Risk Of Postoperative Delirium Research Articles

Correlation Between Reduced Daily Living Competence and the Risk of Postoperative Delirium in Orthopedics and Trauma Surgery

Background/Objectives: Postoperative delirium is a prevalent and serious complication among elderly patients following surgical procedures. Prior research indicates that reduced competence in daily living, as evidenced by limitations in performing Activities of Daily Living (ADL), is directly associated with reduced patient mobility. This study aimed to investigate the potential role of preoperative mobility as a risk factor for the development of postoperative delirium. Methods: To assess preoperative mobility, a comprehensive geriatric evaluation of daily living competence was conducted. This included the Katz Index of Independence in ADL, which assessed basic daily activities over the preceding 14 days, and the Instrumental Activities of Daily Living Scale (IADL). Postoperatively, delirium monitoring was performed twice daily for seven days using validated delirium screening tools, including the Nursing Delirium Screening Scale, the Confusion Assessment Method, and the 4ATest. Results: A significant correlation was observed between the incidence of delirium and the IADL scores in all patients, with p < 0.001 for men and p = 0.001 for women. Among emergency patients, the Katz Index scores significantly differed between those who developed delirium and those who did not (p = 0.015). Additionally, a significant correlation was found between the Katz Index and the incidence of delirium in both groups (p < 0.001). Conclusions: The findings of this study emphasize the necessity of preoperative geriatric assessment using tools such as the Katz Index or IADL to identify patients at risk of delirium. The results confirm the importance of enhanced postoperative monitoring for potential delirium. For elective patients, prehabilitation should be considered when reduced daily living competence is identified. For emergency patients, immediate postoperative interventions, including intensive mobilization and orthogeriatric co-management, are recommended.

Association between duration of phenoxybenzamine use and postoperative delirium in suspected adrenal pheochromocytoma: a retrospective cohort study

BackgroundAt present, the available evidence regarding the relationship between duration of phenoxybenzamine use and postoperative delirium is inadequate in suspected adrenal pheochromocytoma.ObjectiveTo understand how changes in the duration of phenoxybenzamine use may affect postoperative delirium. The secondary objective of this study is to explore how the duration of phenoxybenzamine use may jointly influence postoperative delirium together with other interacting variables.MethodsWe conducted a retrospective cohort study involving 527 participants with a preoperative diagnosis of suspected pheochromocytoma. CT characteristics, preoperative preparation, intraoperative infusion, estimated bleeding, use of intraoperative vasoactive drugs, and outcomes were obtained from all participants. Logistic regression and interaction effects were utilized to substantiate the research objectives.ResultsA total of 108 (20.5%) developed postoperative delirium, which was seen in 37 (18.0%) in the pheochromocytoma group and 71 (22.0%) in the non-pheochromocytoma group. The incidence of postoperative delirium showed no statistically significant differences in the two groups. A positive association between the duration of phenoxybenzamine use and the risk of postoperative delirium was observed (OR = 1.05, 95%CI = 1.03–1.08, p < 0.01), independent of confounders. The relationship between the duration of phenoxybenzamine use and postoperative delirium differed according to the presence or absence of pheochromocytoma, suggesting an interactive effect (p < 0.05).ConclusionThis study highlights the influence of inappropriate duration of phenoxybenzamine use on the risk of incident postoperative delirium, independent of confounders. The effect of duration of phenoxybenzamine use causes a further increase in the risk of postoperative delirium, especially in non-pheochromocytomas.

Prediction of Postoperative Delirium in Older Adults from Preoperative Cognition and Occipital Alpha Power from Resting-State Electroencephalogram.

Postoperative delirium is the most common complication following surgery among older adults, and has been consistently associated with increased mortality and morbidity, cognitive decline, and loss of independence, as well as markedly increased health-care costs. Electroencephalography (EEG) spectral slowing has frequently been observed during episodes of delirium, whereas intraoperative frontal alpha power is associated with postoperative delirium. We sought to identify preoperative predictors that could identify individuals at high risk for postoperative delirium, which could guide clinical decision-making and enable targeted interventions to potentially decrease delirium incidence and postoperative delirium-related complications. In this prospective observational study, we used machine learning to evaluate whether baseline (preoperative) cognitive function and resting-state EEG could be used to identify patients at risk for postoperative delirium. Preoperative resting-state EEGs and the Montreal Cognitive Assessment were collected from 85 patients (age = 73 +- 6.4 years, 12 cases of delirium) undergoing elective surgery. The model with the highest f1-score was subsequently validated in an independent, prospective cohort of 51 older adults (age = 68 +- 5.2 years, 6 cases of delirium) undergoing elective surgery. Occipital alpha powers have higher f1-score than frontal alpha powers and EEG spectral slowing in the training cohort. Occipital alpha powers were able to predict postoperative delirium with AUC, specificity and accuracy all >90%, and sensitivity >80%, in the validation cohort. Notably, models incorporating transformed alpha powers and cognitive scores outperformed models incorporating occipital alpha powers alone or cognitive scores alone. While requiring prospective validation in larger cohorts, these results suggest that strong prediction of postoperative delirium may be feasible in clinical settings using simple and widely available clinical tools. Additionally, our results suggested that the thalamocortical circuit exhibits different EEG patterns under different stressors, with occipital alpha powers potentially reflecting baseline vulnerabilities.

Hip fracture in elderly: malnutrition and health outcomes. A systematic review and meta-analysis

Abstract Background Hip fracture is a common condition among elderly and one of the leading causes of disability. Malnutrition is widely present in older patients and has been identified in several studies as an important and modifiable prognostic factor for several medical conditions, including hip fracture. The aim of the present study is to evaluate the association between malnutrition, assessed by validated tools, and selected health outcomes for different follow-up intervals from hip fracture, in particular: mortality, changes in mobility/living arrangements and postoperative delirium. Methods A literature search on PubMed, Web of Science and Scopus databases up to September 2023, was conducted to identify all studies involving older subjects that reported an association between MNA/GNRI/PNI/CONUT score and health outcome after hip fracture. Meta-analysis was performed by a random-effects model using risk values (RR/OR/HR) extracted from 14 eligible selected studies. Results Malnutrition significantly increased the risk of any adverse outcome by 70% at 1 month, and up to 250% at 1 year, showing an increasing trend with longer follow-up periods. One month after hip fracture, malnutrition significantly increased the risk of postoperative delirium by 275% (OR = 2.75; 95% CI 1.80-4.18; p ≤ 0.05), mortality by 342% (OR = 3.42; 95% CI 2.14-5.48; p ≤ 0.05) and mortality hazard risk by 351% (HR = 3.51; 95% CI 1.63-7.55; p ≤ 0.05). One year after hip fracture, malnutrition significantly increased the risk of transfer to more supported living arrangements by 218% (OR = 2.18; 95% CI 1.58-3.01; p ≤ 0.05), declined mobility by 41% (OR = 1.41; 95% CI 1.14-1.75; p ≤ 0.05), mortality by 368% (OR = 3.68; 95% CI 3.00-4.52; p ≤ 0.05) and mortality hazard risk by 234% (HR = 2.34; 95% CI 1.91-2.87; p ≤ 0.05). Conclusions These findings underscore that malnutrition worsens outcomes after hip fracture in elderly, emphasizing the importance of nutritional assessment to mitigate potential adverse consequences. Key messages • The results of the present study underscore that malnutrition increases the risk of death and worsens mobility and independence after hip fracture in older adults. • Routine nutritional status evaluation could prove beneficial in the management of hip fracture older patients in order to prevent potential adverse outcomes.

Data-driven Machine Learning Models for Risk Stratification and Prediction of Emergence Delirium in Pediatric Patients Underwent Tonsillectomy/Adenotonsillectomy.

In the pediatric surgical population, Emergence Delirium (ED) poses a significant challenge. This study aims to develop and validate machine learning (ML) models to identify key features associated with ED and predict its occurrence in children undergoing tonsillectomy or adenotonsillectomy. The analysis involved data cleaning, exploratory data analysis (EDA), supervised predictive modeling, and unsupervised learning on a medical dataset (n = 423). After preliminary data cleaning, EDA encompassed plotting histograms, boxplots, pairplots, and correlation heatmaps to understand variable distributions and relationships. Four predictive models were trained including logistic regression (LR), random forest (RF), Support Vector Machine (SVM), and Gradient Boosting (XGBoost). The models were evaluated and compared using Receiver Operating Characteristic (ROC) Area Under the Curve (AUC), precision, recall, and feature importance. The RF model showed better performance and was used for the test (AUC-ROC 0.96, precision 1.00, and recall 0.92 on the validation set). K-means clustering was applied to find groups within the data. Elbow method and silhouette scores were used to determine the optimal number of clusters. The formed clusters were analyzed by aggregating features to understand the characteristics of each cluster. EDA revealed significant positive correlations between age, weight, American Society of Anesthesiologists (ASA) health score, and surgery duration with the risk of developing ED. Among the ML models, RF achieved the highest performance. Key predictive variables, based on the model's feature importance, included delirium screening scales, extubation time, and time to regain consciousness. Unsupervised K-means clustering identified 2-3 optimal clusters, which represented distinct patient subgroups: younger, healthier, low-risk individuals (cluster 0), and older patients with increasing chronic disease burden, higher delirium screening scores, and consequently higher post-operative delirium risk (clusters 1 and 2). ML techniques are valuable tools for extracting insights and making accurate predictions from healthcare data. High-performing algorithm-based models can be implemented for clinical decision support systems, facilitating early identification and intervention for ED in pediatric patients. By investigating various variables, it is possible to assess risk and implement preventive measures effectively. Furthermore, unsupervised clustering reveals distinct patient subgroups, enabling personalized perioperative management strategies and enhancing overall patient care.

Assessing the Risk of Postoperative Delirium Through Comprehensive Geriatric Assessment and Eastern Cooperative Oncology Group Performance Status of Elderly Patients With Gastric Cancer.

Postoperative delirium is especially common and often problematic among elderly patients undergoing surgery. This study aimed to explore factors that can predict postoperative delirium in elderly patients undergoing gastric cancer surgery. This cohort study included 255 patients age 75 years or older who underwent gastric cancer surgery between July 2010 and December 2020. All the patients underwent preoperative comprehensive geriatric assessment (CGA) evaluation by a geriatrician. In addition to the CGA items, this study investigated the association between postoperative delirium and clinicopathologic factors, including Eastern Cooperative Oncology Group performance status (ECOG-PS). The most common postoperative complication was delirium, present in 31 patients (12.2%). The group with delirium was significantly more likely to have ECOG-PS≥2, diabetes mellitus, cardiovascular disease, or cerebral infarction. The CGA showed frailty in the Instrumental Activities of Daily Living scale (IADL), the Mini-Mental State Examination (MMSE), the Vitality Index (VI), and the Geriatric Depression Scale 15 (GDS-15). In the multivariate analysis, the independent risk factors for delirium were ECOG-PS ≥2 (P=0.002) and MMSE-frailty (P<0.001). Using an MMSE score of ≤23 and an ECOG-PS score of ≥2 as cutoffs, postoperative delirium was predicted with a sensitivity of 80.7% and a specificity of 74.1%. Postoperative delirium might be more easily predicted based on the combination of MMSE and ECOG-PS for elderly patients with gastric cancer undergoing gastrectomy.

Association of preoperative frailty with risk of postoperative delirium in older patients undergoing craniotomy: a prospective cohort study

BackgroundPreoperative frailty is a risk factor associated with postoperative delirium (POD), which has attracted more attention from clinicians, but no research has shown that it is related to elderly patients undergoing craniotomy. Therefore, the aim of this study was to determine the effect of preoperative frailty on POD in older patients, especially those who underwent craniotomy.MethodsFrom October 2022 to May 2023, older patients who underwent elective craniotomy were collected. Assess the occurrence of frailty using the FRAIL scale one day before surgery. Evaluate the occurrence of POD using the Confusion Assessment Method (CAM) within three days after surgery. Participants were divided into two groups, one group being POD, Logistic regression analysis was used to find the risk variables for POD, and the predictive value of preoperative frailty to POD was determined by using the operating characteristic curve of the subjects.ResultsA total of 300 patients were included in this study, among whom 83 patients (27.7%) exhibited preoperative frailty and 69 patients (23.0%) experienced POD. The results of the multivariate logistic regression analysis indicate that preoperative frailty (OR: 8.816, 95% CI: 3.972–19.572), preoperative hypoalbuminemia (OR: 0.893, 95% CI: 0.811–0.984), low BMI (OR: 0.793, 95% CI: 0.698–0.901), and prolonged operative duration (OR: 1.007, 95% CI: 1.004–1.010) are independent risk factors for POD in older patients who underwent craniotomy. We constructed a risk prediction model using these factors, which had an area under the ROC curve of 0.908 (95% CI: 0.869–0.947, P < 0.001). Preoperative frailty enhanced the discriminative ability of the prediction model by 0.037. POD was associated with a longer length of hospital stay and higher hospitalization costs.ConclusionsPreoperative frailty is an independent risk factor for POD in older patients undergoing elective craniotomy and can predict the occurrence of POD to a certain extent. In addition, early identification of patients at risk of malnutrition and appropriate surgical planning can reduce the incidence of POD.

The effect of two different modes of anaesthesia maintenance on postoperative delirium in elderly patient with low preoperative mini-cog score

BackgroundPostoperative delirium is a common distressing symptom experienced following laparoscopic cholecystectomy. The study aimed to investigate the influence of a low preoperative Mini-Cog testing score and 2 different anesthesia methods: total intravenous anaesthesia (TIVA) versus sevoflurane, on postoperative delirium in elderly patients undergoing laparoscopic cholecystectomy.MethodsA total of 84 patients over 60 years old who underwent laparoscopic cholecystectomy between March 1and – October 1 2023 were included in the study. Patients with a Mini-Cog score of 0–2 were considered to have low and possibly impaired neurocognitive function. We invastigated the effects of preoperative Mini-Cog score and the two anesthesia methods used on the incidence of postoperative delirium.ResultsThe proportion of patients with low Mini-Cog score in the preoperative period was 17.9%. Sevoflurane and TIVA was used in 41 and 43 patients respectively. The incidence of postoperative delirium in patients with low preoperative Mini-Cog scores was 66.7% at postoperative 0 h and 33.3% at the 1st hours. Postoperative delirium was found to be statistically higher in patients with low Mini-cog scores than in those with negatively-screened for Mini-cog scores (p: 0.01–0.035). In patients using sevoflurane, the incidence of postoperative delirium was 26.8% and 24.4% at the 0 and 1st hours, respectively. This was found to be statistically higher than in patients receiving TIVA (p: 0.036 − 0.010).ConclusionLow Mini-Cog score was an indicator of a higher risk of early postoperative delirium. Sevoflurane is more likely to cause postoperative delirium than TIVA.Trial registrationThe study was registered on ClinicalTrials.gov (Identifier: NCT06597812) .

Effect of Suanzaoren on Perioperative Analgesia, Hemodynamics and Postoperative Delirium

Hip fracture is not only accompanied by severe pain, but also impair body tissue and organ functions in patients, particularly in elderly individuals who have reduced tolerance and are prone to organ damage after experiencing a hip fracture. Surgery is the primary clinical approach for treating hip fractures. However, both the fracture trauma and surgical procedure can result in significant pain during the perioperative period, leading to abnormal hemodynamic fluctuations and an increased risk of postoperative delirium. Therefore, it is crucial to select an appropriate intervention method to facilitate the postoperative rehabilitation of hip fracture patients. Traditional Chinese Medicine (TCM) acknowledges that surgery will have different degrees of impact on muscles and bones, Qi and blood. Suanzaoren Decoction contains suanzaoren, anemarrhena asphodeloides, ligusticum chuanxiong and other TCM. The effective components of these TCM, such as spinosin, sarsasapogenin, and tetramethylpyrazine, have been proved to have analgesic effects. This study demonstrates, through clinical trials, that Suanzaoren Decoction exerts a positive influence on promoting the postoperative rehabilitation of hip fracture patients by reducing postoperative pain, stabilizing hemodynamic indexes, improving inflammatory state, and shortening the duration of postoperative delirium (all P &lt;0.05). The fact that Suanzaoren Decoction can effectively promote the postoperative rehabilitation of hip fracture patients may be related to the anti-inflammatory, analgesic and neuroprotective effects of the effective ingredients in the prescription, such as spinosin, sarsasapogenin and tetramethylpyrazine. Therefore, this study believes that Suanzaoren Decoction+ERAS intervention program represents an optimal approach for hip fracture surgery patients within the perioperative period.

Use of dexmedetomidine during light versus deep anaesthesia on postoperative delirium among elderly patients undergoing major non-cardiac surgery: protocol for a multicentre randomised factorial trial.

Elderly patients are at a high risk of postoperative delirium (POD), leading to increased postoperative morbidity and mortality. The use of dexmedetomidine and depth of anaesthesia may influence POD. This study aims to determine the effects of dexmedetomidine infusion versus normal saline placebo during light versus deep anaesthesia on POD among elderly patients undergoing major non-cardiac surgery. This prospective, multicentre, randomised, controlled, factorial trial will be conducted at three tertiary hospitals in Jiangsu, China. We will recruit a total of 420 patients who are at least 60 years old and undergoing major non-cardiac surgery (thoracic, abdominal, urology, orthopaedic and spine surgery) under general anaesthesia. Patients will be randomised (1:1:1:1) to receive one of four anaesthesia regimens: (1) dexmedetomidine and light anaesthesia, (2) dexmedetomidine and deep anaesthesia, (3) placebo and light anaesthesia or (4) placebo and deep anaesthesia. Dexmedetomidine will be infused at 0.5 µg/kg/h throughout surgery, and intraoperative bispectral index target will be 55 for light anaesthesia and 40 for deep anaesthesia. The primary outcome is the occurrence of POD during the first 7 days postoperatively or until hospital discharge, assessed using the 3-min Confusion Assessment Method two times per day. The secondary outcomes include days with POD, type of POD, pain scores at rest and on movement at 24 and 48 hours postoperatively, patient-controlled intravenous fentanyl consumption during 0-24 and 24-48 hours postoperatively, hypotension, bradycardia, postoperative nausea and vomiting, non-delirium complications, length of postoperative hospital stay, 30-day cognitive function and 30-day mortality. Data will be analysed on a modified intention-to-treat basis. This trial was approved by the Ethics Committee of the First Affiliated Hospital of Soochow University and each participating centre. The trial results will be published in a peer-reviewed journal. Chinese Clinical Trial Registry (ChiCTR2300073271).

Benefits of an automated postoperative delirium risk prediction tool combined with non-pharmacological delirium prevention on delirium incidence and length of stay: a before-after analysis based on a quality improvement project.

Postoperative delirium (POD) significantly impacts older surgical patients, necessitating effective prevention strategies. To assess the effectiveness of the Pre-Interventional Preventive Risk Assessment (PIPRA) automated delirium risk prediction tool alongside non-pharmacological prevention strategies on POD incidence, hospital length of stay (LOS) and nursing time. This quality improvement project, set in a 335-bed Swiss private hospital, employed a before-after design to evaluate the impact of PIPRA and preventive measures on POD, LOS and nursing time in non-cardiac and non-intracranial surgery inpatients aged 60 or older. The control phase focused on enhancing POD screening, whilst the intervention phase incorporated PIPRA for risk assessment and staff training to enable targeted non-pharmacological prevention in patients at risk. A total of 866 patients were included; 299 control and 567 intervention. The odds ratio of POD, comparing the intervention group to the control, was 0.71 [95% confidence interval (CI) 0.44-1.16] when adjusting for baseline patient characteristics. The intervention was associated with an LOS 0.94 (95% CI 0.85-1.05) and nursing time 0.96 (95% CI 0.86-1.07) times that of the control, adjusted for baseline patient characteristics. Medium risk patients (21.6% of patients) had an LOS 0.74 (95% CI 0.59-0.92) and required nursing time 0.79 (95% CI from 0.62-1.00) times the control, adjusted for baseline patient characteristics, equivalent to an LOS reduction of 1.36days and nursing time saving of 19.3hours per patient. Medium risk patients in the intervention group had shorter LOS and nursing time compared to the control group, underscoring the importance of targeted prevention.

A Novel Nomogram Developed Based on Preoperative Immune Inflammation-Related Indicators for the Prediction of Postoperative Delirium Risk in Elderly Hip Fracture Cases: A Single-Center Retrospective Cohort Study.

Postoperative delirium (POD) commonly occurs in elderly individuals following hip fracture surgery, with unclear pathophysiological mechanism. Inflammation is a known factor affecting the onset of delirium. The current work aimed to examine the associations of preoperative immune inflammation-related indicators with POD occurrence in elderly cases following hip fracture surgery. The current retrospective cohort study included 437 elderly cases administered hip fracture surgery from January 2018 to December 2023. The clinicodemographic data and laboratory findings of all cases were retrospectively analyzed. Immune inflammation-related indicators were assessed, eg, MLR, NLR and PLR, as well as SII and SIRI. The bootstrap method was employed to assign cases at 7:3 to the training (48 and 258 cases in the POD and no-POD groups, respectively) and internal validation (13 and 118 cases in the POD and no-POD groups, respectively) cohorts. Next, LASSO, univariable and multivariable logistic regression analyses were applied to determine risk factors in the training cohort, based on which a nomogram model was built. The obtained nomogram was examined for accuracy by calibration plot analysis. Finally, the nomogram's clinical value was assessed by decision curve analysis (DCA), followed by internal validation based on the training cohort. Of all 437 cases, 61 developed POD, indicating a POD incidence of 13.96%. LASSO regression and multivariable analyses revealed preoperative SIRI independently predicted POD in the training cohort. The developed nomogram had an area under the curve (AUC) of 0.991 (95% CI 0.983~0.998) in the training cohort versus 0.986 (95% CI 0.966~1.000) in the validation cohort. Calibration curve analysis revealed nomogram-predicted and actual probabilities were in line. DCA demonstrated the novel nomogram could confer net benefits for POD prediction in elderly cases administered hip fracture surgery. The immune inflammation-related indicators SIRI could predict POD in elderly cases following hip fracture surgery.

Association between baseline serum bicarbonate and the risk of postoperative delirium in patients undergoing cardiac surgery in the ICU: a retrospective study from the MIMIC-IV database

BackgroundAlthough serum bicarbonate is a reliable predictor of various disease complications, its relationship with postoperative delirium (POD) remains unclear. Our research aimed to assess the effect of baseline serum bicarbonate levels on the incidence of POD in cardiac surgery patients.MethodsA retrospective analysis was conducted on cardiac surgery patients who met specific inclusion and exclusion criteria, using data from the Marketplace for Information in Critical Care Medicine (MIMIC-IV) database. Univariate and multivariate logistic regression models are employed to explore the correlation between serum bicarbonate levels and the risk of POD, and their predictive efficacy is assessed by means of restricted cubic spline regression models (RCS) and receiver operating characteristic curves (ROC). In addition, subgroup and sensitivity analyses are conducted to test the robustness of the results.ResultsIn this study, 5,422 patients were included, where the incidence of POD was 13.0%. For each 1 mmol/L increase in bicarbonate, a 13% reduction in the risk of POD was observed in the fully adjusted model (OR = 0.87, 95% CI: 0.83–0.91, P < 0.001). The RCS model demonstrated a linear negative correlation between the level of bicarbonate and the risk of POD (P for nonlinearity = 0.987). The ROC curve analysis demonstrated that the bicarbonate level had moderate predictive efficacy (AUC = 0.629). Both subgroup and sensitivity analyses reaffirmed the robustness of these results.ConclusionsLower baseline serum bicarbonate levels in cardiac surgery patients are linked to a higher risk of POD. Monitoring and adjusting serum bicarbonate levels may help identify high-risk patients and potentially improve outcomes.

Cerebrovascular pulsatility indicates preoperative subcortical cognitive impairment and an increased risk for postoperative delirium in elderly patients undergoing elective spine surgery.

Advances in spine surgery enable safe interventions in elderly patients, but perioperative neurocognitive disorders (pNCD), such as post-operative delirium (POD) and cognitive dysfunction (POCD), remain a serious concern. Pre-operative cognitive impairment is a major risk factor for pNCD. Comprehensive pre-operative cognitive assessments are not feasible in clinical practice, making effective screening methods desirable. This study investigates whether pre-operative cerebrovascular duplex sonography can assess subcortical (vascular) cognitive impairment and the risk for POD. This prospective single-center study recruited patients aged ≥60 years scheduled for elective spine surgery at a German university hospital. Patients underwent pre-operative assessments including cognitive abilities (CERAD test battery), structural MRI, and cerebrovascular duplex sonography. POD screening was conducted three times daily for at least 3 days. The primary hypothesis, that the mean pulsatility index (PI) of both internal carotid arteries (ICA) predicts POD risk, was tested using logistic regression. Secondary analyses examined the association between POD risk and ICA flow (time-averaged peak velocities, TAPV) and correlations with cognitive profiles and MRI characteristics. POD occurred in 22% of patients (n = 22/99) within three postoperative days. Patients with POD were significantly older (75.9 ± 5.4 vs. 70.0 ± 6.9 years, p < 0.01) but did not differ by gender (p = 0.51). ICA PI significantly predicted POD risk (OR = 5.46 [95%CI: 1.81-16.49], p = 0.003), which remained significant after adjustment for age and duration of surgery (ORadj = 6.38 [95% CI: 1.77-23.03], p = 0.005). TAPV did not inform the POD risk (p = 0.68). ICA PI Pre-operative cognitive scores were significantly associated with ICA PI (mean CERAD score: r = -0.32, p < 0.001). ICA PI was also significantly associated with total white matter lesion volume (τ = 0.19, p = 0.012) and periventricular white matter lesion volume (τ = 0.21, p = 0.007). This is the first study to demonstrate that cerebrovascular duplex sonography can assess the risk for POD in elderly spine surgery patients. Increased ICA PI may indicate subcortical impairment, larger white matter lesion load, and lower white matter volume, predisposing factors for POD. Pre-operative cerebrovascular duplex sonography of the ICA is widely available, easy-to-use, and efficient, offering a promising screening method for POD risk. Increased ICA PI could supplement established predictors like age to adjust surgical and peri-operative procedures to individual risk profiles.

Practical prognostic tools to predict the risk of postoperative delirium in older patients undergoing cardiac surgery: visual and dynamic nomograms

Practical prognostic tools to predict the risk of postoperative delirium in older patients undergoing cardiac surgery: visual and dynamic nomograms

ASO Visual Abstract: Assessing the Risk of Postoperative Delirium Through Comprehensive Geriatric Assessment and Eastern Cooperative Oncology Group Performance Status in Elderly Patients with Gastric Cancer.

ASO Visual Abstract: Assessing the Risk of Postoperative Delirium Through Comprehensive Geriatric Assessment and Eastern Cooperative Oncology Group Performance Status in Elderly Patients with Gastric Cancer.

Preoperative serum ferritin as a biomarker for predicting delirium among elderly patients receiving non-cardiac surgery: a retrospective cohort study

Iron metabolism disorder has been identified as a contributor to the pathogenesis and progression of multiple cognitive dysfunction-related diseases, including postoperative delirium. However, the association between preoperative iron reserves and postoperative delirium risk remains elusive. This retrospective cohort study aimed to explore the impact of preoperative serum ferritin levels on the risk of postoperative delirium in elderly patients undergoing non-neurosurgical and non-cardiac procedures. Conducted at the Chinese PLA General Hospital between January 2014 and December 2021, the study finally included 12,841 patients aged 65 years and above. Preoperative serum ferritin levels were assessed within 30 days before surgery, and postoperative delirium occurrence within the first seven days after surgery was determined through medical chart review. The analyses revealed that both low and high levels of serum ferritin were associated with an increased risk of postoperative delirium. Patients in the lowest quintile of serum ferritin exhibited an 81% increased risk, while those in the highest quintile faced a 91% increased risk compared to those in the second quintile. Furthermore, mediation analyses indicated that the direct effect of preoperative serum ferritin on postoperative delirium contradicted its indirect effect mediated by hemoglobin levels. These findings suggest that maintaining serum ferritin within moderate range preoperatively could be beneficial for managing postoperative delirium risk among elderly patients.

Postoperative delirium increases follow-up mortality following hip arthroplasty in older patients with femoral neck fracture.

This study aimed to identify independent perioperative risk factors and follow-up mortality associated with postoperative delirium in older patients undergoing hip arthroplasty at a large teaching hospital in South China. We aimed to establish a specialised model to predict the risk of postoperative delirium. This retrospective observational study was conducted in the orthopaedics department of the hospital between January 2018 and December 2022. Participants were stratified into two groups: those with and those without postoperative delirium. The study included demographics, clinical characteristics, surgery-related and laboratory specifics, as well as details on delirium. In this study of 241 participants, the median age was 80 years (IQR, 74.5-85), with postoperative delirium observed in 43 individuals (18%). Multivariate logistic regression analysis identified age (OR, 1.07; 95% CI, 1.01-1.14; p = .03), arrhythmia (OR, 7.97; 95% CI, 2.25-28.29; p = .001), dementia (OR, 7.08; 95% CI, 1.73-28.95; p = .006) and a lower level of red blood cells (RBC) (OR, .33; 95% CI, .17-.64; p < .001) as independent factors associated with postoperative delirium after hip arthroplasty. Patients experiencing both preoperative and postoperative delirium had significantly higher follow-up mortality compared to those with postoperative delirium only and those without delirium (80% vs. 38% vs. 24%, p = .02). The specialised model was established to effectively predict delirium following hip arthroplasty in patients with femoral neck fracture. Postoperative delirium strongly associates with follow-up mortality. Proactive management is crucial for minimising delirium occurrence after hip arthroplasty and improving patient outcomes.

Predicting the Risk of Postoperative Delirium in Elderly Patients Undergoing Hip Arthroplasty: Development and Assessment of a Novel Nomogram

Objective To construct and internally validate a nomogram that predicts the likelihood of postoperative delirium in a cohort of elderly individuals undergoing hip arthroplasty. Methods Data for a total of 681 elderly patients underwent hip arthroplasty were retrospectively collected and divided into a model (n = 477) and a validation cohort (n = 204) according to the principle of 7:3 distribution temporally. The assessment of postoperative cognitive function was conducted through the utilization of The Confusion Assessment Method (CAM). The nomogram model for postoperative cognitive impairments was established by a combination of Lasso regression and logistic regression. The receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA) were used to evaluate the performance. Results The nomogram utilized various predictors, including age, body mass index (BMI), education, preoperative Barthel Index, preoperative hemoglobin level, history of diabetes, and history of cerebrovascular disease, to forecast the likelihood of postoperative delirium in patients. The area under the ROC curves (AUC) for the nomogram, incorporating the aforementioned predictors, was 0.836 (95% CI: 0.797–0.875) for the training set and 0.817 (95% CI: 0.755–0.880) for the validation set. The calibration curves for both sets indicated a good agreement between the nomogram’s predictions and the actual probabilities. Conclusion The use of this novel nomogram can help clinicians predict the likelihood of delirium after hip arthroplasty in elderly patients and help prevent and manage it in advance.

Managing Postoperative Delirium in Patients Receiving Head and Neck Surgery: An Educational Overview.

Postoperative delirium in patients receiving head and neck surgery is a pressing concern, affecting morbidity, mortality, and healthcare costs. With an aging population and about 65,000 new head and neck cancer diagnoses per year in the United States, surgery remains a primary treatment modality, regardless of age. This article offers an educational overview of postoperative delirium management in patients receiving head and neck surgery, summarizing incidence, etiology, pathophysiology, diagnostic tests, treatment, complications, and risk factors. A narrative literature review of articles published in the past 10 years was conducted to consolidate information on postoperative delirium in patients receiving head and neck surgery. Postoperative delirium is characterized by acute, fluctuating cognitive dysfunction within 30 days after surgery, with incidence ranging from 11% to 26%. Pathophysiology is multifactorial, and pharmacologic options are limited because of side effects and varying effectiveness. Nonpharmacologic management focuses on addressing underlying causes and early mobilization. Reducing postoperative delirium risk necessitates interprofessional, systemwide collaboration.