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Varpaei HA, Robbins LB, Farhadi K, Bender CM. Preoperative cognitive function as a risk factor of postoperative delirium in cancer surgeries: A systematic review and meta-analysis. J Surg Oncol 2024. [PMID: 38865298 DOI: 10.1002/jso.27730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 05/24/2024] [Indexed: 06/14/2024]
Abstract
Postoperative delirium (POD) after cancer surgeries can be a result of chemo brain, anesthesia, surgery duration, and preoperative cognitive impairment. Although older age and preoperative cognitive dysfunction were reported to increase the risk of POD in noncardiac surgery, the role of preoperative cognitive function and age in the development of POD after all types of cancer surgeries is not clear. This study aimed to determine the relationship between preoperative cognitive function and likelihood of POD after cancer surgeries. This study used three main online databases and followed PRISMA guidelines. English language original articles that examined preoperative cognitive function before solid tumor cancer surgery and assessed patients for postoperative delirium were included. We employed the random effect meta-analysis method. The overall incidence of POD ranged from 8.7% to 50.9%. The confusion assessment method was the most common tool used to assess delirium. Mini-mental state evaluation (MMSE), Mini-cog, and Montreal cognitive assessment were the most common tools to assess cognitive function. The pooled (total observation = 4676) random effects SMD was estimated at -0.84 (95% confidence interval [CI]: -1.30 to -0.31), indicating that lower MMSE scores before surgery are associated with a higher risk of POD. The pooled (total observation = 2668) random effects OR was estimated at 5.17 (95% CI: 2.51 to -10.63), indicating preoperative cognitive dysfunction can significantly predict the occurrence of POD after cancer surgeries. In conclusion, preoperative cognitive function is an independent and significant predictor of POD after solid tumor cancer surgeries.
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Affiliation(s)
- Hesam A Varpaei
- College of Nursing Michigan State University, East Lansing, Michigan, USA
| | - Lorraine B Robbins
- College of Nursing Michigan State University, East Lansing, Michigan, USA
| | - Kousha Farhadi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Catherine M Bender
- Nursing and Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Luo YG, Wu XD, Song YX, Wang XL, Liu K, Shi CT, Wang ZL, Ma YL, Li H, Liu YH, Mi WD, Lou JS, Cao JB. Development and validation of a nomogram to predict postoperative delirium in older patients after major abdominal surgery: a retrospective case-control study. Perioper Med (Lond) 2024; 13:41. [PMID: 38755693 PMCID: PMC11100071 DOI: 10.1186/s13741-024-00399-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/09/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Postoperative delirium is a common complication in older patients, with poor long-term outcomes. This study aimed to investigate risk factors and develop a predictive model for postoperative delirium in older patients after major abdominal surgery. METHODS This study retrospectively recruited 7577 patients aged ≥ 65 years who underwent major abdominal surgery between January 2014 and December 2018 in a single hospital in Beijing, China. Patients were divided into a training cohort (n = 5303) and a validation cohort (n = 2224) for univariate and multivariate logistic regression analyses and to build a nomogram. Data were collected for 43 perioperative variables, including demographics, medical history, preoperative laboratory results, imaging, and anesthesia information. RESULTS Age, chronic obstructive pulmonary disease, white blood cell count, glucose, total protein, creatinine, emergency surgery, and anesthesia time were associated with postoperative delirium in multivariate analysis. We developed a nomogram based on the above 8 variables. The nomogram achieved areas under the curve of 0.731 and 0.735 for the training and validation cohorts, respectively. The discriminatory ability of the nomogram was further assessed by dividing the cases into three risk groups (low-risk, nomogram score < 175; medium-risk, nomogram score 175~199; high-risk, nomogram score > 199; P < 0.001). Decision curve analysis revealed that the nomogram provided a good net clinical benefit. CONCLUSIONS We developed a nomogram that could predict postoperative delirium with high accuracy and stability in older patients after major abdominal surgery.
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Affiliation(s)
- Yun-Gen Luo
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
- Medical School of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
- Beidaihe Rest and Recuperation Center of People's Liberation Army, Hebei, 066100, China
| | - Xiao-Dong Wu
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yu-Xiang Song
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xiao-Lin Wang
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Kai Liu
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Chun-Ting Shi
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Zi-Lin Wang
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yu-Long Ma
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Hao Li
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yan-Hong Liu
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Wei-Dong Mi
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
- National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Jing-Sheng Lou
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Jiang-Bei Cao
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
- National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Goettel N, Wueest AS. Diagnosing delirium in perioperative and intensive care medicine. Curr Opin Anaesthesiol 2023; 36:491-499. [PMID: 37427443 DOI: 10.1097/aco.0000000000001288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
PURPOSE OF REVIEW This article reviews the current literature on instruments used for screening and diagnosing delirium in perioperative and intensive care medicine. It summarizes recent findings to guide clinicians and researchers in choosing the most appropriate tools. RECENT FINDINGS The incidence of delirium in hospitalized patients ranges from 5% to over 50%, depending on the population of patients studied. Failure to diagnose delirium in a timely manner is associated with serious adverse outcomes, including death and institutionalization. Valid assessment tests are needed for delirium detection, as early identification and treatment of delirium may help to prevent complications. Currently, there are more than 30 available instruments, which have been developed to assist with the screening and diagnosis of delirium. However, these tools vary greatly in sensitivity, specificity, and administration time, and their overabundance challenges the selection of specific tool as well as direct comparisons and interpretation of results across studies. SUMMARY Overlooking or misdiagnosing delirium may result in poor patient outcomes. Familiarizing healthcare workers with the variety of delirium assessments and selecting the most appropriate tool to their needs is an important step toward improving awareness and recognition of delirium.
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Affiliation(s)
- Nicolai Goettel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Clinical Research, University of Basel
| | - Alexandra S Wueest
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel
- Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
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Shi Y, Sun Q, Wang Y, Chen C, Jin J, Wang W, Lu Y, Hua Y, Liu J, Bian J, Yi Z. Can dexamethasone improve postoperative sleep and postoperative delirium in elderly patients undergoing robot-assisted laparoscopic radical prostatectomy? Protocol for a prospective, randomized, double-blind, controlled study. Trials 2023; 24:505. [PMID: 37550718 PMCID: PMC10408050 DOI: 10.1186/s13063-023-07521-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/17/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Perioperative sleep disorders (PSD) are an independent risk factor for postoperative delirium (POD), which is a common complication after surgery. Elderly patients who undergo robot-assisted radical prostatectomy (RARP) often experience perioperative sleep disorders (PSD). Dexamethasone, a medication that works by inhibiting the hypothalamic-pituitary-suprarenal cortical axis, can reduce the negative effects of surgical stress. The objective of this study was to determine whether intravenous administration of dexamethasone at the time of anesthesia induction could improve postoperative sleep quality in elderly patients, thereby indirectly reducing the risk of postoperative cognitive impairment and accelerating postoperative rehabilitation. METHODS/DESIGN This study is a randomized, double-blind, placebo-controlled trial that was conducted at a single center. A sample size of 116 patients was determined through calculation, and these patients were randomly assigned to either the dexamethasone group (group D, n = 58) or the blank control group (group C, n = 58). On the day of surgery, the anesthesia nurse prepared either diluted dexamethasone or saline in advance, according to the patient's assigned group. The blinded anesthesiologist administered the medication during induction, and a dedicated person followed up with the patient for three consecutive postoperative days. All other aspects of care were managed equally between the two groups. The primary outcome measure was sleep quality, while secondary outcome measures included postoperative sleep time, postoperative delirium (POD), pain scores, and other complications. Relevant test measures were recorded for analysis. DISCUSSION This study aims to investigate the impact of intravenous dexamethasone on sleep quality and duration of patients undergoing robot-assisted radical prostatectomy (RARP). If the findings of this study protocol are affirmative, it could enhance the sleep quality of elderly patients after surgery, thereby minimizing the risk of postoperative delirium (POD), and providing substantial evidence for the perioperative enhanced recovery management of elderly patients. TRIAL REGISTRATION Chinese clinical trial registry: ChiCTR2200063488, Registered on 5 October 2022.
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Affiliation(s)
- Yaping Shi
- Department of Anesthesiology, the First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Qingyu Sun
- Department of Anesthesiology, the First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Yue Wang
- Department of Anesthesiology, the First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Chunting Chen
- Department of Anesthesiology, the First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Jianfei Jin
- Department of Anesthesiology, the First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Wei Wang
- Department of Anesthesiology, the First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Yuting Lu
- Department of Anesthesiology, the First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Yi Hua
- Department of Anesthesiology, the First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Jianming Liu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
| | - Jinjun Bian
- Department of Anesthesiology, the First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China.
| | - Zhou Yi
- Department of Anesthesiology, the First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China.
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Igwe EO, Nealon J, O'Shaughnessy P, Bowden A, Chang HCR, Ho MH, Montayre J, Montgomery A, Rolls K, Chou KR, Chen KH, Traynor V, Smerdely P. Incidence of postoperative delirium in older adults undergoing surgical procedures: A systematic literature review and meta-analysis. Worldviews Evid Based Nurs 2023. [PMID: 37128953 DOI: 10.1111/wvn.12649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/05/2023] [Accepted: 03/11/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND With the increase in life expectancy around the globe, the incidence of postoperative delirium (POD) among older people (≥65 years) is growing. Previous studies showed a wide variation in the incidence of POD, from 4% to 53%, with a lack of specific evidence about the incidence of POD by specific surgery type among older people. The aim of this systematic review and meta-analysis was to determine the incidence of POD by surgery type within populations 65 years and over. METHODS Databases including PubMed, Cochrane library, Embase, and CINAHL were searched until October 2020. Due to the relatively higher number of meta-analyses undertaken in this area of research, a streamlined systematic meta-analysis was proposed. RESULTS A total of 28 meta-analyses (comprising 284 individual studies) were reviewed. Data from relevant individual studies (n = 90) were extracted and included in the current study. Studies were grouped into eight surgery types and the incidence of POD for orthopedic, vascular, spinal, cardiac, colorectal, abdominal, urologic, and mixed surgeries was 20%, 14%, 13%, 32%, 14%, 30%, 10%, and 26%, respectively. POD detection instruments were different across the studies, with Confusion Assessment Method (CAM & CAM-ICU) being the most frequently adopted. LINKING EVIDENCE TO ACTION This study showed that POD incidence in older people undergoing surgery varied widely across surgery type. The more complex surgeries like cardiac and abdominal surgeries were associated with a higher risk of POD. This highlights the need to include the level of surgery complexity as a risk factor in preoperative assessments.
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Affiliation(s)
- Ezinne Oyidia Igwe
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, New South Wales, Australia
| | - Jessica Nealon
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, New South Wales, Australia
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Pauline O'Shaughnessy
- School of Mathematics and Applied Statistics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Alera Bowden
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, New South Wales, Australia
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Hui-Chen Rita Chang
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, New South Wales, Australia
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Mu-Hsing Ho
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Jed Montayre
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR
| | - Amy Montgomery
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, New South Wales, Australia
| | - Kaye Rolls
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Kee-Hsin Chen
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Evidence-based Knowledge Translation Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Victoria Traynor
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, New South Wales, Australia
| | - Peter Smerdely
- School of Population Health, UNSW Medicine, Sydney, New South Wales, Australia
- St George Hospital, Kogarah, New South Wales, Australia
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Liu Y, Shen W, Tian Z. Using Machine Learning Algorithms to Predict High-Risk Factors for Postoperative Delirium in Elderly Patients. Clin Interv Aging 2023; 18:157-168. [PMID: 36789284 PMCID: PMC9922512 DOI: 10.2147/cia.s398314] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
Purpose Postoperative delirium (POD) is a common postoperative complication in elderly patients, and it greatly affects the short-term and long-term prognosis of patients. The purpose of this study was to develop a machine learning model to identify preoperative, intraoperative and postoperative high-risk factors and predict the occurrence of delirium after nonbrain surgery in elderly patients. Patients and Methods A total of 950 elderly patients were included in the study, including 132 patients with POD. We collected 30 characteristic variables, including patient demographic characteristics, basic medical history, preoperative examination characteristics, type of surgery, and intraoperative information. Three machine learning algorithms, multilayer perceptron (MLP), extreme gradient boosting (XGBoost), and k-nearest neighbor algorithm (KNN), were applied to construct the model, and the k-fold cross-validation method, ROC curve, calibration curve, decision curve analysis (DCA) and external validation were used for model evaluation. Results XGBoost showed the best performance among the three prediction models. The ROC curve results showed that XGBoost had a high area under the curve (AUC) value of 0.982 in the training set; the AUC value in the validation set was 0.924, and the prediction model was highly accurate. The k-fold cross-validation method was used for internal validation, and the XGBoost model was stable The calibration curve showed high predictive power of the XGBoost model. The DCA curve showed a higher benefit rate for patients who received interventional treatment under the XGBoost model. The AUC value for the external validation set was 0.88, indicating that the predictive model was extrapolative. Conclusion The prediction model of POD derived from the machine learning algorithm in this study has high prediction accuracy and clinical utility, which is beneficial for clinicians to diagnose and treat patients in a timely manner.
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Affiliation(s)
- Yuan Liu
- Department of General Surgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, People’s Republic of China
| | - Wei Shen
- Department of General Surgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, People’s Republic of China,Correspondence: Wei Shen, Department of General Surgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, People’s Republic of China, Tel +86 13385110723, Email
| | - Zhiqiang Tian
- Department of General Surgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, People’s Republic of China
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Zhao B, Ji HS, Xu CY, Li DJ, Xing ZQ, Liu B, Han Y, Xia WJ, Han LH. Incidence and risk factors of postoperative delirium after pancreatic cancer surgery: a retrospective study. Surg Today 2022; 53:736-742. [DOI: 10.1007/s00595-022-02614-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/25/2022] [Indexed: 11/07/2022]
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Xu Y, Ma Q, Du H, Yang C, Lin G. Postoperative Delirium in Neurosurgical Patients: Recent Insights into the Pathogenesis. Brain Sci 2022; 12:brainsci12101371. [PMID: 36291305 PMCID: PMC9599232 DOI: 10.3390/brainsci12101371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 11/16/2022] Open
Abstract
Postoperative delirium (POD) is a complication characterized by disturbances in attention, awareness, and cognitive function that occur shortly after surgery or emergence from anesthesia. Since it occurs prevalently in neurosurgical patients and poses great threats to the well-being of patients, much emphasis is placed on POD in neurosurgical units. However, there are intricate theories about its pathogenesis and limited pharmacological interventions for POD. In this study, we review the recent insights into its pathogenesis, mainly based on studies within five years, and the five dominant pathological theories that account for the development of POD, with the intention of furthering our understanding and boosting its clinical management.
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Affiliation(s)
- Yinuo Xu
- Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
- School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Qianquan Ma
- Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
- Center for Precision Neurosurgery and Oncology, Peking University Health Science Center, Beijing 100191, China
| | - Haiming Du
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
| | - Chenlong Yang
- Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
- Center for Precision Neurosurgery and Oncology, Peking University Health Science Center, Beijing 100191, China
- North America Medical Education Foundation, Union City, CA 94587, USA
- Correspondence: (C.Y.); (G.L.); Tel.: +86-135-1108-7060 (C.Y.); +86-135-5240-0103 (G.L.)
| | - Guozhong Lin
- Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
- Center for Precision Neurosurgery and Oncology, Peking University Health Science Center, Beijing 100191, China
- Correspondence: (C.Y.); (G.L.); Tel.: +86-135-1108-7060 (C.Y.); +86-135-5240-0103 (G.L.)
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Pasqui E, de Donato G, Brancaccio B, Casilli G, Ferrante G, Cappelli A, Palasciano G. The Predictive Role of Inflammatory Biochemical Markers in Post-Operative Delirium After Vascular Surgery Procedures. Vasc Health Risk Manag 2022; 18:747-756. [PMID: 36128257 PMCID: PMC9482775 DOI: 10.2147/vhrm.s368194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background Post-operative delirium (POD) is a common complication, especially in elderly patients who underwent vascular surgery procedures. The aim of this study was to evaluate the relation of inflammatory biochemical markers as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic inflammation index (SII) with POD occurrence. Methods This was a single-center, retrospective, observational study. We analyzed the perioperative data of patients who had undergone elective vascular surgery procedures. The occurrence of delirium after procedure was used to divide the population in two groups: POD-pos and POD-neg group. ROC curves were performed to find the appropriate cut-off values of NLR, PLR and SII. Multivariate analysis was used to identify the independent predictors for POD. Results A total of 646 patients were enrolled. Mean age was 76.2±9.8 years, 68.4% were male. Seventy-three patients (11.3%) developed POD. Mean hospital stay was significantly increased in the POD-pos group (6.1±5.4 vs 3.2±2.8 days, p=0.0001). In-hospital reinterventions were more frequent in the POD-pos group (8.2% vs 3.8%). Blood values analysis reported significant differences: Hb, NLR, PLR, SII, creatinine and RCP were strongly increased (p<0.05) in the POD-pos group. ROC curves identified cut-off values for NLR>3.57, PLR>139.2 and SII>676.4. Multivariate analysis revealed that age, Renal Failure, peripheral revascularization procedures, major amputation, general anesthesia, hospitalization in the previous month, NLR>3.57 and SII>676.4 were independent risk factors for POD. Conclusion POD represents a common complication of vascular surgery patients. Our study demonstrated that NLR, PLR and SII are reliable and readily available laboratory predictors of POD in vascular surgery that could help in POD risk-stratification.
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Affiliation(s)
- Edoardo Pasqui
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Gianmarco de Donato
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Brenda Brancaccio
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giulia Casilli
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giulia Ferrante
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Alessandro Cappelli
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giancarlo Palasciano
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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10
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Perioperative psychological issues and nursing care among patients undergoing minimally invasive surgeries. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2022. [DOI: 10.1016/j.lers.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Ozay HY, Bindal M, Turkkan S, Beyoglu MA, Yekeler E, Turan S. Delirium Development After Lung Transplantation: An Intraoperative Assessment. Transplant Proc 2022; 54:1906-1912. [PMID: 35985880 DOI: 10.1016/j.transproceed.2022.03.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/27/2022] [Accepted: 03/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to evaluate the relationship between intraoperative hemodynamic and laboratory parameters with postoperative delirium development after lung transplantation. METHODS A total of 77 patients who underwent lung transplantation in a single center were included in the study. Demographic and clinical data recorded at critical intraoperative stages (after induction [T1], after bilateral lungs are dissected [T2], while the patient is ventilated for 1 lung [T3], while the unilateral transplanted lung is ventilated [T4], while bilateral transplanted lungs are ventilated [T5], and after the thorax is closed [T6]), postoperative complications, mechanical ventilation duration, intensive care, and hospitalization durations and mortality rates were recorded. RESULTS A total of 83.1% of the 77 patients were male, and the mean (SD) age was 47.56 (12.95) years. The mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 23.30 (3.99), and the median Charles Comorbidity Index (CCI) was 1. The diagnosis of 36.4% of the patients was chronic obstructive pulmonary disease. Delirium was seen in 51.9% of the patients. Age, CCI, intraoperative mean arterial pressure changes, lactate levels, mechanical ventilation duration, and hospital stay were all associated with delirium development. CONCLUSION Age, CCI, duration of mechanical ventilation, and hospital stay were independent predictors of postoperative delirium development. We believe that our study will be a guide for future prospective randomized controlled studies.
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Affiliation(s)
- Hulya Yigit Ozay
- Department of Anesthesiology and Reanimation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Mustafa Bindal
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Sinan Turkkan
- Department of Anesthesiology and Reanimation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey; Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Muhammet Ali Beyoglu
- Department of Anesthesiology and Reanimation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey; Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.
| | - Erdal Yekeler
- Department of Anesthesiology and Reanimation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey; Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Sema Turan
- Department of Anesthesiology and Reanimation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey; Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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12
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Shimomoto Y, Mukaiyama K, Hori T, Inaki Y, Masai T, Hayashi Y. Postoperative delirium does not affect cardiopulmonary exercise testing in aged patients undergoing cardiac valve surgery. JA Clin Rep 2022; 8:64. [PMID: 35962209 PMCID: PMC9374849 DOI: 10.1186/s40981-022-00553-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background The effect of delirium on cardiopulmonary exercise testing (CPX) is unknown. This retrospective study was to examine the effect of delirium on CPX at discharge in aged patients undergoing cardiac surgery. Methods This study included seventy patients aged 70 or older undergoing cardiac valve surgery, who entered our ICU and were discharged from our hospital between June 2016 and July 2018. All patients received active exercise by our rehabilitation team from the first postoperative day and were performed a CPX on a cycle ergometer before discharge. The anaerobic threshold oxygen uptake and the slope of the relationship between carbon dioxide output and minute ventilation were examined. We obtained the patient’s data, including patient’s characteristics, cardiac function, anesthesia data, laboratory data, ICU data, and length of ICU and hospital stay. Data were analyzed by unpaired t test or Fisher’s exact test. P < 0.05 was considered statistically significant. Results Of the 70 patients, 21 patients experienced delirium during ICU stay. The delirium group needed longer administration of sedatives and longer ICU stay and showed higher CRP value and lower renal function but similar cardiopulmonary function before discharge from our hospital compared with the non-delirium group. Conclusions Patients with a history of delirium during ICU showed higher CRP value and lower renal function before discharge, but the CPX values at discharge were not significantly affected by delirium.
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Mietani K, Hasegawa-Moriyama M, Inoue R, Ogata T, Shimojo N, Kurano M, Yatomi Y, Uchida K, Sumitani M. Serum levels of apolipoprotein A-I and E are associated with postoperative delirium: A post hoc analysis. Medicine (Baltimore) 2022; 101:e29906. [PMID: 35905282 PMCID: PMC9333508 DOI: 10.1097/md.0000000000029906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Postoperative delirium is a common complication for elderly patients. Detection of phosphorylated neurofilament heavy subunit in the serum reflects axonal damage with postoperative delirium. Although it has been implicated that serum apolipoprotein levels might be associated with senile cognitive disorder, its role in the development of delirium has not been fully investigated. This study examined the association of apolipoproteins with delirium after surgery. This was a post hoc analysis of 117 patients who participated in a prospective observational study of delirium in patients undergoing cancer surgery. Patients were clinically assessed for delirium within the first 5 days of surgery. Serum levels of apolipoprotein A-I, B, and E were measured on postoperative day 3. Forty-one patients (35%) were clinically diagnosed with postoperative delirium. Serum levels of apolipoprotein A-I and B were increased in patients with delirium whereas those of apolipoprotein E were decreased. These changes in apolipoprotein A-I and E levels were associated with the presence of phosphorylated neurofilament heavy subunit in the serum, and were significantly associated with delirium (A-I: adjusted odds ratio [aOR], 6.238; 95% confidence interval [CI], 2.766-20.68; P < .0001; E: aOR, 0.253; 95% CI, 0.066-0.810; P = .0193). A combination of apolipoprotein A-I and E offers significant discrimination between delirium and nondelirium with high accuracy (area under the curve, 0.8899). Serum apolipoprotein A-I and E levels were associated with delirium and the presence of phosphorylated neurofilament heavy subunit in serum. Therefore, apolipoproteins might be useful biomarkers of postoperative delirium.
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Affiliation(s)
- Kazuhito Mietani
- Department of Anaesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Maiko Hasegawa-Moriyama
- Department of Pain and Palliative Medical Sciences, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Reo Inoue
- Department of Anaesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Toru Ogata
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobutake Shimojo
- Department of Emergency and Critical Care Medicine, Tsukuba University Hospital, Ibaraki, Japan
| | - Makoto Kurano
- Department of Clinical Laboratory Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Yutaka Yatomi
- Department of Clinical Laboratory Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Kanji Uchida
- Department of Anaesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicines, The University of Tokyo Hospital, Tokyo, Japan
- * Correspondence: Masahiko Sumitani, MD, PhD, Department of Pain and Palliative Medicines, The University of Tokyo, Tokyo, Japan (e-mail: )
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14
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Elnour AA, Babkir S, A AKK. The predictors of postoperative delirium at surgical units in Sudan: A multicenter, cross-sectional, prospective study. Pharm Pract (Granada) 2022; 20:2705. [PMID: 36733520 PMCID: PMC9851826 DOI: 10.18549/pharmpract.2022.3.2705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/02/2022] [Indexed: 02/05/2023] Open
Abstract
Background Knowledge of potential and amenable risk factors involved in the development of postoperative delirium (POD) is imperative for successful prevention and subsequent management. Objective The current study objective was to delineate the risk factors associated with the occurrence of POD among patients undergoing surgical procedures. Methods 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. Results 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. Conclusion 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.
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Affiliation(s)
- Asim Ahmed Elnour
- PhD, MSc. Program of Clinical Pharmacy, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi-United Arab Emirates. AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates.
| | - Sara Babkir
- MSc, B-Pharm. Clinical Pharmacist, Clinical and Drug Supply Chain Management, MSc in Medical Health Professions Education - Alneelain University and MSc in Hospital Pharmacy - National University, Doctors Without Borders "Medicines Sans Frontiers-MSF": Supply Department Khartoum-Sudan, Sudan.
| | - Al-Kubaissi Khalid A
- PhD, MSc. Department of Pharmacy Practice & Pharmacotherapeutics, College of Pharmacy-University of Sharjah, Sharjah-United Arab Emirates.
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Menzenbach J, Kirfel A, Guttenthaler V, Feggeler J, Hilbert T, Ricchiuto A, Staerk C, Mayr A, Coburn M, Wittmann M. PRe-Operative Prediction of postoperative DElirium by appropriate SCreening (PROPDESC) development and validation of a pragmatic POD risk screening score based on routine preoperative data. J Clin Anesth 2022; 78:110684. [DOI: 10.1016/j.jclinane.2022.110684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 12/19/2022]
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16
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Wiegand TLT, Rémi J, Dimitriadis K. Electroencephalography in delirium assessment: a scoping review. BMC Neurol 2022; 22:86. [PMID: 35277128 PMCID: PMC8915483 DOI: 10.1186/s12883-022-02557-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/13/2022] [Indexed: 01/03/2023] Open
Abstract
Background Delirium is a common disorder affecting around 31% of patients in the intensive care unit (ICU). Delirium assessment scores such as the Confusion Assessment Method (CAM) are time-consuming, they cannot differentiate between different types of delirium and their etiologies, and they may have low sensitivities in the clinical setting. While today, electroencephalography (EEG) is increasingly being applied to delirious patients in the ICU, a lack of clear cut EEG signs, leads to inconsistent assessments. Methods We therefore conducted a scoping review on EEG findings in delirium. One thousand two hundred thirty-six articles identified through database search on PubMed and Embase were reviewed. Finally, 33 original articles were included in the synthesis. Results EEG seems to offer manifold possibilities in diagnosing delirium. All 33 studies showed a certain degree of qualitative or quantitative EEG alterations in delirium. Thus, normal routine (rEEG) and continuous EEG (cEEG) make presence of delirium very unlikely. All 33 studies used different research protocols to at least some extent. These include differences in time points, duration, conditions, and recording methods of EEG, as well as different patient populations, and diagnostic methods for delirium. Thus, a quantitative synthesis and common recommendations are so far elusive. Conclusion Future studies should compare the different methods of EEG recording and evaluation to identify robust parameters for everyday use. Evidence for quantitative bi-electrode delirium detection based on increased relative delta power and decreased beta power is growing and should be further pursued. Additionally, EEG studies on the evolution of a delirium including patient outcomes are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02557-w.
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Wang LH, Jin TT, Zhang XW, Xu GH. Risk factors and prevention for postoperative delirium after orthopedic surgery. Indian J Psychiatry 2021; 63:554-559. [PMID: 35136252 PMCID: PMC8793712 DOI: 10.4103/psychiatry.indianjpsychiatry_781_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/30/2020] [Accepted: 04/10/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Postoperative delirium significantly delays the recovery of patients. This study sought to explore the risk factors and to prevent postoperative delirium after orthopedic surgery. MATERIALS AND METHODS In the part of retrospective study, 456 cases over 70-year-old that underwent one of three types of orthopedic surgery were included and were defined as the retrospective group. The risk factors of postoperative delirium were analyzed by logistic regression. In the part of prospective study, 86 cases of the same age and the same surgery were included and were defined as the prospective group. Positive interventions were used by shortening the fasting time and increasing the perioperative rehydration. The differences of postoperative delirium incidence between the retrospective group and the prospective group were analyzed. RESULTS Compared with patients with normal postoperative electrolytes, postoperative creatinine <68.20 μmol/L, and fluid infusion during fasting >119.66 mL/h, postoperative electrolyte disorders (odds ratio [OR]: 2.864; 95% confidence interval [CI]: 1.374, 5.970), postoperative creatinine ≥68.20 μmol/L (OR: 2.660; 95% CI: 1.328, 5.328), and fluid infusion during fasting ≤119.66 mL/h (OR: 2.372; 95% CI: 1.197, 4.704) were the risk factors for postoperative delirium. After positive intervention, the postoperative delirium incidence of the prospective group was 5.8% (5/86), and it was lower than 18.4% (84/456) of the retrospective group (P < 0.05). CONCLUSIONS Elevated postoperative creatinine, postoperative electrolyte disorders, and lower fluid infusion during fasting were three risk factors for postoperative delirium. By shortening the fasting time and increasing the perioperative rehydration, the incidence of postoperative delirium could be reduced.
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Affiliation(s)
- Li-Hong Wang
- Department of Orthopedics, Dongyang People's Hospital, Wenzhou Medical University, Dongyang, China
| | - Ting-Ting Jin
- Department of Orthopedics, Dongyang People's Hospital, Wenzhou Medical University, Dongyang, China
| | - Xiao-Wei Zhang
- Department of Pathology, Dongyang People's Hospital, Wenzhou Medical University, Dongyang, China
| | - Guo-Hong Xu
- Department of Orthopedics, Dongyang People's Hospital, Wenzhou Medical University, Dongyang, China
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Arita A, Takahashi H, Ogino T, Miyoshi N, Uemura M, Akasaka H, Sugimoto K, Rakugi H, Doki Y, Eguchi H. Grip strength as a predictor of postoperative delirium in patients with colorectal cancers. Ann Gastroenterol Surg 2021; 6:265-272. [PMID: 35261952 PMCID: PMC8889853 DOI: 10.1002/ags3.12519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/01/2021] [Accepted: 10/04/2021] [Indexed: 01/01/2023] Open
Abstract
Background The population is aging rapidly, and the population of patients who undergo surgeries is aging, too. Elderly patients have much risk of postoperative delirium, which increases the number of adverse events. The aim of this study was to investigate the risk factors of postoperative delirium in elderly patients with colorectal cancer. Methods We conducted a retrospective cohort analysis of consecutive patients aged 70 years and older who underwent surgeries for colorectal cancer at our department in the period from May 2012 to October 2019. We investigated the correlation between the incidence of postoperative delirium and Comprehensive Geriatric Assessment (CGA) scores, comorbidities, and perioperative factors. Postoperative delirium was retrospectively diagnosed by checking clinical records. Results Postoperative delirium was diagnosed in 36 of 271 patients (13.3%) with colorectal cancer. Among many comorbidities, only renal disease was significantly associated with postoperative delirium. Among the items in the CGA, age; Mini‐Mental State Exam (MMSE), Barthel Index, Instrumental Activities of Daily Living (IADL), Vitality Index, and Geriatric Depression Scale (GDS) scores; and grip strength were associated with postoperative delirium. Among perioperative factors, blood transfusion was associated with postoperative delirium. Multivariate logistic regression analysis identified older age, MMSE, GDS, and grip strength as significant independent risk factors for postoperative delirium. Conclusions This single‐center retrospective observational study demonstrated that grip strength is an independent predictor of postoperative delirium, along with age, MMSE, and GDS.
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Affiliation(s)
- Asami Arita
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Suita City Japan
| | - Hidekazu Takahashi
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Suita City Japan
| | - Takayuki Ogino
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Suita City Japan
| | - Norikatsu Miyoshi
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Suita City Japan
| | - Mamoru Uemura
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Suita City Japan
| | - Hiroshi Akasaka
- Department of Geriatric and General Medicine Graduate School of Medicine Osaka University Suita City Japan
| | - Ken Sugimoto
- Department of General and Geriatric Medicine Graduate School of Medicine Kawasaki Medical School Kurashiki City Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine Graduate School of Medicine Osaka University Suita City Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Suita City Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Suita City Japan
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Emergence Delirium in a 29-Year-Old Man following an Uneventful Appendectomy. Case Rep Med 2021; 2021:1338823. [PMID: 34608393 PMCID: PMC8487383 DOI: 10.1155/2021/1338823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/01/2021] [Accepted: 09/11/2021] [Indexed: 02/07/2023] Open
Abstract
Emergence delirium (ED) is defined as the delirium that occurs during the transition from the sleep state to full consciousness. ED increases the risk for injury, self-extubation, hemorrhages, and prolonged hospitalization and occurs in patients of any age but most often in children and elderly patients. However, ED in young adults is rarely reported. We presented a case of typical ED occurring in a young healthy man following an uneventful appendectomy. The causes of ED can be classified as either predisposing or precipitating factors. In this case, the unnoticeable mental stress may be the predisposing factor and the sevoflurane maintenance of anesthesia may be the precipitating factor. ED occurs at any age of patient and in any minor surgery, and anesthesiologists should do some work to prevent it from happening.
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20
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Spies CD, Knaak C, Mertens M, Brockhaus WR, Shadenok A, Wiebach J, Kunzmann K, Feldheiser A, Pratschke J, Müller O, Kipping V, Fabian M, Abels W, Borchers F, Akyüz L, Ely EW, Wernecke KD, Menon DK, Piper SK. Physostigmine for prevention of postoperative delirium and long-term cognitive dysfunction in liver surgery: A double-blinded randomised controlled trial. Eur J Anaesthesiol 2021; 38:943-956. [PMID: 33534264 DOI: 10.1097/eja.0000000000001456] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Anecdotally, cholinergic stimulation has been used to treat delirium and reduce cognitive dysfunction. OBJECTIVE The aim of this investigation was to evaluate whether physostigmine reduced the incidence of postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) in patients undergoing liver resection. DESIGN This was a double-blind, randomised, placebo-controlled trial. Between 11 August 2009 and 3 March 2016, patients were recruited at the Charité - Universitätsmedizin Berlin in Germany. Follow-ups took place at 1 week (T1), 90 days (T2) and 365 days (T3) after surgery. SETTING This single-centre study was conducted at an academic medical centre. PARTICIPANTS In total, 261 participants aged at least 18 years scheduled for elective liver surgery were randomised. The protocol also included 45 non-surgical matched controls to provide normative data for POCD and neurocognitive deficit (NCD). INTERVENTION Participants were allocated to receive either intravenous physostigmine, as a bolus of 0.02 mg kg-1 body weight followed by 0.01 mg kg-1 body weight per hour (n = 130), or placebo (n = 131), for 24 h after induction of anaesthesia. MAIN OUTCOMES AND MEASURES Primary outcomes were POD, assessed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-4-TR) twice daily up to day 7 after surgery, and POCD assessed via the CANTAB neuropsychological test battery, and two paper pencil tests on the day before surgery, and on postoperative days 7, 90 and 365. RESULTS In total, 261 patients were randomised, 130 to the physostigmine and 131 to the placebo group. The incidence of POD did not differ significantly between the physostigmine and placebo groups (20 versus 15%; P = 0.334). Preoperative cognitive impairment and POCD frequencies did not differ significantly between the physostigmine and placebo groups at any time. Lower mortality rates were found in the physostigmine group compared with placebo at 3 months [2% (95% confidence interval (CI), 0 to 4) versus 11% (95% CI, 6 to 16), P = 0.002], and 6 months [7% (95% CI, 3 to 12) versus 16% (95% CI, 10 to 23), P = 0.012] after surgery. CONCLUSION Physostigmine had no effect on POD and POCD when applied after induction of anaesthesia up to 24 h. TRIAL REGISTRATION DOI 10.1186/ISRCTN18978802, EudraCT 2008-007237-47, Ethics approval ZS EK 11 618/08 (15 January 2009).
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Affiliation(s)
- Claudia D Spies
- From the Department of Anaesthesiology and Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, and Berlin Institute of Health (CDS, CK, MM, W-RB, AS, AF, OM, VK, MF, WA, FB), Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, and Berlin Institute of Health (JW, KDW, SKP), Berlin Institute of Health (BIH), Anna-Louisa-Karsch 2, Berlin, Germany (JW, SKP), Addenbrooke's Hospital, Division of Anaesthesia, University of Cambridge, Cambridge, UK (KK, DKM), Department of Surgery (JP), Institute of Immunology, Charité - Universitätsmedizin Berlin, and Berlin Institute of Health (LA), Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany (LA), Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, and the Veteran's Affairs Tennessee Valley Geriatric Research Education Clinical Center (GRECC), USA (EWE) and SOSTANA GmbH Berlin, Germany (KDW)
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Xiang XB, Chen H, Wu YL, Wang K, Yue X, Cheng XQ. The effect of pre-operative methylprednisolone on postoperative delirium in elderly patients undergoing gastrointestinal surgery: a randomized, double-blind, placebo-controlled trial. J Gerontol A Biol Sci Med Sci 2021; 77:517-523. [PMID: 34423832 DOI: 10.1093/gerona/glab248] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pre-operative administration of methylprednisolone reduced circulating markers of endothelial activation. This randomized, double-blind was to evaluate whether a single pre-operative dose of methylprednisolone reduced the rate of postoperative delirium (POD) in older patients undergoing gastrointestinal surgery, and its association with the shedding of endothelial glycocalyx markers. METHODS 168 patients, aged 65-80 years and scheduled for laparoscopic gastrointestinal surgery, were randomized to 2 mg·kg -1 methylprednisolone (Group M, n = 84); or equivalent dose of placebo (Group C, n = 84). The primary outcome was the incidence of delirium during the first 5 days after surgery, assessed by the confusion assessment method (CAM). POD severity was rated daily using CAM-Severity (CAM-S). Level of syndecan-1, heparan sulfate, tumor necrosis factor-α(TNF-α), and brain-derived neurotrophic factor (BDNF) were measured at baseline, 1-day, and 3-day after surgery. RESULTS Compared with placebo, methylprednisolone greatly reduced the incidence of delirium at 72 h following surgery [9(10.7%) versus 20(23.8%), P =0.03, OR=2.22(95%CI 1.05-4.59)]. No between-group difference was found in the cumulative CAM-S score (P=0.14). The levels of heparan sulfate, syndecan-1, and TNF-α in Group M were lower than that in Group C (P <0.05 and P <0.01), while the level of BDNF in Group M was higher than that in Group C (P <0.01). CONCLUSIONS Pre-operative administration of methylprednisolone does not reduce the severity of POD, but may reduce the incidence of delirium after gastrointestinal surgery in elderly patients, which may be related to a reduction in circulating markers of endothelial degradation, followed by the increase of BNDF level.
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Affiliation(s)
- Xiao-Bing Xiang
- Department of Anesthesiology, the Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Institute of Basic Medicine and Cancer(IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Hao Chen
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Ying-Li Wu
- Department of Anesthesiology, the Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Institute of Basic Medicine and Cancer(IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Ke Wang
- Department of Anesthesiology, the Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Institute of Basic Medicine and Cancer(IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Xiang Yue
- Department of Anesthesiology, the Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Institute of Basic Medicine and Cancer(IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Xin-Qi Cheng
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
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A clinical risk analysis of early post-operative delirium after laparoscopic colorectal cancer surgery in elderly patients: a retrospective study. Int J Colorectal Dis 2021; 36:1461-1468. [PMID: 33782764 DOI: 10.1007/s00384-021-03919-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Early post-operative delirium (EPOD) is a frequent complication following colorectal surgery. The present study investigated the risk factors for EPOD after laparoscopic colorectal surgery in elderly patients. METHODS A retrospective study was conducted among 208 patients ≥70 years old who underwent laparoscopic colorectal surgery. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with the EPOD. RESULTS The overall incidence of EPOD was 10.1% (21/208). The univariate analysis showed that an older age (≥80 years old; P=0.002), sleeping pill medication before surgery (P=0.037), a history of dementia (P=0.030) and cerebrovascular disease (P=0.017), elevated levels of D-dimer (P=0.016), maximum intraoperative temperature ≥37 °C (P=0.036), and non-continuous usage of droperidol with analgesia (P=0.005) were associated with EPOD. The multivariate logistic regression analysis revealed an older age (≥80 years old; odds ratio [OR]: 6.26, 95% confidence interval [CI]: 1.94-20.15, P=0.002), sleeping pill medication before surgery (OR: 5.39, 95% CI: 1.36-21.28, P=0.016), history of cerebrovascular disease (OR: 3.91, 95% CI: 1.12-13.66, P=0.033), and maximum intraoperative temperature ≥37 °C (OR: 5.10, 95% CI: 1.53-16.92, P=0.008) to be independent risk factors. When the patients were divided into groups according to the number of positive risk factors, the prevalence rate was 6.5%, 16.0%, and 63.6% for patients with 1, 2, and 3 positive risk factors, respectively. CONCLUSION Our findings suggest that an older age, sleeping pill medication before surgery, history of cerebrovascular disease, and maximum intraoperative temperature ≥37 °C are independent risk factors of EPOD after laparoscopic colorectal surgery in elderly patients.
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Lin X, Wang P, Liu DW, Guo YW, Xie CH, Wang B, Dong R, Sun LX, Wang MS, Bi YL. Intraoperative Oxygen Concentration and Postoperative Delirium After Laparoscopic Gastric and Colorectal Malignancies Surgery: A Randomized, Double-Blind, Controlled Trial. Clin Interv Aging 2021; 16:1085-1093. [PMID: 34163152 PMCID: PMC8214551 DOI: 10.2147/cia.s311190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/03/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Postoperative delirium (POD) is common in elderly patients undergoing laparoscopic surgery for gastric and colorectal malignancies. POD may be affected by different fraction of inspired oxygen (FiO2). The purpose of this study was to compare the effects of different FiO2 on POD. Patients and Methods A randomized, double-blind controlled trial was performed in Qingdao Municipal Hospital Affiliated to Qingdao University. A total of 662 patients aged 65 to 85 years old underwent isolated laparoscopic radical gastrectomy, radical resection of colon cancer, or radical resection of rectal cancer only. A random number table method was used to divide the patients into two groups: 40% FiO2 (group A) and 80% FiO2 (group B). The primary endpoint was the incidence of POD, which was assessed by the Confusion Assessment Method (CAM) twice daily during the first 7 postoperative days, and POD severity was measured by the Memorial Delirium Assessment Scale (MDAS). The secondary endpoints were the intraoperative regional cerebral oxygen saturation (rSO2), Bispectral (BIS) index, invasive arterial blood pressure (IABP), oxygen saturation (SpO2), end-tidal carbon dioxide partial pressure (PETCO2), the number of atelectasis cases and visual analogue scale (VAS) scores on days 1-7 after surgery. Results The incidence of POD was 19.37% (122/630), including 20.38% (64/314) in group A and 18.35% (58/316) in group B. No statistical significance was found in the incidence of POD between the two groups (P > 0.05); compared with group B, SpO2, rSO2 and PaO2 decreased at T2 to T4 time point (P < 0.01), and the incidence of postoperative atelectasis decreased (P < 0.05) in group A. Conclusion The incidence of POD was not significantly affected by different FiO2 and the incidence of postoperative atelectasis was decreased at low FiO2.
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Affiliation(s)
- Xu Lin
- Department of Anesthesiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, People's Republic of China
| | - Pei Wang
- Department of Anesthesiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, People's Republic of China
| | - Ding-Wei Liu
- Department of Laboratory, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, People's Republic of China
| | - Yu-Wei Guo
- Department of Anesthesiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, People's Republic of China
| | - Chun-Hui Xie
- Department of Anesthesiology, Weifang Medical University, Weifang, People's Republic of China
| | - Bin Wang
- Department of Anesthesiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, People's Republic of China
| | - Rui Dong
- Department of Anesthesiology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, People's Republic of China
| | - Li-Xin Sun
- Department of Anesthesiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, People's Republic of China
| | - Ming-Shan Wang
- Department of Anesthesiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, People's Republic of China
| | - Yan-Lin Bi
- Department of Anesthesiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, People's Republic of China
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Factors Affecting the Length of Hospital Days After Laparoscopic Gastrectomy for Elderly Patients with Gastric Cancer. J Gastrointest Cancer 2021; 53:472-479. [PMID: 33905108 DOI: 10.1007/s12029-021-00633-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To clarify the factors affecting the length of hospitalization after laparoscopic gastrectomy based on the physical function, body composition, and postoperative course of the patients. METHODS Of the patients with gastric cancer who underwent laparoscopic resection at the Ageo Central General Hospital, Japan, during 2018-2019, 51 underwent physical therapy. Data regarding the objective variables, such as length of postoperative hospital stay, and baseline attributes, such as age, body weight, body mass index (BMI), and corrected limb muscle mass, postoperative course (operation time, the estimated blood loss, the day before walking independently), preoperative physical function (grip strength, 6-min walking distance), and preoperative respiratory function (vital capacity [VC]%, one-second rate) were collected retrospectively from the medical records and analyzed using multiple regression plots. RESULTS The most suitable hospital day model after surgery is one that incorporates the total postoperative course, respiratory function, physical function (R2 = 0.45, p < 0001), and operation time (β = 0.12, p < 0.06). The information of the day before independent walking (β = 0.68, p < 0.001) and % VC (β = -0.19, p < 0.04) was extracted as factors. CONCLUSION We concluded that the operation time, walking independence days, and % VC influence the postoperative length of hospital days.
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Bendayan M, Messas N, Perrault LP, Asgar AW, Lauck S, Kim DH, Arora RC, Langlois Y, Piazza N, Martucci G, Lefèvre T, Noiseux N, Lamy A, Peterson MD, Labinaz M, Popma JJ, Webb JG, Afilalo J. Frailty and Bleeding in Older Adults Undergoing TAVR or SAVR: Insights From the FRAILTY-AVR Study. JACC Cardiovasc Interv 2020; 13:1058-1068. [PMID: 32381184 DOI: 10.1016/j.jcin.2020.01.238] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The aim of this study was to examine the value of frailty to predict in-hospital major bleeding and determine its impact on mid-term mortality following transcatheter (TAVR) or surgical (SAVR) aortic valve replacement. BACKGROUND Bleeding complications are harbingers of mortality and major morbidity in patients undergoing TAVR or SAVR. Despite the high prevalence of frailty in this population, little is known about its effects on bleeding risk. METHODS A post hoc analysis was performed of the multinational FRAILTY-AVR (Frailty Aortic Valve Replacement) cohort study, which prospectively enrolled older adults ≥70 years of age undergoing TAVR or SAVR. Trained researchers assessed frailty using a questionnaire and physical performance battery pre-procedure and ascertained clinical data from the electronic health record. The primary endpoint was major or life-threatening bleeding during the index hospitalization, and the secondary endpoint was units of packed red blood cells transfused. RESULTS The cohort consisted of 1,195 patients with a mean age of 81.3 ± 6.0 years. The incidence of life-threatening bleeding, major bleeding with a clinically apparent source, and major bleeding without a clinically apparent source was, respectively, 3%, 6%, and 9% in the TAVR group and 8%, 10%, and 31% in the SAVR group. Frailty measured using the Essential Frailty Toolset was an independent predictor of major bleeding and packed red blood cell transfusions in both groups. Major bleeding was associated with a 3-fold increase in 1-year mortality following TAVR (odds ratio: 3.40; 95% confidence interval: 2.22 to 5.21) and SAVR (odds ratio: 2.79; 95% confidence interval: 1.25 to 6.21). CONCLUSIONS Frailty is associated with post-procedural major bleeding in older adults undergoing TAVR and SAVR, which is in turn associated with a higher risk for mid-term mortality.
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Affiliation(s)
- Melissa Bendayan
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada; Centre for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Nathan Messas
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Louis P Perrault
- Division of Cardiac Surgery, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Anita W Asgar
- Division of Cardiology, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Sandra Lauck
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dae H Kim
- Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts
| | - Rakesh C Arora
- Divisions of Cardiac Surgery and Critical Care, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba
| | - Yves Langlois
- Division of Cardiac Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Nicolo Piazza
- Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Giuseppe Martucci
- Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Thierry Lefèvre
- Division of Cardiology, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Nicolas Noiseux
- Division of Cardiac Surgery, Center Hospitalier de l'Université de Montréal, Centre de Recherche du CHUM, Montreal, Quebec
| | - Andre Lamy
- Division of Cardiac Surgery, Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Mark D Peterson
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marino Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jeffrey J Popma
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan Afilalo
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada; Centre for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada; Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
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Ehsani R, Djalali Motlagh S, Zaman B, Sehat Kashani S, Ghodraty MR. Effect of General Versus Spinal Anesthesia on Postoperative Delirium and Early Cognitive Dysfunction in Elderly Patients. Anesth Pain Med 2020; 10:e101815. [PMID: 33134142 PMCID: PMC7539056 DOI: 10.5812/aapm.101815] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/14/2020] [Accepted: 07/06/2020] [Indexed: 11/16/2022] Open
Abstract
Background Postoperative cognitive dysfunction (POCD) and delirium are common in the elderly patients, given the controversial results of previous studies about the impact of anesthesia type on the occurrence of these complications. Objectives This study was planned to compare the effects of general and spinal anesthesia on the prevalence of POCD and delirium. Methods A single-blind non-randomized clinical trial. Setting was in two academic hospitals. Ninety-four patients over 50 years old scheduled for hip fracture fixation. Patients were divided into two groups to receive either general (GA) or spinal (SA) anesthesia. Both Mini-Mental State examination (MMSE) and Wechsler tests were used before the operation and 3 times postoperatively to assess the cognitive function and detect early POCD. The DSM-IV criteria were also used for the diagnosis of delirium. The incidence of delirium and POCD and their precipitating factors were compared between the two groups. Results Ninety-four patients with a mean age of 67.12 years were studied. The overall prevalence of POCD and delirium was 17.02%; however, it was significantly higher in the GA group rather than the SA group, 29.7%, and 4.25%, respectively (P < 0.001). There was a significant relationship between age (P = 0.048), ASA class (P = 0.034), and educational level with the incidence of POCD, meaning that the probability of developing cognitive impairment decreases with patients' higher level of education and lower ASA-physical status. Also, the rate of POCD in men was significantly higher than in women (P = 0.026). Conclusions The finding of this study showed that, if there is no specific contraindication, neuraxial anesthesia may be preferred over general anesthesia in elderly patients.
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Affiliation(s)
- Roghayeh Ehsani
- Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Soudabeh Djalali Motlagh
- Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Behrooz Zaman
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saloumeh Sehat Kashani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Ghodraty
- Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Kunst G, Green DW, Ballard C. Can Intraoperative Optimization of Both Anesthetic Depth and Cerebral Oxygenation Really Result in Different Influences on Cognitive Function and Delirium in Elderly Patients Undergoing Cardiac Surgery? Response to Letter to the Editor by Xue et al. J Cardiothorac Vasc Anesth 2020; 34:3166-3167. [PMID: 32711937 DOI: 10.1053/j.jvca.2020.06.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Gudrun Kunst
- Department of Anaesthetics, King's College Hospital, London, United Kingdom; School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence
| | - David W Green
- Department of Anaesthetics, King's College Hospital, London, United Kingdom
| | - Clive Ballard
- University of Exeter Medical School, Exeter, United Kingdom
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Saravana-Bawan B, Warkentin LM, Rucker D, Carr F, Churchill TA, Khadaroo RG. Incidence and predictors of postoperative delirium in the older acute care surgery population: a prospective study. Can J Surg 2019; 62:33-38. [PMID: 30693744 DOI: 10.1503/cjs.016817] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background Among older inpatients, the highest incidence of delirium is within the surgical population. Limited data are available regarding postoperative delirium risk in the acute care surgical population. The purpose of our study was to establish the incidence of and risk factors for delirium in an older acute care surgery population. Methods Patients aged 65 years or more who had undergone acute care surgery between April 2014 and September 2015 at 2 university-affiliated hospitals in Alberta were followed prospectively and screened for delirium by means of a validated chart review method. Delirium duration was recorded. We used separate multivariable logistic regression models to identify independent predictors for overall delirium and longer episodes of delirium (duration ≥ 48 h). Results Of the 322 patients included, 73 (22.7%) were identified as having experienced delirium, with 49 (15.2%) experiencing longer episodes of delirium. Postoperative delirium risk factors included Foley catheter use, intestinal surgery, gallbladder surgery, appendix surgery, intensive care unit (ICU) admission and mild to moderate frailty. Risk factors for prolonged postoperative delirium included Foley catheter use and mild to moderate frailty. Surgical approach (open v. laparoscopic) and overall operative time were not found to be significant. Conclusion In keeping with the literature, our study identified Foley catheter use, frailty and ICU admission as risk factors for delirium in older acute care surgical patients. We also identified an association between delirium risk and the specific surgical procedure performed. Understanding these risk factors can assist in prevention and directed interventions for this high-risk population.
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Affiliation(s)
- Bianka Saravana-Bawan
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Saravana-Bawan, Warkentin, Churchill, Khadaroo); the Division of Geriatrics, Department of Medicine, University of Alberta, Edmonton, Alta. (Rucker, Carr); and the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Khadaroo)
| | - Lindsey M. Warkentin
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Saravana-Bawan, Warkentin, Churchill, Khadaroo); the Division of Geriatrics, Department of Medicine, University of Alberta, Edmonton, Alta. (Rucker, Carr); and the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Khadaroo)
| | - Diana Rucker
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Saravana-Bawan, Warkentin, Churchill, Khadaroo); the Division of Geriatrics, Department of Medicine, University of Alberta, Edmonton, Alta. (Rucker, Carr); and the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Khadaroo)
| | - Frances Carr
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Saravana-Bawan, Warkentin, Churchill, Khadaroo); the Division of Geriatrics, Department of Medicine, University of Alberta, Edmonton, Alta. (Rucker, Carr); and the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Khadaroo)
| | - Thomas A. Churchill
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Saravana-Bawan, Warkentin, Churchill, Khadaroo); the Division of Geriatrics, Department of Medicine, University of Alberta, Edmonton, Alta. (Rucker, Carr); and the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Khadaroo)
| | - Rachel G. Khadaroo
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Saravana-Bawan, Warkentin, Churchill, Khadaroo); the Division of Geriatrics, Department of Medicine, University of Alberta, Edmonton, Alta. (Rucker, Carr); and the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Khadaroo)
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Cai S, Latour JM, Lin Y, Pan W, Zheng J, Xue Y, Gao J, Lv M, Zhang X, Luo Z, Wang C, Zhang Y. Preoperative cardiac function parameters as valuable predictors for nurses to recognise delirium after cardiac surgery: A prospective cohort study. Eur J Cardiovasc Nurs 2019; 19:310-319. [PMID: 31674797 DOI: 10.1177/1474515119886155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Delirium is a common postoperative complication after cardiac surgery. The relationship between delirium and cardiac function has not been fully elucidated. AIMS The aim of this study was to identify the association between preoperative cardiac function and delirium among patients after cardiac surgery. METHODS We prospectively recruited 635 cardiac surgery patients with a planned cardiac intensive care unit admission. Postoperative delirium was diagnosed using the confusion assessment method for the intensive care unit. Preoperative cardiac function was assessed using N-terminal prohormone of brain natriuretic peptide (NT-proBNP), New York Heart Association functional classification and left ventricular ejection fraction. RESULTS Delirium developed in 73 patients (11.5%) during intensive care unit stay. NT-proBNP level (odds ratio (OR) 1.24, 95% confidence interval (CI) 1.01-1.52) and New York Heart Association functional classification (OR 2.34, 95% CI 1.27-4.31) were both independently associated with the occurrence of delirium after adjusting for various confounders. The OR of delirium increased with increasing NT-proBNP levels after the turning point of 7.8 (log-transformed pg/ml). The adjusted regression coefficients were 1.19 (95% CI 0.95-1.49, P=0.134) for NT-proBNP less than 7.8 (log-transformed pg/ml) and 2.78 (95% CI 1.09-7.12, P=0.033) for NT-proBNP greater than 7.8 (log-transformed pg/ml). No association was found between left ventricular ejection fraction and postoperative delirium. CONCLUSION Preoperative cardiac function parameters including NT-proBNP and New York Heart Association functional classification can predict the incidence of delirium following cardiac surgery. We suggest incorporating an early determination of preoperative cardiac function as a readily available risk assessment for delirium prior to cardiac surgery.
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Affiliation(s)
- Shining Cai
- Department of Nursing, Zhongshan Hospital, China
| | - Jos M Latour
- School of Nursing and Midwifery, University of Plymouth, UK
| | - Ying Lin
- Department of Nursing, Zhongshan Hospital, China
| | - Wenyan Pan
- Department of Nursing, Zhongshan Hospital, China
| | - Jili Zheng
- Department of Nursing, Zhongshan Hospital, China
| | - Yan Xue
- Department of Nursing, Zhongshan Hospital, China
| | - Jian Gao
- Department of Biostatistics, Zhongshan Hospital, China
| | - Minzhi Lv
- Department of Biostatistics, Zhongshan Hospital, China
| | | | - Zhe Luo
- Department of Cardiac Surgical Intensive Care Unit, Zhongshan Hospital, China
| | - Chunsheng Wang
- Department of Cardiac Surgery, Zhongshan Hospital, China
| | - Yuxia Zhang
- Department of Nursing, Zhongshan Hospital, China
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Liu Z, Li R, Wang S, Zhou Y, Yin L, Qu Y, Peng C. Postoperative delirium after hysteroscopy in young woman: A case report. Medicine (Baltimore) 2019; 98:e17663. [PMID: 31689778 PMCID: PMC6946505 DOI: 10.1097/md.0000000000017663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 08/24/2019] [Accepted: 09/26/2019] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Postoperative delirium is extremely rare in young women and in minimally invasive endoscopic surgeries in gynecology and obstetrics. It greatly affects both physicians and patients. This report presents a special case of postoperative delirium after hysteroscopy in a young woman and a literature review of the associated etiology, diagnosis, and treatment. PATIENT CONCERNS A 39-year-old woman was admitted to the gynecology ward following irregular vaginal bleeding for 3 months and an intrauterine space-occupying lesion for 1 week. Hysteroscopy, endometrial polypectomy, and fractional curettage procedures were successfully performed; however, the patient became unresponsive after surgery. DIAGNOSIS Postoperative delirium. INTERVENTIONS Sedatives and vasoactive medicines, such as dexmedetomidine, midazolam, and dopamine were administered for maintenance treatment. OUTCOMES The patients gradually regained consciousness. LESSONS Physicians should attach importance and improvise effective clinical management strategies for postoperative delirium based on clinical specialty characteristics and related guidelines.
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Affiliation(s)
- Zhen Liu
- Department of Obstetrics and Gynecology
| | - Ran Li
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | | | | | - Ling Yin
- Department of Obstetrics and Gynecology
| | - Yuan Qu
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Chao Peng
- Department of Obstetrics and Gynecology
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Makarem J, Larijani AH, Eslami B, Jafarzadeh A, Karvandian K, Mireskandari SM. Risk factors of inadequate emergence following general anesthesia with an emphasis on patients with substance dependence history. Korean J Anesthesiol 2019; 73:302-310. [PMID: 31612693 PMCID: PMC7403114 DOI: 10.4097/kja.19214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 10/13/2019] [Indexed: 12/13/2022] Open
Abstract
Background This study aims to define the incidence and risk factors of both emergence agitation and hypoactive emergence in adult patients and substance-dependent patients following general anesthesia to elaborate on the risk factors and precise management of them. Methods The study recruited 1,136 adult patients who received elective surgeries under general anesthesia for this prospective observational study. Inadequate emergence was determined according to the Richmond Agitation-Sedation Scale (RASS). Emergence agitation was defined as a RASS ≥ +1 point, and hypoactive emergence was defined as a RASS ≤ –2 points. Subgroup analyses were then conducted on patients with substance dependence. Results Inadequate emergence in the post-anesthesia care unit (PACU) occurred in 20.3% of patients, including 13.9% with emergence agitation and 6.4% with hypoactive emergence. Ninety-five patients had a history of substance dependence. Compared to divorced patients, never-married and presently married patients, who underwent gynecological and thoracic surgeries, had a lower risk of agitation. Neurologic disorders, intraoperative blood loss, intraoperative morphine, and PACU analgesic drug administration were associated with increased agitation risk. Hypertension and psychological disorders, intraoperative opioids, and PACU Foley catheter fixation were associated with increased hypoactive emergence risk. Substance-dependent patients had higher risk for agitation (21.1%, P = 0.019) and hypoactive emergence (10.5%, P = 0.044). Conclusions Inadequate emergence in PACU following general anesthesia is a significant problem correlated with several perioperative factors. Patients with a history of substance dependence appear to be more at risk of inadequate emergence than the general population.
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Affiliation(s)
- Jalil Makarem
- Department of Anesthesia and Critical Care, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Babak Eslami
- Department of Anesthesia and Critical Care, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Jafarzadeh
- Department of Anesthesia and Critical Care, Tehran University of Medical Sciences, Tehran, Iran
| | - Kasra Karvandian
- Department of Anesthesia and Critical Care, Tehran University of Medical Sciences, Tehran, Iran
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Cai S, Lv M, Latour JM, Lin Y, Pan W, Zheng J, Cheng L, Li J, Zhang Y. Incidence and risk factors of PostopeRativE delirium in intensive care unit patients: A study protocol for the PREDICt study. J Adv Nurs 2019; 75:3068-3077. [PMID: 31197839 DOI: 10.1111/jan.14097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/18/2019] [Accepted: 04/09/2019] [Indexed: 01/14/2023]
Abstract
AIM The aims of this study are: (a) to determine the incidence of postoperative delirium (POD) among surgical intensive care unit (ICU) patients in China and identify risk factors, especially, which are modifiable and have value for developing a prediction model; (b) to develop and validate a prediction model of delirium to recognize high-risk patients in surgical ICUs; (c) to investigate the short- and long-term outcomes of delirious patients and identify the predictors of patient outcomes. DESIGN A single-centre prospective cohort study. METHODS Patients will be enrolled from three surgical ICUs in a tertiary teaching hospital. Delirium assessment and perioperative data will be collected throughout the hospitalization. Delirious patients will be followed up for 2 years. The study was approved by the ethics committee in May 2018 and was funded by the clinical research grant from Zhongshan hospital, Fudan University, Shanghai. DISCUSSION Developing POD can be a burden to patients both for the short- and long-term period. Due to the lack of effective treatments for POD, prevention remains the best strategy. This study will provide an effective tool for early screening of high-risk patients of POD and provide a better understanding of the aetiology and outcome of delirium. IMPACT In clinical practice, a prediction model will offer an effective tool for ICU nurses to assess high-risk patients, which can support them to implement preventive strategies at the early stages to targeted patients. The follow-up results will help us better understand the impact of delirium on patients' long-term outcome.
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Affiliation(s)
- Shining Cai
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Minzhi Lv
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jos M Latour
- Faculty of Health and Human Sciences, School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| | - Ying Lin
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenyan Pan
- Department of Surgery Intensive Care Unit, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jili Zheng
- Department of Cardiac Surgery Intensive Care Unit, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lihong Cheng
- Department of Liver Surgery Intensive Care Unit, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingjing Li
- Department of Surgery Intensive Care Unit, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuxia Zhang
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
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Dementia in elderly patients undergoing early cholecystectomy for acute cholecystitis: a retrospective observational study. BMC Surg 2019; 19:71. [PMID: 31262275 PMCID: PMC6604413 DOI: 10.1186/s12893-019-0548-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 06/26/2019] [Indexed: 12/24/2022] Open
Abstract
Background Dementia often adversely affects postoperative outcomes in surgical patients. This study evaluated postoperative outcomes among elderly patients with and without dementia undergoing early cholecystectomy for acute cholecystitis (AC). Methods A total of 182 patients over 85 years of age who were diagnosed with AC and treated from January 2005 to March 2018 were reviewed retrospectively; 59 patients who underwent early cholecystectomy were enrolled. The complication rates, length of postoperative hospital stay, and rates of routine discharge (i.e., returning to their preoperative living location) were compared between two groups of patients with and without dementia. Results The overall complication rate after early cholecystectomy for AC in 59 patients was 11.9%, and there was no mortality in this series. The median postoperative hospital stay was 9.0 days, and the routine discharge rate was 89.8%. Of the 59 patients, 22 patients (37.3%) had a history of dementia. Complication rates were comparable between the groups, despite the rate of delirium development being significantly higher in the dementia group. The median length of postoperative hospital stay and routine discharge rates did not significantly differ between groups. Conclusions Early cholecystectomy for patients with AC over 85 years of age was performed safely, and elderly patients with dementia had similar postoperative outcomes as compared with patients without dementia.
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Perioperative Risk Factors for Postoperative Delirium in Patients Undergoing Esophagectomy. Ann Thorac Surg 2019; 108:190-195. [DOI: 10.1016/j.athoracsur.2019.01.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 12/12/2022]
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Park SY, Lee HB. Prevention and management of delirium in critically ill adult patients in the intensive care unit: a review based on the 2018 PADIS guidelines. Acute Crit Care 2019; 34:117-125. [PMID: 31723916 PMCID: PMC6786674 DOI: 10.4266/acc.2019.00451] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 02/16/2019] [Indexed: 12/16/2022] Open
Abstract
Delirium is an acute, confusional state characterized by altered consciousness and a reduced ability to focus, sustain, or shift attention. It is associated with a number of complex underlying medical conditions and can be difficult to recognize. Many critically ill patients (e.g., up to 80% of patients in the intensive care unit [ICU]) experience delirium due to underlying medical or surgical health problems, recent surgical or other invasive procedures, medications, or various noxious stimuli (e.g., underlying psychological stressors, mechanical ventilation, noise, light, patient care interactions, and drug-induced sleep disruption or deprivation). Delirium is associated with a longer duration of mechanical ventilation and ICU admittance as well as an increased risk of death, disability, and long-term cognitive dysfunction. Therefore, the early recognition of delirium is important and ICU medical staff should devote careful attention to both watching for the occurrence of delirium and its prevention and management. This review presents a brief overview of delirium and an update of the literature with reference to the 2018 Society of Critical Care Medicine Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU.
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Affiliation(s)
- Seung Yong Park
- Department of Internal Medicine, Research Center for Pulmonary Disorders, Chonbuk National University Medical School, Jeonju, Korea
| | - Heung Bum Lee
- Department of Internal Medicine, Research Center for Pulmonary Disorders, Chonbuk National University Medical School, Jeonju, Korea
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Maeda T, Kayashima H, Imai D, Otsu H, Ohmine T, Yamaguchi S, Konishi K, Hamatake M, Tsutsui S, Matsuda H, Harada K. Noise Pareidolia Test for the Prediction of Postoperative Delirium in Elderly Patients. Am Surg 2019. [DOI: 10.1177/000313481908500404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Takashi Maeda
- Department of Surgery Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital Hiroshima, Japan
| | - Hiroto Kayashima
- Department of Surgery Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital Hiroshima, Japan
| | - Daisuke Imai
- Department of Surgery Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital Hiroshima, Japan
| | - Hajime Otsu
- Department of Surgery Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital Hiroshima, Japan
| | - Takahiro Ohmine
- Department of Surgery Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital Hiroshima, Japan
| | - Shohei Yamaguchi
- Department of Surgery Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital Hiroshima, Japan
| | - Kozo Konishi
- Department of Surgery Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital Hiroshima, Japan
| | - Motoharu Hamatake
- Department of Surgery Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital Hiroshima, Japan
| | - Shinichi Tsutsui
- Department of Surgery Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital Hiroshima, Japan
| | - Hiroyuki Matsuda
- Department of Surgery Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital Hiroshima, Japan
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Chaiwat O, Chanidnuan M, Pancharoen W, Vijitmala K, Danpornprasert P, Toadithep P, Thanakiattiwibun C. Postoperative delirium in critically ill surgical patients: incidence, risk factors, and predictive scores. BMC Anesthesiol 2019; 19:39. [PMID: 30894129 PMCID: PMC6425578 DOI: 10.1186/s12871-019-0694-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 02/11/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A common postoperative complication found among patients who are critically ill is delirium, which has a high mortality rate. A predictive model is needed to identify high-risk patients in order to apply strategies which will prevent and/or reduce adverse outcomes. OBJECTIVES To identify the incidence of, and the risk factors for, postoperative delirium (POD) in surgical intensive care unit (SICU) patients, and to determine predictive scores for the development of POD. METHODS This study enrolled adults aged over 18 years who had undergone an operation within the preceding week and who had been admitted to a SICU for a period that was expected to be longer than 24 h. The CAM - ICU score was used to determine the occurrence of delirium. RESULTS Of the 250 patients enrolled, delirium was found in 61 (24.4%). The independent risk factors for delirium that were identified by a multivariate analysis comprised age, diabetes mellitus, severity of disease (SOFA score), perioperative use of benzodiazepine, and mechanical ventilation. A predictive score (age + (5 × SOFA) + (15 × Benzodiazepine use) + (20 × DM) + (20 × mechanical ventilation) + (20 × modified IQCODE > 3.42)) was created. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.84 (95% CI: 0.786 to 0.897). The cut point of 125 demonstrated a sensitivity of 72.13% and a specificity of 80.95%, and the hospital mortality rate was significantly greater among the delirious than the non-delirious patients (25% vs. 6%, p < 0.01). CONCLUSIONS POD was experienced postoperatively by a quarter of the surgical patients who were critically ill. A risk score utilizing 6 variables was able to predict which patients would develop POD. The identification of high-risk patients following SICU admission can provide a basis for intervention strategies to improve outcomes. TRIAL REGISTRATION Thai Clinical Trials Registry TCTR20181204006 . Date registered on December 4, 2018. Retrospectively registered.
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Affiliation(s)
- Onuma Chaiwat
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand. .,Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Mellada Chanidnuan
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Worapat Pancharoen
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Kittiya Vijitmala
- Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Praniti Danpornprasert
- Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Puriwat Toadithep
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Chayanan Thanakiattiwibun
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Mansouri N, Nasrollahi K, Shetabi H. Prevention of Cognitive Dysfunction after Cataract Surgery with Intravenous Administration of Midazolam and Dexmedetomidine in Elderly Patients Undergoing Cataract Surgery. Adv Biomed Res 2019; 8:6. [PMID: 30820427 PMCID: PMC6385669 DOI: 10.4103/abr.abr_190_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: This study aimed to compare the effects of preoperative administration of midazolam and dexmedetomidine on cognitive dysfunction prevention after cataract surgery. Materials and Methods: This research was a double-blind controlled clinical trial. In this study, 150 candidates for cataract surgery under general anesthesia, over 65 years, and similar to American Society of Anesthesiologists I and II characteristics were selected as the sample and randomly assigned to three groups. Participants of these three groups were treated with 0.1 mg/kg of midazolam, 1 μg/kg of dexmedetomidine, and the same volume of normal saline (control), respectively. Hemodynamic parameters and cognitive dysfunction score of the participants were measured using the Mini-Mental State Examination (MMSE) before the surgery, 24 h and 1 week after the surgery. Results: An evaluation of hemodynamic parameters before anesthesia up to 24 h after the surgery showed no significant difference between the midazolam, dexmedetomidine, and control groups in terms of systolic and diastolic blood pressure, heart rate, and blood oxygen saturation (P > 0.05). In addition, there was no statistically significant difference between the midazolam and dexmedetomidine groups in the MMSE score before the surgery and 24 h and 1 week after that (P > 0.05). However, there was a significant difference between these two groups and control (P < 0.05). Conclusion: There was no significant difference between midazolam and dexmedetomidine in reducing postoperative cognitive dysfunction (POCD). However, there is a significant difference between these two groups and control. Hence, either midazolam or dexmedetomidine can be prescribed to reduce POCD in cataract surgeries.
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Affiliation(s)
- Neda Mansouri
- Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kobra Nasrollahi
- Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Shetabi
- Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran
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Marcantonio AJ, Pace M, Brabeck D, Nault KM, Trzaskos A, Anderson R. Team Approach: Management of Postoperative Delirium in the Elderly Patient with Femoral-Neck Fracture. JBJS Rev 2019; 5:e8. [PMID: 29064845 DOI: 10.2106/jbjs.rvw.17.00026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Andrew J Marcantonio
- Departments of Orthopaedics (A.J.M.), Anesthesiology (M.P.), Hospital Medicine (D.B.), and Rehabilitation Services (A.T.), and Surgical Critical Care Clinical Pharmacy (K.M.N. and R.A.), Lahey Hospital and Medical Center, Burlington, Massachusetts
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Lower risk of postoperative delirium using laparoscopic approach for major abdominal surgery. Surg Endosc 2019; 33:2121-2127. [DOI: 10.1007/s00464-018-6483-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/11/2018] [Indexed: 12/19/2022]
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D'Ettorre M, Rosa F, Coppola A, Mele C, Alfieri S, Doglietto GB. Postoperative Suspected Wernicke's Encephalopathy in A Rectal Cancer Patient: A Case Report. J Palliat Care 2018. [DOI: 10.1177/082585971202800408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Marco D'Ettorre
- M D'Ettorre (corresponding author): Department of Plastic and Reconstructive Surgery, Catholic University of the Sacred Heart, Largo A. Gemelli, 8-00168 Rome, Italy
| | - Fausto Rosa
- F Rosa, S Alfieri, GB Doglietto: Department of Digestive Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessandro Coppola
- F Rosa, S Alfieri, GB Doglietto: Department of Digestive Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Caterina Mele
- F Rosa, S Alfieri, GB Doglietto: Department of Digestive Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Sergio Alfieri
- A Coppola, C Mele: Hepatobiliary Surgery Unit, Catholic University of the Sacred Heart, Rome, Italy
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Honda S, Furukawa K, Nishiwaki N, Fujiya K, Omori H, Kaji S, Makuuchi R, Irino T, Tanizawa Y, Bando E, Kawamura T, Terashima M. Risk Factors for Postoperative Delirium After Gastrectomy in Gastric Cancer Patients. World J Surg 2018; 42:3669-3675. [PMID: 29850948 DOI: 10.1007/s00268-018-4682-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE The incidence of postoperative delirium is reported to range from 9 to 87%; however, no report has focused on cases of postoperative delirium in gastric cancer surgery alone. Therefore, we investigated the incidence of and risk factors for postoperative delirium after gastrectomy in patients with gastric cancer. METHODS A total of 1037 patients who underwent surgery were included in the study. Patients were divided into two groups-those with (delirium group) or without (non-delirium group) postoperative delirium-and their backgrounds were compared. The short-term outcomes and the overall survival were also investigated. RESULTS Postoperative delirium was observed in 47 of 1037 patients (4.5%). A multivariate analysis revealed that male gender, age ≥ 75 years, a history of cerebrovascular disease, and the habitual use of sleeping pills were independent predictive factors for postoperative delirium. The postoperative hospital stay was significantly longer in the postoperative delirium group than in the non-delirium group. Postoperative delirium was significantly associated with postoperative complications. The 3-year overall survival was 74.3% in the delirium group and 85.5% in the non-delirium group (log-rank p = 0.006). A multivariate analysis revealed that postoperative delirium was an independent prognostic factor, along with the age and cancer stage. CONCLUSION The incidence of postoperative delirium was 4.5% in gastric cancer patients. Male gender, age ≥ 75 years, a history of cerebrovascular disease, and the habitual use of narcoleptic agents were risk factors for postoperative delirium after gastrectomy in gastric cancer patients. Postoperative delirium was strongly associated with other postoperative complications and a poor survival after surgery.
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Affiliation(s)
- Shinsaku Honda
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan
| | - Kenichiro Furukawa
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan
| | - Noriyuki Nishiwaki
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan
| | - Keiichi Fujiya
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan
| | - Hayato Omori
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan
| | - Sanae Kaji
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan
| | - Rie Makuuchi
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan
| | - Tomoyuki Irino
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan
| | - Yutaka Tanizawa
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan
| | - Etsuro Bando
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan
| | - Taiichi Kawamura
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan
| | - Masanori Terashima
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Shizuoka, 411-8777, Japan.
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Abstract
Delirium can be defined as an ‘acute brain dysfunction.’ Compared to dementia, which is a disease that deteriorates the brain function chronically, delirium shows very similar symptoms but is mostly ameliorated when the causative factors are normalized. Due to the heterogeneity in etiologies and symptoms, people including health care workers often mistake delirium for dementia or other psychiatric disorders. Delirium has attracted global interest increasingly and a vast amount of research on its management has been conducted. Experts in the field have constantly suggested that systematic intervention should be implemented through a team-based multicomponent approach aimed to reduce the incidence and duration of delirium. Surgery involves many health care workers with different expertise who are not familiar with delirium. For a team-based approach on the management of delirium, it is vital that all medical personnel concerned have a common understanding of delirium and keep in constant communication. Postoperative delirium is a common complication and exerts an enormous burden on patients, their families, hospitals, and public resources. To alleviate this burden, this article aimed to review general features and the latest evidence-based knowledge of delirium with a focus on postoperative delirium.
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Affiliation(s)
- Seung-Taek Oh
- Institute of Behavioral Science in Medicine at Yonsei University College of Medicine, Korea.,Department of Psychiatry, The Armed Forces Hongcheon Hospital, Hongcheon, Korea
| | - Jin Young Park
- Institute of Behavioral Science in Medicine at Yonsei University College of Medicine, Korea.,Department of Psychiatry, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea
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A contemporary population-based analysis of the incidence, cost, and outcomes of postoperative delirium following major urologic cancer surgeries. Urol Oncol 2018; 36:341.e15-341.e22. [DOI: 10.1016/j.urolonc.2018.04.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/09/2018] [Accepted: 04/17/2018] [Indexed: 11/24/2022]
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Yu A, Wu S, Zhang Z, Dening T, Zhao S, Pinner G, Xia J, Yang D. Cholinesterase inhibitors for the treatment of delirium in non-ICU settings. Cochrane Database Syst Rev 2018; 6:CD012494. [PMID: 29952000 PMCID: PMC6513030 DOI: 10.1002/14651858.cd012494.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Delirium is a common clinical syndrome defined as alterations in attention with an additional disturbance in cognition or perception, which develop over a short period of time and tend to fluctuate during the course of the episode. Delirium is commonly treated in hospitals or community settings and is often associated with multiple adverse outcomes such as increased cost, morbidity, and even mortality. The first-line intervention involves a multicomponent non-pharmacological approach that includes ensuring effective communication and reorientation in addition to providing reassurance or a suitable care environment. There are currently no drugs approved specifically for the treatment of delirium. Clinically, however, various medications are employed to provide symptomatic relief, such as antipsychotic medications and cholinesterase inhibitors, among others. OBJECTIVES To evaluate the effectiveness and safety of cholinesterase inhibitors for treating people with established delirium in a non-intensive care unit (ICU) setting. SEARCH METHODS We searched ALOIS, which is the Cochrane Dementia and Cognitive Improvement Group's Specialised Register, on 26 October 2017. We also cross-checked the reference lists of included studies to identify any potentially eligible trials. SELECTION CRITERIA We included randomised controlled trials, published or unpublished, reported in English or Chinese, which compared cholinesterase inhibitors to placebo or other drugs intended to treat people with established delirium in a non-ICU setting. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. The primary outcomes were duration of delirium, severity of delirium, and adverse events. The secondary outcomes were use of rescue medications, persistent cognitive impairment, length of hospitalisation, institutionalisation, mortality, cost of intervention, leaving the study early, and quality of life. For dichotomous outcomes, we calculated the risk ratio (RR) with 95% confidence intervals (CIs); for continuous outcomes we calculated the mean difference (MD) with 95% CIs. We assessed the quality of evidence using GRADE to generate a 'Summary of findings' table. MAIN RESULTS We included one study involving 15 participants from the UK. The included participants were diagnosed with delirium based on the Confusion Assessment Method (CAM) criteria. Eight males and seven females were included, with a mean age of 82.5 years. Seven of the 15 participants had comorbid dementia at baseline. The risk of bias was low in all domains.The study compared rivastigmine with placebo. We did not find any clear differences between the two groups in terms of duration of delirium (MD -3.6, 95% CI -15.6 to 8.4), adverse events (nausea, RR 0.30, 95% CI 0.01 to 6.29), use of rescue medications (RR 0.13, 95% CI 0.01 to 2.1), mortality (RR 0.10, 95% CI 0.01 to 1.56), and leaving the study early (RR 0.88, 95% CI 0.07 to 11.54). Evidence was not available regarding the severity of delirium, persistent cognitive impairment, length of hospitalisation, cost of intervention, or other predefined secondary outcomes.The quality of evidence is low due to the very small sample size. AUTHORS' CONCLUSIONS There is insufficient evidence to support or refute the use of cholinesterase inhibitors for the treatment of delirium in non-ICU settings. No clear benefits or harms associated with cholinesterase inhibitors were observed when compared with placebo due to the lack of data. More trials are required.
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Affiliation(s)
- Ailan Yu
- Liaocheng People's HospitalAnaesthesiologyNo.67 Dongchang West RoadLiaocheng CityShandongChina
| | - Shanshan Wu
- Liaocheng People's HospitalAnaesthesiologyNo.67 Dongchang West RoadLiaocheng CityShandongChina
| | - Zongwang Zhang
- Liaocheng People's HospitalAnaesthesiologyNo.67 Dongchang West RoadLiaocheng CityShandongChina
| | - Tom Dening
- The University of NottinghamDivision of Psychiatry & Applied PsychologyTriumph RoadNottinghamUKNG7 2TU
| | - Sai Zhao
- The Ingenuity Centre, The University of NottinghamSystematic Review Solutions LtdTriumph RoadNottinghamUKNG7 2TU
| | - Gillian Pinner
- The University of NottinghamOld Age PsychiatryNottinghamUKNG7 2TU
| | - Jun Xia
- Institute of Mental Health, University of NottinghamCochrane Schizophrenia GroupTriumph RoadNottinghamUKNG7 2TU
| | - Daogui Yang
- Liaocheng People's HospitalDepartment of Gastrointestinal SurgeryNo.67 Dongchang West RoadLiaochengShandongChina252000
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Watt J, Tricco AC, Talbot-Hamon C, Pham B, Rios P, Grudniewicz A, Wong C, Sinclair D, Straus SE. Identifying Older Adults at Risk of Delirium Following Elective Surgery: A Systematic Review and Meta-Analysis. J Gen Intern Med 2018; 33:500-509. [PMID: 29374358 PMCID: PMC5880753 DOI: 10.1007/s11606-017-4204-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/22/2017] [Accepted: 09/29/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Postoperative delirium is a common preventable complication experienced by older adults undergoing elective surgery. In this systematic review and meta-analysis, we identified prognostic factors associated with the risk of postoperative delirium among older adults undergoing elective surgery. METHODS Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and AgeLine were searched for articles published between inception and April 21, 2016. A total of 5692 titles and abstracts were screened in duplicate for possible inclusion. Studies using any method for diagnosing delirium were eligible. Two reviewers independently completed all data extraction and quality assessments using the Cochrane Risk-of-Bias Tool for randomized controlled trials (RCTs) and the Newcastle-Ottawa Scale (NOS) for cohort studies. Random effects meta-analysis models were used to derive pooled effect estimates. RESULTS Forty-one studies (9384 patients) reported delirium-related prognostic factors. Among our included studies, the pooled incidence of postoperative delirium was 18.4% (95% confidence interval [CI] 14.3-23.3%, number needed to follow [NNF] = 6). Geriatric syndromes were important predictors of delirium, namely history of delirium (odds ratio [OR] 6.4, 95% CI 2.2-17.9), frailty (OR 4.1, 95% CI 1.4-11.7), cognitive impairment (OR 2.7, 95% CI 1.9-3.8), impairment in activities of daily living (ADLs; OR 2.1, 95% CI 1.6-2.6), and impairment in instrumental activities of daily living (IADLs; OR 1.9, 95% CI 1.3-2.8). Potentially modifiable prognostic factors such as psychotropic medication use (OR 2.3, 95% CI 1.4-3.6) and smoking status (OR 1.8 95% CI 1.3-2.4) were also identified. Caregiver support was associated with lower odds of postoperative delirium (OR 0.69, 95% CI 0.52-0.91). DISCUSSION Though caution must be used in interpreting meta-analyses of non-randomized studies due to the potential influence of unmeasured confounding, we identified potentially modifiable prognostic factors including frailty and psychotropic medication use that should be targeted to optimize care.
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Affiliation(s)
- Jennifer Watt
- Department of Geriatric Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada.,Institute for Health Policy Management & Evaluation, University of Toronto, 4th Floor, 155 College Street, Toronto, Ontario, M5T 3M6, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Room 716, Toronto, Ontario, M5B 1W8, Canada.,Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada
| | - Catherine Talbot-Hamon
- Department of Geriatric Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada
| | - Ba' Pham
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Room 716, Toronto, Ontario, M5B 1W8, Canada.,Toronto Health Economics and Technology Assessment Collaborative, Faculty of Pharmacy and Institute of Health Policy Management Evaluation, University of Toronto, 144 College Street, Toronto, Ontario, M5S 3M2, Canada
| | - Patricia Rios
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Room 716, Toronto, Ontario, M5B 1W8, Canada
| | - Agnes Grudniewicz
- Telfer School of Management, University of Ottawa, 55 Laurier Avenue East, Ottawa, Ontario, K1N 6N5, Canada
| | - Camilla Wong
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Room 716, Toronto, Ontario, M5B 1W8, Canada
| | - Douglas Sinclair
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Room 716, Toronto, Ontario, M5B 1W8, Canada
| | - Sharon E Straus
- Department of Geriatric Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada. .,Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Room 716, Toronto, Ontario, M5B 1W8, Canada.
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Plas M, Hemmer PHJ, Been LB, van Ginkel RJ, de Bock GH, van Leeuwen BL. Reply to comment on: Incidence and predictors of postoperative delirium after cytoreduction surgery-hyperthermic intraperitoneal chemotherapy. J Surg Oncol 2017; 117:808. [PMID: 29228456 DOI: 10.1002/jso.24914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 10/12/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Matthijs Plas
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Patrick H J Hemmer
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lukas B Been
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert J van Ginkel
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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48
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Plas M, Hemmer PH, Been LB, van Ginkel RJ, de Bock GH, van Leeuwen BL. Incidence and predictors of postoperative delirium after cytoreduction surgery-hyperthermic intraperitoneal chemotherapy. J Surg Oncol 2017; 117:260-268. [DOI: 10.1002/jso.24811] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/24/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Matthijs Plas
- Department of Surgical Oncology, University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Patrick H.J. Hemmer
- Department of Surgical Oncology, University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Lukas B. Been
- Department of Surgical Oncology, University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Robert J. van Ginkel
- Department of Surgical Oncology, University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Geertruida H. de Bock
- Department of Epidemiology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Barbara L. van Leeuwen
- Department of Surgical Oncology, University Medical Center Groningen; University of Groningen; Groningen The Netherlands
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49
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European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol 2017; 34:192-214. [DOI: 10.1097/eja.0000000000000594] [Citation(s) in RCA: 491] [Impact Index Per Article: 70.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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50
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Wu S, Zhang Z, Dening T, Zhao S, Pinner G, Xia J, Yu A, Yang D. Cholinesterase inhibitors for the treatment of delirium in non-ICU settings. Hippokratia 2017. [DOI: 10.1002/14651858.cd012494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Shanshan Wu
- Liaocheng People's Hospital; Anaesthesiology; No.67 Dongchang West Road Liaocheng City Shandong China
| | - Zongwang Zhang
- Liaocheng People's Hospital; Anaesthesiology; No.67 Dongchang West Road Liaocheng City Shandong China
| | - Tom Dening
- The University of Nottingham; Division of Psychiatry & Applied Psychology; Triumph Road Nottingham UK NG7 2TU
| | - Sai Zhao
- Systematic Review Solutions Ltd; 5-6 West Tashan Road Yan Tai Tianjin China 264000
| | - Gillian Pinner
- The University of Nottingham; Old Age Psychiatry; Nottingham UK NG7 2TU
| | - Jun Xia
- The University of Nottingham; Cochrane Schizophrenia Group; Institute of Mental Health University of Nottingham Innovation Park, Triumph Road, Nottingham UK NG7 2TU
| | - Ailan Yu
- Liaocheng People's Hospital; Anaesthesiology; No.67 Dongchang West Road Liaocheng City Shandong China
| | - Daogui Yang
- Liaocheng People's Hospital; Department of Gastrointestinal Surgery; No.67 Dongchang West Road Liaocheng Shandong China 252000
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