Risk Factors For Postoperative Delirium Research Articles

Is a hyperosmolar pump prime for cardiopulmonary bypass a risk factor for postoperative delirium? A double blinded randomised controlled trial

Objective: Postoperative delirium (POD) is common after cardiac surgery. We have previously identified plasma sodium concentration and the volume of infused fluids during surgery as possible risk factors. Both are linked to the selection and composition of the pump prime used for cardiopulmonary bypass (CPB). Present study aims to examine whether hyperosmolality increases the risk for POD. Design: Patients ≥65 years (n = 195) scheduled for cardiac surgery were prospectively enrolled into this double blinded randomised clinical trial. Study group received a pump prime containing mannitol and ringer-acetate (966 mOsmol) (n = 98) vs. ringer-acetate (388 mOsmol) (n = 97) in the control group. Postoperative delirium was defined according to DSM-5 criteria based on a test-battery pre- and postoperatively (days 1–3). Plasma osmolality was measured on five occasions and coordinated with the POD assessments. The primary outcome was the POD incidence related to hyperosmolality as the secondary outcome. Results: The incidence of POD was 36% in the study group and 34% in the control group, without intergroup difference (p=.59). The plasma osmolality was significantly higher in the study group, both on days 1 and 3 and after CPB (p<.001). Post hoc analysis indicated that high osmolality levels increased the risk for delirium on day 1 by 9% (odds ratio (OR) 1.09, 95% CI 1.03–1.15) and by 10% on day 3 (OR 1.10, 95% CI 1.04–1.16). Conclusions: Use of a prime solution with high osmolality did not increase the incidence of POD. However, the influence of hyperosmolality as a risk factor for POD warrants further investigation.

Prospective study of incidence and risk factors of post-operative delirium following hip/femur surgery in elder patients (age &amp;gt; 60years) in tertiary care hospital

Prospective study of incidence and risk factors of post-operative delirium following hip/femur surgery in elder patients (age &amp;gt; 60years) in tertiary care hospital

Postoperative C-Reactive Protein Predicts Postoperative Delirium in Colorectal Cancer Following Surgery.

Postoperative delirium (POD) is a common complication in operative patients. Neuroinflammation has been reported to be a potential mechanism associated with the development of POD. Identifying available inflammatory markers such as C-reactive protein (CRP) would aid clinicians in early detection of POD. Previous studies have demonstrated that CRP may be a promising predictive marker for POD. Thus, this study aimed to explore the association between CRP and POD among those elderly colorectal cancer (CRC) patients. 643 patients with CRC were included in this study. CRP levels were measured before operation and on postoperative day 1. The univariate and multivariate regression analyses were used to identify risk factors for POD. Of 643 patients with CRC, 112 cases (17.4%) had POD. CRC patients with POD showed older age, higher CRP level on postoperative day 1, and higher percentage of smoking, diabetes mellitus, and chronic obstructive pulmonary disease (COPD) than CRC patients without POD. Preoperative CRP level was not associated with the POD. Univariate and multivariate regression analyses showed that older age (> 70 years), diabetes mellitus, COPD, and higher CRP level on postoperative day 1 (> 48 mg/L) were risk factors for POD in CRC patients. Postoperative CRP level is an independent indicator for POD among CRC patients, suggesting the predictive role of postoperative CRP levels for POD in elderly CRC patients undergoing surgery.

Correlation and influencing factors of preoperative anxiety, postoperative pain, and delirium in elderly patients undergoing gastrointestinal cancer surgery

BackgroundThe correlation and influencing factors of preoperative anxiety, postoperative pain, and delirium in elderly patients undergoing gastrointestinal cancer surgery were explored with the Beck Anxiety Inventory (BAI) scale, 10-point Visual Analogue Scale (VAS), and Confusion Assessment Method Chinese Reversion (CAM-CR) scale.MethodsA total of 120 patients aged 65 years old who receiving gastrointestinal cancer surgery were enrolled in the study. Perioperative anxiety, pain, and delirium were assessed by the BAI scale, VAS scale, and CAM-CR scale, respectively. The correlation and influencing factors of preoperative high anxiety, postoperative high pain, and postoperative delirium were analyzed.ResultsPreoperative high anxiety had a moderate positive correlation with postoperative high pain (P < 0.001, r = 0.410), and had a weak positive correlation with postoperative delirium (P = 0.005, r = 0.281). postoperative high pain had a weak positive correlation with postoperative delirium (P = 0.017, r = 0.236). Type of cancer and surgical approach were considered to be independent risk factors of preoperative high anxiety (P = 0.006 and P = 0.021). Preoperative high anxiety was considered to be an independent risk factor of postoperative high pain (P< 0.001). Age and preoperative high anxiety were considered to be independent risk factors of postoperative delirium (P< 0.001 and P = 0.010).ConclusionsElderly patients undergoing gastrointestinal cancer surgery had a higher incidence of preoperative anxiety, as well as first-day postoperative pain and first-day postoperative delirium. Factors such as type of cancer, surgical approach and preoperative anxiety had been identified as influencing preoperative anxiety levels; preoperative anxiety had been linked to postoperative pain; and age and preoperative anxiety have been identified as influencing factors of postoperative delirium.Trial registrationhiCTR2000032008, 17/04/2020, Title: “Effects of different analgesic methods on postoperative recovery of elderly patients with digestive tract tumor”. Website: https://www.chictr.ogr.cn.

Global trends in research related to emergence delirium, 2012-2021: A bibliometric analysis.

Emergence delirium is a kind of mental disorder during the early awakening period after general anesthesia, which is manifested as the combination of perceptual disturbance and psychomotor agitation. It is an independent risk factor for postoperative delirium and even long-term postoperative cognitive decline, which often affects the postoperative outcome and deserves the attention of clinical anesthesiologists. There are many studies on emergence delirium, but the quantity and quality of these studies are unclear. Therefore, we conducted a bibliometric analysis of studies on emergence delirium between January 2012 and December 2021. Through the analysis of relevant literature, the research hotspots and trends of emergence delirium are understood, which can provide a reference for future research. We searched the Web of Science Core Collection (WoSCC) for original articles and reviews related to emergence delirium published between 2012 and 2021, and collected a variety of bibliographic elements, including annual publications, authors, countries/regions, institutions, journals, and keywords. Three different science-based tools (CiteSpace, VOSviewer and Bibliometrix) were used for this comprehensive analysis. From January 2012 to December 2021, a total of 912 emergence delirium (ED) related literature were published, including 766 original research articles and 146 review articles. The number of publications has increased every year except 2016. The United States published 203 articles, ranking first with China, followed by South Korea (95 articles). The United States is also the country with the most citations (4,508), and Yonsei Univ is the most productive institution. The most published journal was PEDIATRIC ANESTHESIA, with the highest h and g index. LEE JH is the most influential author in this field. "Children, emergence agitation, delirium, dexmedetomidine" are the hot topics in this field in recent years. The bibliometric analysis in this field will provide the future direction for the study of emergence delirium for clinicians.

Postoperative serum interleukin-6 level as a risk factor for development of hyperactive delirium with agitation after head and neck surgery with free tissue transfer reconstruction

ObjectiveOccurrence of hyperactive postoperative delirium (POD) with agitation after head and neck surgery with free tissue transfer reconstruction (HNS-FTTR) is associated with the risk of life-threatening complications. The relationships between occurrence of hyperactive POD after HNS-FTTR and inflammatory markers reflecting the surgical stress response, represented by postoperative interleukin-6 levels, are not fully understood. MethodsA retrospective study was conducted on 221 consecutive patients who underwent HNS-FTTR at our department between September 2016 and December 2021. Potential risk factors for POD were examined, including age, operation time, intraoperative blood loss, and postoperative serum levels of blood parameters such as interleukin-6, C-reactive protein, and neutrophil-to-lymphocyte ratio. ResultsHyperactive POD with agitation was observed in 54 subjects (24.4%). The postoperative hospital stay in the POD group was significantly longer than that in the non-POD group (median: 32.5 days vs. 28 days; p=0.0129). Multivariate logistic regression analysis identified age (in years) (odds ratio: 1.102; p<0.0001), operation time (min) (odds ratio: 1.004; p=0.0359), and postoperative serum interleukin-6 level (pg/mL) (odds ratio: 1.005; p=0.0384) as significant risk factors for development of POD. In a receiver operating characteristic curve and area under the curve analysis, the cut-off value for postoperative serum interleukin-6 level to predict POD development was 82.5 pg/mL. The postoperative serum interleukin-6 ≥82.5 pg/mL group developed hyperactive POD with agitation significantly more often than the postoperative serum IL-6 <82.5 pg/mL group (odds ratio: 4.400; p<0.0001). The postoperative serum IL-6 ≥82.5 pg/mL group also had significantly longer postoperative hospital stay (41.58 ± 33.42 days vs. 31.73 ± 22.89 days; p=0.0151), older age (68.60 ± 9.99 years vs. 64.30 ± 12.58 years; p=0.0054), and longer operation time (625.4 ± 114.05 min vs. 575.5 ± 98.73 min; p=0.0009) than the postoperative serum IL-6 <82.5 pg/mL group. ConclusionPostoperative serum interleukin-6 level, as well as age and operation time, were identified as significant independent risk factors for development of hyperactive POD with agitation after HNS-FTTR. Inflammation is a potential target for the prevention and treatment of POD after HNS-FTTR.

Preoperative Risk Factors Associated with Increased Incidence of Postoperative Delirium: Systematic Review of Qualified Clinical Studies.

Postoperative delirium (POD) is an acute alteration of mental state, characterized by reduced awareness and attention, occurring up to five postoperative days after recovery from anesthesia. Several original studies and reviews have identified possible perioperative POD risk factors; however, there is no comprehensive review of the preoperative risk factors in patients diagnosed with POD using only validated diagnostic scales. The aim of this systematic review was to report the preoperative risk factors associated with an increased incidence of POD in patients undergoing non-cardiac and non-brain surgery. The reviewed studies included original research papers that used at least one validated diagnostic scale to identify POD occurrence for more than 24 h. A total of 6475 references were retrieved from the database search, with only 260 of them being suitable for further review. Out of the 260 reviewed studies, only 165 that used a validated POD scale reported one or more preoperative risk factors. Forty-one risk factors were identified, with various levels of statistical significance. The extracted risk factors could serve as a preoperative POD risk assessment workup. Future studies dedicated to the further evaluation of the specific preoperative risk factors' contributions to POD could help with the development of a weighted screening tool.

Intraoperative 5-HT3 receptor antagonists decrease the prevalence of postoperative delirium in older adults undergoing hip fracture surgery: a single-center retrospective study.

Postoperative delirium (POD) occurs commonly in older adults, resulting in unfavorable outcomes. Several recent clinical studies have suggested that 5-hydroxytryptamine 3 (5-HT3) receptor antagonists can treat and prevent POD. In this retrospective study, the association between 5-HT3 receptor antagonists and POD was investigated in older adults who underwent hip fracture surgery. The electronic medical records of older adults aged ≥ 65years who underwent hip fracture surgery between January 2011 and June 2018 were reviewed retrospectively. Multivariable logistic regression analysis was used to investigate the association between 5-HT3 receptor antagonists and the occurrence of POD. In addition to the incidence of POD, anesthesia-, surgery-, and patient-related factors related to POD were evaluated. Of the 1025 patients included, 813 (79.3%) were administered 5-HT3 receptor antagonists intraoperatively; 471 (45.9%) were administered ramosetron, and 342 (33.4%) were administered palonosetron. POD was identified in 242 patients (23.6%). Ramosetron and palonosetron reduced the POD incidence by 53% (odds ratio [OR] 0.47; 95% confidence interval [CI] 0.32‒0.71; P < 0.001) and 41% (OR 0.59; 95% CI 0.39‒0.89; P = 0.011), respectively. Additionally, age, American Society of Anesthesiologists physical status class 4, and male were confirmed as risk factors for POD. Intraoperative 5-HT3 receptor antagonists may be associated with a reduced risk of POD and can be considered one of the preventive strategies for POD in older adults undergoing hip fracture surgery.

Systematic review and meta-analysis of the risk factors for postoperative delirium in patients with acute type A aortic dissection.

Delirium is a common postoperative complication of acute type an aortic dissection, which is a serious threat to the patient's life after operation. However, there are many risk factors for delirium and there are different conclusions. The aim of this study was to systematically analyze the risk factors for postoperative delirium in patients with acute type a aortic dissection by means of meta-analysis. Literature related to the risk factors of postoperative delirium in patients with acute type A aortic dissection was searched via the China National Knowledge Infrastructure (CNKI), cqvip.com (VIP), WanFang, PubMed, Willey Library, Embase, and Web of Science databases. Two persons independently conducted literature screening, data extraction and literature quality evaluation according to the inclusion and exclusion criteria. The quality of literature was evaluated with Newcastle-Ottawa Scale (NOS). R 4.2.1 was used to compare the risk factors for meta-analysis. After screening, 12 articles were included with a total of 2,511 cases, and 4 articles were at medium risk of bias and 8 articles were at low risk of bias. The meta-analysis results showed that patients in the delirium group had a higher probability of postoperative hypoxemia [odds ratio (OR) =1.65, 95% confidence interval (CI): 1.28-2.13, P<0.01], longer postoperative duration of ventilator assistance (OR =3.05, 95% CI: 2.47-3.77, P<0.01), higher incidence of renal insufficiency (OR =1.86, 95% CI: 1.33-2.58, P<0.01), lower hemoglobin levels (OR =0.33, 95% CI: 0.23-0.48, P<0.01), longer postoperative stay duration in the intensive care unit (ICU) (OR =2.25, 95% CI: 2.13-2.37, P<0.01), longer duration of hospitalization (OR =2.74, 95% CI: 2.37-3.16, P<0.01), and higher postoperative Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (OR =1.01, 95% CI: 0.90-1.12, P=0.92). Post-op aortic dissection in patients with acute type A diabetes should be monitored for oxygen and blood levels. When patients had prolonged mechanical ventilation, renal insufficiency, decreased hemoglobin, and prolonged ICU stay, timely intervention is needed to prevent the high-risk factors of postoperative delirium.

Desflurane is risk factor for postoperative delirium in older patients' independent from intraoperative burst suppression duration.

Postoperative Delirium (POD) is the most frequent neurocognitive complication after general anesthesia in older patients. The development of POD is associated with prolonged periods of burst suppression activity in the intraoperative electroencephalogram (EEG). The risk to present burst suppression activity depends not only on the age of the patient but is also more frequent during propofol anesthesia as compared to inhalative anesthesia. The aim of our study is to determine, if the risk to develop POD differs depending on the anesthetic agent given and if this correlates with a longer duration of intraoperative burst suppression. In this secondary analysis of the SuDoCo trail [ISRCTN 36437985] 1277 patients, older than 60 years undergoing general anesthesia were included. We preprocessed and analyzed the raw EEG files from each patient and evaluated the intraoperative burst suppression duration. In a logistic regression analysis, we assessed the impact of burst suppression duration and anesthetic agent used for maintenance on the risk to develop POD. 18.7% of patients developed POD. Burst suppression duration was prolonged in POD patients (POD 27.5 min ± 21.3 min vs. NoPOD 21.4 ± 16.2 min, p < 0.001), for each minute of prolonged intraoperative burst suppression activity the risk to develop POD increased by 1.1% (OR 1.011, CI 95% 1.000-1.022, p = 0.046). Burst suppression duration was prolonged under propofol anesthesia as compared to sevoflurane and desflurane anesthesia (propofol 32.5 ± 20.3 min, sevoflurane 17.1 ± 12.6 min and desflurane 20.1 ± 16.0 min, p < 0.001). However, patients receiving desflurane anesthesia had a 1.8fold higher risk to develop POD, as compared to propofol anesthesia (OR 1.766, CI 95% 1.049-2.974, p = 0.032). We found a significantly increased risk to develop POD after desflurane anesthesia in older patients, even though burst suppression duration was shorter under desflurane anesthesia as compared to propofol anesthesia. Our finding might help to explain some discrepancies in studies analyzing the impact of burst suppression duration and EEG-guided anesthesia on the risk to develop POD.

Ability of clock drawing errors on Mini-Cog test to predict development of delirium after major urological cancer surgery

Abstract Background This study aimed to evaluate the impact of the clock drawing test (CDT) on postoperative delirium and compare the abilities of the mini-cognitive (Mini-Cog) test and the CDT for predicting postoperative delirium after major urological cancer surgery. Materials and methods In this single-center retrospective observational study, we collected the medical records of patients who underwent major urologic cancer surgery and preoperative cognitive screening based on the Mini-Cog test consisting of the CDT and the 3-word recall task at our department in 2020–2021 (n = 387). Univariate and multivariate logistic regression analyses were used to identify the clinical risk factors for postoperative delirium. We also compared the ability of the CDT alone and the Mini-Cog test consisting of the CDT and 3-word recall task to predict postoperative delirium. Results A total of 117 patients (30%) had abnormal CDT results. Postoperative delirium occurred in 29 patients (7%). On multivariate analysis, American Society of Anesthesiologists physical status ≥3 (odds ratio [OR], 5.0; p = 0.01), abnormal CDT (OR, 4.8; p &lt; 0.001), preoperative benzodiazepine use (OR, 4.9; p &lt; 0.001), and operative time ≥237 minutes (OR, 3.0; p = 0.01) were independent risk factors for postoperative delirium. The area under the curve for predicting postoperative delirium was 0.709 for CDT alone and 0.743 for the Mini-Cog test. No significant intergroup difference was observed (p = 0.43). Conclusions The CDT served as a formal but simple tool with adequate predictive power to identify the risk of postoperative delirium among patients undergoing major urological cancer surgery. Effective screening using the CDT might help provide optimal urological care for older patients.

Research progress on risk factors of postoperative delirium in elderly patients with hip fracture

Research progress on risk factors of postoperative delirium in elderly patients with hip fracture

High ASA Physical Status and Low Serum Uric Acid to Creatinine Ratio are Independent Risk Factors for Postoperative Delirium Among Older Adults Undergoing Urinary Calculi Surgery

This study was to investigate the incidence and potential predictive factors for postoperative delirium (POD) in older people following urinary calculi surgery, and to establish the corresponding risk stratification score by the significant factors to predict the risk of POD. We retrospectively analyzed the perioperative data of 195 patients aged 65 or older who underwent elective urinary calculi surgery between September 2020 and September 2022. POD was defined by chart-based method, and the serum uric acid to creatinine (SUA/Cr) ratio as well as neutrophil-to-lymphocyte ratio (NLR) were calculated, respectively. Identification of the risk factors for POD was performed by univariate and multivariate logistic regression analysis. Moreover, the risk stratification score was developed based on the regression coefficients of the associated variables. In 195 eligible patients following urinary calculi surgery, the median age was 69 (66-72) and 19 patients ultimately developed POD (9.7%). The results by univariate analysis showed that patients with advanced age, high American Society of Anesthesiologists (ASA) physical status (≥3) and low SUA/Cr ratio (≤3.3) were more likely to develop POD, but dexmedetomidine can significantly decrease the risk of the occurrence of POD. The multivariate analysis further indicated that high ASA physical status (≥3) and low SUA/Cr ratio (≤3.3) were independently associated with POD, and the POD incidence could obviously be elevated with the increase of risk stratification score. Moreover, patients with delirium had longer hospital stays. POD is frequent in geriatric patients following urinary calculi surgery (9.7%). The high ASA physical status (≥3) and low SUA/Cr ratio (≤3.3) were effective predictors of POD. The corresponding risk stratification based on these factors could be beneficial to determining patients who are susceptible to POD, and thus better preventing and reducing the occurrence of POD. However, large prospective studies are needed to confirm this finding.

Retracted: Elevated Substance P Is a Risk Factor for Postoperative Delirium in Patients with Hip Fracture

Retracted: Elevated Substance P Is a Risk Factor for Postoperative Delirium in Patients with Hip Fracture

Assessment of Risk Factors for Postoperative Delirium in Older Adults Who Underwent Spinal Surgery and Identifying Associated Biomarkers Using Exosomal Protein.

With an increase in the aging population, the number of patients with degenerative spinal diseases undergoing surgery has risen, as has the incidence of postoperative delirium. This study aimed to investigate the risk factors affecting postoperative delirium in older adults who had undergone spine surgery and to identify the associated biomarkers. This study is a prospective study. Data of 100 patients aged ≥ 70 years who underwent spinal surgery were analyzed. Demographic data, medical history, clinical characteristics, cognitive function, depression symptoms, functional status, frailty, and nutritional status were investigated to identify the risk factors for delirium. The Confusion Assessment Method, Delirium Rating Scale-R-98, and Nursing Delirium Scale were also used for diagnosing delirium. To discover the biomarkers, urine extracellular vesicles (EVs) were analyzed for tau, ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), neurofilament light, and glial fibrillary acidic protein using digital immunoassay technology. Nine patients were excluded, and data obtained from the remaining 91 were analyzed. Among them, 18 (19.8%) developed delirium. Differences were observed between participants with and without delirium in the contexts of a history of mental disorder and use of benzodiazepines (p = .005 and p = .026, respectively). Tau and UCH-L1-concentrations of urine EVs-were comparatively higher in participants with severe delirium than that in participants without delirium (p = .002 and p = .001, respectively). These findings can assist clinicians in accurately identifying the risk factors before surgery, classifying high-risk patients, and predicting and detecting delirium in older patients. Moreover, urine EV analysis revealed that postoperative delirium following spinal surgery is most likely associated with brain damage.

Higherintraoperative mean arterial blood pressure does not reduce postoperative delirium in elderly patients following gastrointestinal surgery: A prospective randomized controlled trial.

This study aimed to describe the relationship between the different levels of intraoperative mean arterial blood pressure (MAP) and postoperative delirium in elderly patients undergoing gastrointestinal laparoscopic surgery. This prospective controlled clinical trial enrolled 116 patients aged 65 to 85 years who underwent gastrointestinal laparoscopic surgery. These patients were randomized 1:1 to a MAP goal of 65 to 85 mmHg (L group) or an 86 to 100 mmHg (H group). The primary endpoint was the incidence of postoperative delirium, assessed twice daily with the Confusion Assessment Method (CAM) and Richmond Agitation-Sedation Scale (RASS) during the first five postoperative days. Delirium severity was evaluated with the Delirium-O-Meter (D-O-M). 108 patients (L group n = 55, H group n = 53) were eventually included in intention-to-treat analyses. Postoperative delirium occurred in 18 (32.7%) of 55 cases of L group and in 15 (28.3%) of 53 cases of H group. The incidence of delirium subtypes between the two groups: hypoactive delirium 14.5% (8/55) vs 11.3% (6/53); hyperactive delirium 7.3% (4/55) vs 3.8% (2/53); mixed delirium 10.9% (6/55) vs 13.2% (7/53). However, the L group showed higher D-O-M scores of the first episode of delirium: 14.5 (Q1 = 12, Q3 = 18.5) vs 12 (Q1 = 10, Q3 = 14), which means the delirium is more severe. Compared with 65 to 85 mmHg, maintaining intraoperative MAP at 86-100 mmHg did not reduce the incidence of postoperative delirium in elderly patients undergoing gastrointestinal laparoscopic surgery. However, the severity of delirium could be reduced and blood loss is a risk factor for postoperative delirium.

Risk Factors for Delirium after Deep Brain Stimulation Surgery under Total Intravenous Anesthesia in Parkinson's Disease Patients.

Postoperative delirium (POD) is associated with perioperative complications and mortality. Data on the risk factors for delirium after subthalamic nucleus deep brain stimulation (STN-DBS) surgery is not clarified in Parkinson's disease (PD) patients receiving total intravenous anesthesia. We aimed to investigate the risk factors for delirium after STN-DBS surgery in PD patients. The retrospective cohort study was conducted, including 131 PD patients who underwent STN-DBS for the first time under total intravenous anesthesia from January to December 2021. Delirium assessments were performed twice daily for 7 days after surgery or until hospital discharge using the confusion assessment method for the intensive care unit. Multivariate logistic regression analysis was used to determine the risk factor of POD. In total, 22 (16.8%) of 131 patients were in the POD group, while the other 109 patients were in the Non-POD group. Multivariate logistic regression analysis showed that preoperative Mini-mental State Examination score [odds ratio = 0.855, 95% confidence interval = 0.768-0.951, p = 0.004] and unified Parkinson's disease rating scale part 3 (on state) score (odds ratio = 1.061, 95% confidence interval = 1.02-1.104, p = 0.003) were independently associated with delirium after surgery. In this retrospective cohort study of PD patients, a lower Mini-mental State Examination score and a higher unified Parkinson's disease rating scale part 3 (on state) score were the independent risk factors for delirium after STN-DBS surgery in PD patients under total intravenous anesthesia.

Association of C-reactive protein to albumin ratio with postoperative delirium and mortality in elderly patients undergoing hip fracture surgery: A retrospective cohort study in a single large center

BackgroundPostoperative delirium is a common complication in elderly patients who have undergone hip fracture surgery. Since postoperative delirium is associated with poor outcomes and the treatment is very complicated, identifying the patients at high risk for delirium and providing more attentive care to prevent postoperative delirium is essential. In this study, we aimed to assess the association of an elevated C-reactive protein (CRP)/albumin ratio with the increased incidence of postoperative delirium in elderly people who had undergone hip fracture surgery. MethodsA total of 629 patients who underwent hip fracture surgery between January 2014 and December 2018 were retrospectively analyzed. Patients were classified into two groups according to preoperative CRP/albumin cut-off levels (<1.5 and ≥1.5). We performed a propensity score matching analysis to compare the incidence of postoperative delirium and overall mortality between the two groups. Multivariate logistic regression and Cox regression analyses were performed to examine the association of the preoperative CRP/albumin ratio with postoperative delirium and overall mortality. ResultsThere were significant differences in the incidence of postoperative delirium (18.0 % vs. 35.8 %, P < 0.001) and overall mortality (26.7 % vs. 46.9 %, P < 0.001) between the groups before matching. We also observed significant differences in the incidence of postoperative delirium (20.7 % vs. 32.7 %, P = 0.019) and overall mortality (34.7 % vs. 46.0 %, P = 0.046) between the groups after matching. A high CRP/albumin ratio (≥1.5) was significantly associated with a higher incidence of postoperative delirium (adjusted odds ratio [OR]: 2.11, 95 % confidence interval [CI]: 1.40–3.18, P < 0.001) and a higher rate of overall mortality (adjusted hazard ratio [HR]: 1.44, 95 % CI: 1.07–1.93, P = 0.015). ConclusionPreoperative CRP/albumin ratio might be an independent risk factor of postoperative delirium and surgical prognosis in elderly patients undergoing hip fracture surgery.

A predictive nomogram model for postoperative delirium in elderly patients following laparoscopic surgery for gynecologic cancers.

This study aimed to investigate potential risk factors associated with postoperative delirium (POD) in elderly patients following laparoscopic surgery for gynecologic cancers and construct a nomogram predictive model based on these factors. Eligible elderly patients who underwent laparoscopic surgery for gynecologic cancers were enrolled and grouped according to the development of POD within postoperative 7days. Potential risk factors were assessed by the univariate and multivariate logistic regression analyses. A nomogram model was constructed based on these factors and evaluated by R. A total of 226 elderly patients were enrolled in the final data analysis and 39 patients had suffered POD with an incidence of 17.3%. Older age, modified frailty index (mFI) ≥ 0.225, C-reactive protein (CRP) ≥ 8.0, systemic immune-inflammation index (SII), and albumin/fibrinogen ratio (AFR) were five independent risk factors for POD by univariate and multivariate analyses. The area under the curve (AUC) of the constructed nomogram model based on these five factors was 0.833. The constructed nomogram model based on age, CRP, SII, mFI, and AFR could effectively predict POD in elderly patients with gynecologic cancers.

Contribution of intraoperative electroencephalogram suppression to frailty-associated postoperative delirium: mediation analysis of a prospective surgical cohort

BackgroundFrailty is a risk factor for postoperative delirium (POD), and has led to preoperative interventions that have reduced, but not eliminated, the risk. We hypothesised that EEG suppression, another risk factor for POD, mediates some of the frailty risk for POD. MethodsA prospective cohort study enrolled patients aged 65 yr or older, scheduled for noncardiac surgery under total intravenous anaesthesia. Frailty was assessed using the FRAIL scale. Cumulative duration of EEG suppression, defined as an amplitude between –5 and 5 μV for >0.5 s during anaesthesia, was measured. POD was diagnosed by either confusion assessment method (CAM), CAM-ICU, or medical records. The severity of POD was assessed using the Delirium Rating Scale – Revised-98 (DRS). Mediation analysis was used to estimate the relationships between frailty, EEG suppression, and severity of POD. ResultsAmong 252 enrolled patients, 51 were robust, 129 were prefrail, and 72 were frail. Patients classified as frail had higher duration of EEG suppression than either the robust (19 vs 0.57 s, P<0.001) or prefrail groups (19 vs 3.22 s, P<0.001). Peak delirium score was higher in the frail group than either the robust (17 vs 15, P<0.001) or prefrail groups (17 vs 16, P=0.007). EEG suppression time mediated 24.2% of the frailty–DRS scores association. ConclusionEEG suppression time mediated a statistically significant portion of the frailty–POD association in older noncardiac surgery patients. Trials directed at reducing EEG suppression time could result in intraoperative interventions to reduce POD in frail patients. Clinical trial registrationChiCTR2000041092 (Chinese Clinical Trial Registry).