Early identification of high-risk patients is crucial for preventing POD. Sarcopenia is an age-related geriatric syndrome characterized by the loss of skeletal muscle mass and function, and previous studies indicated that preoperative low muscle mass might be a predictor for POD. However, the association between preoperative sarcopenia and POD remains to be fully elucidated. This study was to explore the correlation between preoperative sarcopenia and POD following gastrointestinal cancer surgery in older patients. Older patients (≥60 years) undergoing gastrointestinal cancer surgery were enrolled. Sarcopenia was defined based on the Special Interest Group on sarcopenia of the International Society of Physical and Rehabilitation Medicine (ISarcoPRM), which combined the loss of muscle mass (evaluated by ultrasound) and function (assessed by chair stand test and handgrip strength) before surgery. POD assessment was performed using the Confusion Assessment Method (CAM) or CAM for the intensive care unit (CAM-ICU) during the first 7 days after surgery or before discharge. Multivariate logistic regression analysis examined the correlation between preoperative sarcopenia and POD. Moreover, the receiver operator characteristic (ROC) curve was applied to analyze the predictive effect of the preoperative sarcopenia in POD. One hundred and thirty patients were finally included, of which 43 patients presented with sarcopenia before surgery. Twenty-four patients ultimately developed POD, and the incidence was 18.5%. The results of the multivariate analyses demonstrated that preoperative sarcopenia was still independently associated with POD after adjusting for age ≥70 years, preoperative Mini-Mental State Examination score, and intraoperative blood transfusion. The area under the ROC curve of preoperative sarcopenia in predicting POD was 0.680 (95% confidence interval 0.557-0.804). Preoperative sarcopenia defined by ISarcoPRM criteria was independently associated with POD in geriatric patients after gastrointestinal cancer surgery.

Development and internal validation of a nomogram to predict temporary acute agitated delirium after surgery for chronic subdural hematoma in elderly patients: an analysis of the clinical database.

This study aimed to develop a nomogram for predicting temporary acute agitated delirium after surgery in patients with chronic subdural hematoma (CSH) without neurological compromise and hospitalized in the neurosurgery. We included 289 patients with chronic subdural hematoma (CSH) from the medical information system of Yuebei People's Hospital of Shaoguan City, Guangdong Province, and collected 16 clinical indicators within 24 h of admission. We used the least absolute shrinkage and selection operator (LASSO) regression to identify risk factors. We established a multivariate logistic regression model and constructed a nomogram. We performed internal validation by 1,000 bootstrap samples; we plotted a receiver operating curve (ROC) and calculated the area under the curve (AUC), sensitivity, and specificity. We also evaluated the calibration of our model by the calibration curve and the Hosmer-Lemeshow goodness-of-fit test (HL test). We performed a decision curve analysis (DCA) and a clinical impact curve (CIC) to assess the net clinical benefit of our model. The nomogram included alcoholism history, hepatic insufficiency, verbal rating scale for postoperative pain (VRS), pre-hospital modified Rankin Scale (mRS), and preoperative hematoma thickness as predictors. Our model showed satisfactory diagnostic performance with an AUC value of 0.8474 in the validation set. The calibration curve and the HL test showed good agreement between predicted and observed outcomes (p = 0.9288). The DCA and CIC showed that our model had a high predictive ability for the occurrence of postoperative delirium in patients with CSDH. We identified alcoholism, liver dysfunction, pre-hospital mRS, preoperative hematoma thickness, and postoperative VRS pain as predictors of postoperative delirium in chronic subdural hematoma patients. We developed and validated a multivariate logistic regression model and a nomogram.

Association Between Nutritional Status and Postoperative Delirium in Elderly Surgical Patients

Postoperative delirium is a common and severe complication among elderly surgical patients . This study aimed to investigate the relationship between preoperative nutritional status and the incidence of postoperative delirium among elderly surgical patients. This cross-sectional study enrolled 210 elderly patients (≥65 years) who underwent elective surgery. Nutritional status was assessed using the Mini Nutritional Assessment tool, and postoperative delirium was evaluated using the confusion assessment method. Of the 210 patients, 57% were well-nourished, 33% were at risk of malnutrition, and 10% were malnourished. The incidence of postoperative delirium was 14.3%. A statistically significant association was observed between malnutrition and the incidence of postoperative delirium (P &lt; 0.05). Malnourished patients had 3.4 times greater odds of developing postoperative delirium than well-nourished patients (P &lt; 0.05). The average length of hospital stays and complication rates were directly correlated with nutritional status. Malnourished patients had substantially longer hospital stays and higher complication rates than others (P &lt; 0.05). Additionally, age and surgical duration were identified as considerable predictors of postoperative delirium. Malnutrition is thus substantially associated with an increased risk of postoperative delirium and other adverse postoperative outcomes in elderly surgical patients. These findings highlighted the importance of preoperative nutritional assessments and interventions as part of the standard care protocols for improving surgical outcomes in the elderly.

Correlation between burst suppression and postoperative delirium in elderly patients: a prospective study.

To explore the correlation between intraoperative burst suppression (BS) and postoperative delirium (POD) in elderly patients, and provide more ideas for reducing POD in clinical. Ninety patients, aged over 60years, who underwent lumbar internal fixation surgery in our hospital were selected. General information of patients was obtained and informed consent was signed during preoperative visits. Patients were divided into burst suppression (BS) group and non-burst suppression (NBS) group by intraoperative electroencephalogram monitoring. Intraoperative systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded, and the variation and minimum value were obtained by calculating. Hemoglobin (HGB), C-reactive protein (CRP), system immune inflammatory index (SII) at 24 and 72h after surgery, the incidence of postoperative adverse reactions, postoperative hospital stay, and total cost were recorded after operation. POD assessment was performed using CAM within 7days after surgery or until discharge. SPSS25.0 was used for statistical analysis. Compared with the NBS group, the number of elderly patients with high frailty level in BS group was more (P = 0.048). There is correlation between BS and POD (OR: 4.954, 95%CI 1.034-23.736, P = 0.045), and most of the POD patients in BS group behave as hyperactive type. The occurrence of intraoperative BS is associated with POD, and elderly patients with frailty are more likely to have intraoperative BS. BS can be used as a predictor of POD.

Predictors of Postoperative Delirium in Older Patients Undergoing Elective Spine Surgery.

This prospective study was conducted to investigate the prevalence and predictors of postoperative delirium (POD) in a cohort of patients aged ≥65 years who were scheduled to undergo elective spine surgery. Patients aged ≥65 years who were scheduled to undergo elective spine surgery from February 2018 to May 2019 were prospectively recruited for this study. Delirium was diagnosed according to the Confusion Assessment Method algorithm. Candidate predictors included patient characteristics, comorbidities, surgical time, blood loss, preoperative laboratory parameters, and preoperative cognitive function, as assessed by the Mini-Cog test. These variables were compared between patients with and without POD. Multivariate logistic regression was performed to identify the independent predictors of POD. For the continuous variables, a receiver operating characteristic curve was used to determine the optimal cutoff value for predicting POD. Of the 106 patients included in the study, 12 (11.3%) patients developed POD, with a median time to onset of 3 d and median duration of 2 d. After adjusting for confounders, the occurrence of POD was independently associated with older age, a higher blood urea nitrogen (BUN) concentration, and a lower Mini-Cog score. The optimal cutoff point of the Mini-Cog score for predicting the occurrence of POD was ≤3. POD was a common complication after spine surgery, showing an incidence of 11.3% in this study. Older age, a higher BUN concentration, and impaired cognition, as defined by the Mini-Cog, were independent predictors of POD. The current results may be useful for early identification of patients at risk of POD and facilitation of targeted interventions for preventing POD or mitigating its severity.

The role of inflammatory parameters in the prediction of postoperative delirium in patients undergoing coronary artery bypass grafting.

In this study, we aimed to evaluate the association of pre-operative and early postoperative inflammatory parameters with postoperative delirium in patients operated on for coronary artery bypass grafting. The data of 1 279 cardiac surgery patients operated on between June 2014 and March 2020 were analysed retrospectively. Among these, 777 (61.2%) patients operated on for isolated coronary artery bypass grafting surgery with cardiopulmonary bypass were enrolled. Two groups were formed. The patients who developed postoperative delirium were placed in group 1 (n = 187) and the patients with uneventful postoperative follow up (n = 590) were enrolled in group 2. Pre- and early postoperative mean platelet volume, C-reactive protein level, erythrocyte sedimentation rate, platelet- to-lymphocyte ratio and neutrophil-to-lymphocyte ratio were elevated in group 1 (p = 0.0001). The APACHE II score and duration of hospital and intensive care unit stay were significantly elevated in group 1 (p < 0.05). An early-stage neurological event was observed in eight patients (4.3%) in group 1 and 12 patients (2%) in group 2, which was not statistically significantly different between the groups (p = 0.09). In-hospital mortality was observed in three patients (1.6%) in group 1 and five patients (0.8%) in group 2, which did not show a statistically significant difference (p > 0.05). In univariate and multivariate regression analysis, the pre-operative platelet-to-lymphocyte ratio (p = 0.013), mean platelet volume (p = 0.0001) and erythrocyte sedimentation rate (p = 0.002) were determined as independent risk factors for the occurrence of delirium in the early postoperative period. Also, the postoperative platelet-to-lymphocyte ratio (p = 0.0001), neutrophil-to-lymphocyte ratio (p = 0.0001) and erythrocyte sedimentation rate (p = 0.0001) were determined as independent risk factors for the occurrence of delirium in the early postoperative period. Pre- and early postoperative inflammatory parameters were observed to be predictors of postoperative delirium in patients operated on for coronary artery bypass grafting.

The predictors of postoperative delirium at surgical units in Sudan: A multicenter, cross-sectional, prospective study.

Knowledge of potential and amenable risk factors involved in the development of postoperative delirium (POD) is imperative for successful prevention and subsequent management. The current study objective was to delineate the risk factors associated with the occurrence of POD among patients undergoing surgical procedures. This multi-center (6 hospitals), cross-sectional prospective hospital-based study recruited 415 subjects aged ≥50 years who were scheduled to undergo different types of surgery. Delirium Observational Screening Scale used for the diagnosis of POD. Short Nutritional Assessment Questionnaire used for assessing the nutritional and the hydration status of patients. Pre and postoperative risk factors analyzed by univariate (chi square) and then multivariate analyses and the incidence rate of POD, was reported. The main outcome measure was the development of POD. Out of the 385, only 43 subjects (11.2%) developed POD. High American Society of Anesthesiologists score (OR: 10.76, 95% CI: 1.379-83.99, P =0.023), duration of surgery (OR: 5.426, 95% CI: [2.249-13.092]; P =0.0001), were the strongest independent risk factors for the development of POD. Katz Index of Independence in Activities of Daily Living score (OR: 3.227, 95% CI: [1.177-8.844], P =0.023), and age ≥ 70 years (OR: 1.174, 95% CI: [1.015-1.359]; P =0.027) were additional strongest independent risk factors for the development of POD. Based on analysis or study, we found High American Society of Anesthesiologist sore, Katz-ADL, duration of surgery, and advanced age were predictors of POD. Our findings suggest preventive measures initiated in subjects identified at risk of developing POD. These results support the healthcare providers in the early prevention, diagnosis, and timely management of POD.

A machine-learning model to predict postoperative delirium following knee arthroplasty using electronic health records

BackgroundPostoperative delirium is a challenging complication due to its adverse outcome such as long hospital stay. The aims of this study were: 1) to identify preoperative risk factors of postoperative delirium following knee arthroplasty, and 2) to develop a machine-learning prediction model.MethodA total of 3,980 patients from two hospitals were included in this study. The model was developed and trained with 1,931 patients from one hospital and externally validated with 2,049 patients from another hospital. Twenty preoperative variables were collected using electronic hospital records. Feature selection was conducted using the sequential feature selection (SFS). Extreme Gradient Boosting algorithm (XGBoost) model as a machine-learning classifier was applied to predict delirium. A tenfold-stratified area under the curve (AUC) served as the metric for variable selection and internal validation.ResultsThe incidence rate of delirium was 4.9% (n = 196). The following seven key predictors of postoperative delirium were selected: age, serum albumin, number of hypnotics and sedatives drugs taken preoperatively, total number of drugs (any kinds of oral medication) taken preoperatively, neurologic disorders, depression, and fall-down risk (all p < 0.05). The predictive performance of our model was good for the developmental cohort (AUC: 0.80, 95% CI: 0.77–0.84). It was also good for the external validation cohort (AUC: 0.82, 95% CI: 0.80–0.83). Our model can be accessed at https://safetka.connecteve.com.ConclusionsA web-based predictive model for delirium after knee arthroplasty was developed using a machine-learning algorithm featuring seven preoperative variables. This model can be used only with information that can be obtained from pre-operative electronic hospital records. Thus, this model could be used to predict delirium before surgery and may assist physician’s effort on delirium prevention.

Depression is associated with delirium after cardiac surgery-a population-based cohort study.

OBJECTIVESDepression is common in patients with cardiac disease, and preoperative depression is associated with worse outcomes after cardiac surgery. Depression is also correlated with postoperative delirium (POD) after major surgery. However, the association between preoperative depression and POD after cardiac surgery is sparsely studied. The aim of this study was to investigate depression as a predictor for POD in cardiac surgery patients.METHODSThis population-based cohort study included 1133 cardiac surgery patients in Stockholm 2013–2016. Depression was defined by the Patient Health Questionnaire-9, and POD was evaluated by assessing medical records for symptoms of POD according to Diagnostic and Statistical Manual of Mental Disorders criteria. The association between depression and POD was determined through multivariable logistic regression analysis.RESULTSA total of 162 (14%) individuals reported depressive symptoms preoperatively. The incidence of POD was 26% and highest among elderly patients. Among patients with depression, 34% developed POD. In the group of non-depressed patients, 24% developed POD. The overall adjusted odds of delirium were 2.19 times higher in individuals with depressive symptoms compared to controls (95% confidence interval 1.43–3.34). The onset of delirium was most common on Days 0–2 after surgery.CONCLUSIONSThis unique population-based study in patients undergoing cardiac surgery shows that preoperative depression is associated with POD in a large proportion of treated patients. The findings support the need for improved preoperative screening for depression, especially in younger patients, and enhanced clinical surveillance in the early postoperative period for all patients.

The Clock Drawing Test as a Predictor of Postoperative Delirium After Urgent Hip Fracture Surgery (P7-6.004)

The Clock Drawing Test as a Predictor of Postoperative Delirium After Urgent Hip Fracture Surgery (P7-6.004)

Preoperative Low Physical Activity is a Predictor of Postoperative Delirium in Patients with Gastrointestinal Cancer: A Retrospective Study

Background:Postoperative delirium (POD) is one of the most common postoperative complications in gastrointestinal surgery patients. POD has been reported to affect long-term activities of daily living, cognitive function decline, and mortality. Previous studies have indicated that preoperative physical activity (PA) predicted POD in patients with other diseases, but we have not found any reports in patients with gastrointestinal cancer. In this retrospective study, we investigated the relationship between preoperative PA and POD in gastrointestinal cancer patients. Methods:POD was diagnosed based on the short confusion assessment method. We divided patients into active and inactive groups based on their preoperative PA assessed by the International Physical Activity Questionnaire (Japanese version). Multivariate logistic analysis was conducted to investigate the association between preoperative PA and POD. Results:POD occurred in 25 of the 151 patients (16.6%). Preoperative low PA was associated with POD after adjusting for confounders, namely, diabetes mellitus, sedentary time, and usual gait speed (odds ratio, 2.83; 95% confidence interval: 1.06–7.58; p=0.03). Conclusion:Preoperative low PA was a predictor of POD independent of the confounding factors in patients with gastrointestinal cancer.

Correlation Analysis of Inflammatory Markers CRP and IL-6 and Postoperative Delirium (POD) in Elderly Patients: A Meta-Analysis of Observational Studies.

Postoperative delirium (POD) is very common in the elderly surgical population, and its occurrence is associated with multiple factors such as preoperative, intraoperative, and postoperative factors, and the increase of serum inflammatory markers such as C-reactive protein (CRP) and interleukin-6 (IL-6) is considered to be associated with the occurrence of POD, but the results of multiple studies are inconsistent. In this study, we investigated the correlation between inflammatory markers CRP and IL-6 and POD in elderly patients by literature search and meta-analysis. We searched PubMed, Web of Science, the Cochrane library, Embase, Ovid, and Springer Link for cohort studies or case-control studies that investigated the factors involved in the occurrence of POD, used the Newcastle-Ottawa Scale (NOS) to assess the quality of the selected literature, and combined the differences in serum CRP and IL-6 levels between POD and non-POD patients after surgery to evaluate the predictive value of CRP and IL-6 for the occurrence of POD. This research comprised 16 papers for quantitative analysis, with a total of 2967 patients, 758 with POD and 2209 with non-POD. There were 16 cohort studies (100%) and 0 case-control studies (0%) across all the collected literatures; there were 15 prospective cohort studies and 1 retrospective cohort research. A meta-analysis revealed a statistically significant difference in serum IL-6 levels between POD patients after surgery and non-POD patients [MD = 115.68, 95% CI (25.70, 206.66), Z = 2.52, P = 0.012], as well as a statistically significant difference in serum CRP levels [MD = 27.67, 95% CI (12.77, 42.58), Z = 3.64, P = 0.0003]. Discussion. Early after surgery, serum IL-6 and CRP levels were considerably higher in POD patients than in non-POD patients, indicating that early serum inflammatory variables are likely to be predictors of POD. After surgery, the levels of the aforementioned inflammatory factors should be actively monitored to forecast the emergence of delirium, and active treatment should be used to limit the creation and release of the aforementioned inflammatory factors.

Cerebrovascular Reserve Capacity as a Predictor of Postoperative Delirium: A Pilot Study.

Introduction: Postoperative delirium is a common complication after cardiac surgery with cardiopulmonary bypass (CPB). Compromised regulation of the cerebral circulation may be a predisposing factor for delirium. However, the potential relationship between cerebrovascular reserve capacity and delirium is unknown. The aim of this study was to investigate if impaired cerebrovascular reserve capacity was associated with postoperative delirium.Methods: Forty-two patients scheduled for cardiac surgery with CPB were recruited consecutively. All patients underwent preoperative transcranial Doppler (TCD) ultrasound with calculation of breath-hold index (BHI). BHI < 0.69 indicated impaired cerebrovascular reserve capacity. In addition, patients were examined with preoperative neuropsychological tests such as MMSE (Mini Mental State Examination) and AQT (A Quick Test of cognitive speed). Postoperative delirium was assessed using Nursing Delirium Screening Scale (Nu-DESC) in which a score of ≥2 was considered as delirium.Results: Six patients (14%) scored high for postoperative delirium and all demonstrated impaired preoperative cerebrovascular reserve capacity. Median (25th−75th percentile) BHI in patients with postoperative delirium was significantly lower compared to the non-delirium group [0.26 (−0.08–0.44) vs. 0.83 (0.57–1.08), p = 0.002]. Preoperative MMSE score was lower in patients who developed postoperative delirium (median, 25th−75th percentile; 26.5, 24–28 vs. 28.5, 27–29, p = 0.024). Similarly, patients with postoperative delirium also displayed a slower performance during the preoperative cognitive speed test AQT color and form (mean ± SD; 85.8 s ± 19.3 vs. 69.6 s ± 15.8, p = 0.043).Conclusion: The present findings suggest that an extended preoperative ultrasound protocol with TCD evaluation of cerebrovascular reserve capacity and neuropsychological tests may be valuable in identifying patients with increased risk of developing delirium after cardiac surgery.

P.0203 Exploring resting-state functional connectivity as a potential predictor of postoperative delirium

P.0203 Exploring resting-state functional connectivity as a potential predictor of postoperative delirium

Predictors of postoperative delirium in elderly patients following total hip and knee arthroplasty: a systematic review and meta-analysis

BackgroundPostoperative delirium (POD) is widely reported as a common postoperative complication following total joint arthroplasty (TJA) of the hip and knee in elderly patients, leading to many adverse effects. We sought to investigate predictors of delirium after TJA.MethodsPubMed, EMBASE, Cochrane Library and Web of Science were searched up to 2020 for studies examining POD following TJA in elderly patients. Pooled odds ratio (OR) and mean difference (MD) of those who experienced delirium compared to those who did not were calculated for each variable. The Newcastle-Ottawa Scale (NOS) was used for the study quality evaluation.ResultsFifteen studies with 31 potential factors were included. In the primary analysis, 9 factors were associated with POD, comprising advanced age (MD 3.81; 95% confidence interval (CI) 1.80–5.83), dementia (OR 24.85; 95% CI 7.26–85.02), hypertension (OR 2.26; 95% CI 1.31–3.89), diabetes (OR 2.02; 95% CI 1.15–3.55), stroke (OR 14.61; 95% CI 5.26–40.55), psychiatric illness (OR 2.72; 95% CI 1.45–5.08), use of sedative-hypnotics (OR 6.42; 95% CI 2.53–16.27), lower preoperative levels of hemoglobin (MD − 0.56; 95% CI − 0.89−− 0.22), and lower preoperative mini-mental state examination score (MD − 0.40; 95% CI − 0.69−− 0.12). Twelve studies were included in the systematic review, of which 24 factors were additionally correlated with POD using single studies.ConclusionsStrategies and interventions should be implemented for the elderly patients receiving TJA surgeries with potential predictors identified in this meta-analysis.

Cognitive Impairment and Delirium in Older Patients Undergoing Major Head and Neck Surgery

The study objective was to measure the prevalence and predictors of cognitive impairment (CI) and delirium. Adults undergoing major head and neck cancer surgery completed the Clock Draw Test to screen for CI, defined as a score of 0 or 1. Postoperative delirium was recorded. Predictors of delirium and length of stay were assessed by univariate logistic regression and the latter with multivariate linear regression. Overall 274 patients were included, of which 47% had a Clock Draw Test score of 0 or 1. Post-operative delirium occurred in 17 (6%). CI was a predictor of postoperative delirium (odds ratio, 3.9; 95% CI, 1.2-12; P = .02). Postoperative delirium was a predictor of increased length of stay (adjusted odds ratio, 1.30; 95% CI, 1.07-1.57; P = .0073) on multivariate regression while baseline Clock Draw Test result was not a predictor on univariate regression (P = .98). Screening for CI can help predict delirium and facilitate targeted interventions in the postoperative period.