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Richardson SJ, Cropp AD, Ellis SW, Gibbon J, Sayer AA, Witham MD. The interrelationship between multiple long-term conditions (MLTC) and delirium: a scoping review. Age Ageing 2024; 53:afae120. [PMID: 38965032 PMCID: PMC11223896 DOI: 10.1093/ageing/afae120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Delirium and multiple long-term conditions (MLTC) share numerous risk factors and have been shown individually to be associated with adverse outcomes following hospitalisation. However, the extent to which these common ageing syndromes have been studied together is unknown. This scoping review aims to summarise our knowledge to date on the interrelationship between MLTC and delirium. METHODS Searches including terms for delirium and MLTC in adult human participants were performed in PubMed, EMBASE, Medline, Psycinfo and CINAHL. Descriptive analysis was used to summarise findings, structured according to Synthesis Without Meta-analysis reporting guidelines. RESULTS After removing duplicates, 5256 abstracts were screened for eligibility, with 313 full-texts sought along with 17 additional full-texts from references in review articles. In total, 140 met inclusion criteria and were included in the final review. Much of the literature explored MLTC as a risk factor for delirium (n = 125). Fewer studies explored the impact of MLTC on delirium presentation (n = 5), duration (n = 3) or outcomes (n = 6) and no studies explored how MLTC impacts the treatment of delirium or whether having delirium increases risk of developing MLTC. The most frequently used measures of MLTC and delirium were the Charlson Comorbidity Index (n = 98/140) and Confusion Assessment Method (n = 81/140), respectively. CONCLUSION Existing literature largely evaluates MLTC as a risk factor for delirium. Major knowledge gaps identified include the impact of MLTC on delirium treatment and the effect of delirium on MLTC trajectories. Current research in this field is limited by significant heterogeneity in defining both MLTC and delirium.
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Affiliation(s)
- Sarah Joanna Richardson
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Faculty of Medical Sciences Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | | | | | - Jake Gibbon
- South Tyneside and Sunderland NHS Foundation Trust, South Shields, Tyne and Wear, UK
| | - Avan Aihie Sayer
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Faculty of Medical Sciences Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Miles David Witham
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Faculty of Medical Sciences Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
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Fan Y, Yang T, Liu Y, Gan H, Li X, Luo Y, Yang X, Pang Q. Nomogram for predicting the risk of postoperative delirium in elderly patients undergoing orthopedic surgery. Perioper Med (Lond) 2024; 13:34. [PMID: 38702728 PMCID: PMC11069318 DOI: 10.1186/s13741-024-00393-9] [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: 07/20/2023] [Accepted: 04/26/2024] [Indexed: 05/06/2024] Open
Abstract
OBJECTIVE To retrospectively analyze the risk factors for postoperative delirium (POD) after orthopedic surgery in elderly patients and establish an individualized nomogram to predict the risk of POD. METHODS The data of 1011 patients who underwent orthopedic surgery from January 2019 to January 2022 were retrospectively analyzed. Univariate and multivariate logistic analyses were used to screen for independent risk factors. Stepwise regression was conducted to screen risk factors to construct a nomogram to predict the risk of POD after orthopedic surgery in elderly individuals, and nomogram validation analyses were performed. RESULTS The logistic regression results showed that age (≥ 75 years old vs. < 75 years old; odds ratio (OR) = 2.889; 95% confidence interval (CI), 1.149, 7.264), sex (male vs. female, OR = 2.368; 95% CI, 1.066, 5.261), and preoperative cognitive impairment (yes vs. no, OR = 13.587; 95% CI, 4.360, 42.338) were independent risk factors for POD in elderly patients who underwent orthopedic surgery (P < 0.05). A nomogram was constructed using 7 risk factors, i.e., age, American Society of Anesthesiologists (ASA) classification, sex, preoperative hemoglobin (Hb), preoperative pulmonary disease, cognitive impairment, and intraoperative infusion volume. The area under the curve (AUC) showed good discrimination (0.867), the slope of the calibration curve was 1.0, and the optimal net benefit of the nomogram from the decision curve analysis (DCA) was 0.01-0.58. CONCLUSION This study used 7 risk factors to construct a nomogram to predict the risk of POD after major orthopedic surgery in elderly individuals, and the nomogram had good discrimination ability, accuracy, and clinical practicability.
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Affiliation(s)
- Yunping Fan
- Department of Anesthesiology, Shizhu Tujia Autonomous County People's Hospital, Chongqing, 409100, China
| | - Tingjun Yang
- Department of Anesthesiology, Shizhu Tujia Autonomous County People's Hospital, Chongqing, 409100, China
| | - Yuhan Liu
- Department of Anesthesiology, Shizhu Tujia Autonomous County People's Hospital, Chongqing, 409100, China
| | - Haibin Gan
- Department of Anesthesiology, Shizhu Tujia Autonomous County People's Hospital, Chongqing, 409100, China
| | - Xiaohua Li
- Department of Anesthesiology, Shizhu Tujia Autonomous County People's Hospital, Chongqing, 409100, China
| | - Yanrong Luo
- Department of Anesthesiology, Shizhu Tujia Autonomous County People's Hospital, Chongqing, 409100, China
| | - Xuping Yang
- Department of Anesthesiology, Shizhu Tujia Autonomous County People's Hospital, Chongqing, 409100, China
| | - Qianyun Pang
- Department of Anesthesiology, Chongqing University Cancer Hospital, Hanyu Road No. 181, Shapingba District, Chongqing, 400030, China.
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Oldham MA, Kukla B, Walsh P, Lee HB. Sex Differences in Delirium after Coronary Artery Bypass Graft Surgery and Perioperative Neuropsychiatric Conditions: A Secondary Analysis of a Cohort Study. J Geriatr Psychiatry Neurol 2024:8919887241246226. [PMID: 38604978 DOI: 10.1177/08919887241246226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUND Biological sex influences the risk of depression and cognitive impairment, but its role in relation to postoperative delirium is unclear. This analysis investigates sex differences in delirium risk after coronary artery bypass graft (CABG) surgery and sex-related differences in relation to affective and cognitive symptoms. METHODS This is a secondary analysis of the Neuropsychiatric Outcomes After Heart Surgery (NOAHS) study, a single-site, observational study of a CABG surgery cohort (n = 149). Preoperative characteristics are stratified by sex, and baseline variables that differ by sex are evaluated to understand whether sex modifies their relationships with delirium. We also evaluate sex differences in one-month depression and cognition. RESULTS Female sex is associated with several delirium risk factors, including higher risk of preoperative depression and middle cerebral artery (MCA) stenosis. MCA stenosis was statistically associated with delirium only among women (OR 15.6, 95% CI 1.5, 164.4); mild cognitive impairment (MCI) was associated with delirium only in men (OR 4.6, 95% CI 1.2, 17.9). Other sex-based differences failed to reach statistical significance. Depression remained commoner among women 1 month post-CABG. CONCLUSIONS Women in this CABG cohort were more likely to have depression at baseline and 1 month postoperatively, as well as MCA stenosis and postoperative delirium. Sex might modify the relationship between post-CABG delirium and its risk factors including MCA stenosis and MCI. Cerebrovascular disease deserves study as a potential explanation linking female sex and a range of poor outcomes among women with coronary heart disease.
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Affiliation(s)
- Mark A Oldham
- Department of Psychiatry University of Rochester Medical Center, Rochester, NY, USA
| | - Bennett Kukla
- College of Arts and Sciences, Cornell University, Ithaca, NY, USA
| | - Patrick Walsh
- Department of Psychiatry University of Rochester Medical Center, Rochester, NY, USA
| | - Hochang B Lee
- Department of Psychiatry University of Rochester Medical Center, Rochester, NY, USA
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Han F, Liu X, Huang H, Chu H, Feng W. Effect of preoperative sleep disorders on delirium in proximal femoral surgery patients aged 60 or older. BMC Anesthesiol 2023; 23:376. [PMID: 37978346 PMCID: PMC10655383 DOI: 10.1186/s12871-023-02331-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To examine the effect of preoperative sleep disorders on delirium in patients older than 60 years of age who underwent surgery for proximal femoral fracture. METHODS This is a prospective observational study. We prospectively selected 143 patients with proximal femoral fracture who underwent surgery between April 2021 and April 2022. The primary outcome was postoperative delirium (PD). Multiple logistic regression analyses were performed and a receiver operating characteristic (ROC) curve was generated. The preoperative sleep quality of all eligible participants was assessed through the Pittsburgh Sleep Quality Index (PSQI). The Confusion Assessment Method (CAM) was used to assess PD from the first to the seventh day postoperatively. Patients were divided into two groups according to the PD diagnosis: (1) the no PD (NPD) group and (2) the PD (PD) group. RESULTS Of 143 eligible patients, 43 (30.1%) were diagnosed with PD. Multiple logistic regression analysis demonstrated that postoperative ICU admissions (OR = 2.801, p = 0.049) and preoperative sleep disorders (OR = 1.477 p < 0.001) were independently associated with PD. A receiver operating characteristic (ROC) curve demonstrated that the preoperative PSQI score was predictive of PD (AUC 0.808, 95% CI 0.724 ~ 0.892, p < 0.001). CONCLUSION Preoperative sleeping disorders may be an independent risk factor leading to PD and an independent predictive factor for the development of delirium in proximal femoral surgery patients aged 60 or older.
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Affiliation(s)
- Fuyi Han
- Department of Anesthesiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China
| | - Xiaojie Liu
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Hui Huang
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Haichen Chu
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Wei Feng
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
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Dong B, Wang J, Li P, Li J, Liu M, Zhang H. The impact of preoperative malnutrition on postoperative delirium: a systematic review and meta-analysis. Perioper Med (Lond) 2023; 12:55. [PMID: 37884977 PMCID: PMC10604920 DOI: 10.1186/s13741-023-00345-9] [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: 04/29/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Postoperative delirium (POD) is a common postoperative complication, characterized by disturbance of attention, perception, and consciousness within 1 week after surgery, and linked to cognitive decline, increased mortality, and other serious surgical outcomes. Early identification and treatment of risk factors for POD could reduce the occurrence of delirium and the related poor outcomes. Malnutrition as a possible precipitating factor, defined as the poor anthropometric, functional, and clinical outcomes of nutrient deficiency, has been investigated. However, the evidence is controversial. The goal of this systematic review and meta-analysis was to comprehensively assess the correlation between preoperative malnutrition and POD. METHODS PubMed, Embase, Cochrane Library, and Web of Science were used to search prospective cohort articles that explored the correlation between preoperative malnutrition and POD from inception until September 30, 2022. Two researchers independently conducted the literature selection and data extraction. The quality of the literature was evaluated according to the Newcastle-Ottawa scale (NOS). Odds ratios (ORs) and 95% confidence intervals (CIs) for POD associated with malnutrition relative to normal nutritional status were calculated. RESULTS Seven prospective cohort studies qualified for the meta-analysis, which included 2701 patients. The pooled prevalence of preoperative malnutrition was 15.1% (408/2701), and POD occurred in 428 patients (15.8%). The NOS score was above 7 points in all 7 studies. Our results demonstrated that the pooled OR for malnutrition and POD was 2.32 (95% CI 1.62-3.32) based on a random-effects model. Our subgroup analysis suggested that the relationship between malnutrition and POD was significant in adults following noncardiac surgery (OR = 3.04, 95% CI, 1.99-4.62, P < 0.001), while there was no statistical significance in adults following cardiac surgery (OR = 1.76, 95% CI, 0.96-3.22, P = 0.07). Additionally, in the subgroup analysis based on different malnutrition assessment tools (MNA-SF versus others), a significant association was found in the MNA-SF group (OR = 3.04, 95% CI, 1.99-4.62, P < 0.001), but not in the others group (OR = 1.76, 95% CI, 0.96-3.22, P = 0.07). Other subgroup analyses showed that this association was not significantly affected by evaluation instruments for POD, location of the study, or quality of the article (all P < 0.05). CONCLUSIONS Based on the currently available evidence, our results suggested that preoperative malnutrition was independently associated with POD in adult surgical patients.
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Affiliation(s)
- Bo Dong
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, China
- Graduate Faculty, Hebei North University, Zhangjiakou, 075132, China
| | - Jing Wang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, China
| | - Pan Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, China.
| | - Meinv Liu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, China
| | - Huanhuan Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, China
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Kim J, Park S, Kim KN, Ha Y, Shin SJ, Cha W, Lee KY, Choi J, Koo BN. Resting-state prefrontal EEG biomarker in correlation with postoperative delirium in elderly patients. Front Aging Neurosci 2023; 15:1224264. [PMID: 37818480 PMCID: PMC10561289 DOI: 10.3389/fnagi.2023.1224264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
Postoperative delirium (POD) is associated with adverse outcomes in elderly patients after surgery. Electroencephalography (EEG) can be used to develop a potential biomarker for degenerative cerebral dysfunctions, including mild cognitive impairment and dementia. This study aimed to explore the relationship between preoperative EEG and POD. We included 257 patients aged >70 years who underwent spinal surgery. We measured the median dominant frequency (MDF), which is a resting-state EEG biomarker involving intrinsic alpha oscillations that reflect an idle cortical state, from the prefrontal regions. Additionally, the mini-mental state examination and Montreal cognitive assessment (MoCA) were performed before surgery as well as 5 days after surgery. For long-term cognitive function follow up, the telephone interview for cognitive status™ (TICS) was performed 1 month and 1 year after surgery. Fifty-two (20.2%) patients were diagnosed with POD. A multivariable logistic regression analysis that included age, MoCA score, Charlson comorbidity index score, Mini Nutritional Assessment, and the MDF as variables revealed that the MDF had a significant odds ratio of 0.48 (95% confidence interval 0.27-0.85). Among the patients with POD, the postoperative neurocognitive disorders could last up to 1 year. Low MDF on preoperative EEG was associated with POD in elderly patients undergoing surgery. EEG could be a novel potential tool for identifying patients at a high risk of POD.
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Affiliation(s)
- Jeongmin Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sujung Park
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Keung-Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- POSTECH Biotech Center, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Sang-Jun Shin
- Department of Biomedical Systems Informatics, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wonseok Cha
- Human Anti-Aging Standards Research Institute, Gyeongsangnam-Do, Republic of Korea
| | - Ki-young Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jungmi Choi
- Human Anti-Aging Standards Research Institute, Gyeongsangnam-Do, Republic of Korea
| | - Bon-Nyeo Koo
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Sugi T, Enomoto T, Ohara Y, Furuya K, Kitaguchi D, Moue S, Akashi Y, Ogawa K, Owada Y, Oda T. Risk factors for postoperative delirium in elderly patients undergoing gastroenterological surgery: A single-center retrospective study. Ann Gastroenterol Surg 2023; 7:832-840. [PMID: 37663963 PMCID: PMC10472384 DOI: 10.1002/ags3.12676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 09/05/2023] Open
Abstract
Aim To investigate the risk factors for postoperative delirium among elderly patients undergoing elective surgery for gastroenterological cancer. Methods From May 2020 to March 2022, patients ≥75 years old with gastroenterological cancer who underwent radical surgery were enrolled. The geriatric assessment, including evaluations of frailty, physical function, nutrition status, and cognitive function, was conducted preoperatively. The confusion assessment method was used to diagnose postoperative delirium. A multivariate logistic regression analysis was used to determine risk factors for postoperative delirium. Results A total of 158 patients were eligible for inclusion in this study. Of these 53 patients (34%) developed postoperative delirium. In the univariate analysis, the age, regular use of sleeping drugs and benzodiazepine, Charlson Comorbidity Index score, performance status, Fried's frailty score, Vulnerable Elders Survey-13 score, grip weakness, Short Physical Performance Battery (SPPB) score, Mini Nutritional Assessment Short-Form score, and Mini-Mental State Examination score were statistically associated with the incidence of postoperative delirium. In the multivariate analysis, a SPPB score ≤9, Mini Nutritional Assessment score ≤11, a Mini-Mental State Examination score ≤24, and regular use of benzodiazepine were found to be independent preoperative risk factors for postoperative delirium. Conclusion Certain findings during the preoperative geriatric assessment, especially low SPPB, Mini Nutritional Assessment Short-Form and Mini-Mental State Examination scores, and regular use of benzodiazepine were risk factors for postoperative delirium in elderly patients undergoing gastroenterological surgery.
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Affiliation(s)
- Tomoyuki Sugi
- Department of Gastrointestinal and Hepatobiliary‐Pancreatic Surgery, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Tsuyoshi Enomoto
- Department of Gastrointestinal and Hepatobiliary‐Pancreatic Surgery, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Yusuke Ohara
- Department of Gastrointestinal and Hepatobiliary‐Pancreatic Surgery, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Kinji Furuya
- Department of Gastrointestinal and Hepatobiliary‐Pancreatic Surgery, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Daichi Kitaguchi
- Department of Gastrointestinal and Hepatobiliary‐Pancreatic Surgery, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Shoko Moue
- Department of Gastrointestinal and Hepatobiliary‐Pancreatic Surgery, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Yoshimasa Akashi
- Department of Gastrointestinal and Hepatobiliary‐Pancreatic Surgery, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Koichi Ogawa
- Department of Gastrointestinal and Hepatobiliary‐Pancreatic Surgery, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Yohei Owada
- Department of Gastrointestinal and Hepatobiliary‐Pancreatic Surgery, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Tatsuya Oda
- Department of Gastrointestinal and Hepatobiliary‐Pancreatic Surgery, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
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Gong XY, Hou DJ, Yang J, He JL, Cai MJ, Wang W, Lu XY, Gao J. Incidence of delirium after non-cardiac surgery in the Chinese elderly population: a systematic review and meta-analysis. Front Aging Neurosci 2023; 15:1188967. [PMID: 37455941 PMCID: PMC10346854 DOI: 10.3389/fnagi.2023.1188967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Background POD places a heavy burden on the healthcare system as the number of elderly people undergoing surgery is increasing annually because of the aging population. As a large country with a severely aging population, China's elderly population has reached 267 million. There has been no summary analysis of the pooled incidence of POD in the elderly Chinese population. Methods Systematic search databases included PubMed, Web of Science, EMBASE, Cochrane Library Databases, China Knowledge Resource Integrated Database (CNKI), Chinese Biomedical Database (CBM), WanFang Database, and Chinese Science and Technology Periodicals (VIP). The retrieval time ranged from the database's establishment to February 8, 2023. The pooled incidence of delirium after non-cardiac surgery was calculated using a random effects model. Meta-regression, subgroup, and sensitivity analyses were used to explore the source of heterogeneity. Results A total of 52 studies met the inclusion criteria, involving 18,410 participants. The pooled incidence of delirium after non-cardiac surgery in the elderly Chinese population was 18.6% (95% CI: 16.4-20.8%). The meta-regression results revealed anesthesia method and year of publication as a source of heterogeneity. In the subgroup analysis, the gender subgroup revealed a POD incidence of 19.6% (95% CI: 16.9-22.3%) in males and 18.3% (95% CI: 15.7-20.9%) in females. The year of publication subgroup analysis revealed a POD incidence of 20.3% (95% CI: 17.4-23.3%) after 2018 and 14.6 (95% CI: 11.6-17.6%) in 2018 and before. In the subgroup of surgical types, the incidence of hip fracture surgery POD was 20.7% (95% CI: 17.6-24.3%), the incidence of non-cardiac surgery POD was 18.4% (95% CI: 11.8-25.1%), the incidence of orthopedic surgery POD was 16.6% (95% CI: 11.8-21.5%), the incidence of abdominal neoplasms surgery POD was 14.3% (95% CI: 7.6-21.1%); the incidence of abdominal surgery POD was 13.9% (95% CI: 6.4-21.4%). The anesthesia methods subgroup revealed a POD incidence of 21.5% (95% CI: 17.9-25.1%) for general anesthesia, 15.0% (95% CI: 10.6-19.3%) for intraspinal anesthesia, and 8.3% (95% CI: 10.6-19.3%) for regional anesthesia. The measurement tool subgroup revealed a POD incidence of 19.3% (95% CI: 16.7-21.9%) with CAM and 16.8% (95% CI: 12.6-21.0%) with DSM. The sample size subgroup revealed a POD incidence of 19.4% (95% CI: 16.8-22.1%) for patients ≤ 500 and 15.3% (95% CI: 11.0-19.7%) for patients > 500. The sensitivity analysis suggested that the pooled incidence of postoperative delirium in this study was stable. Conclusion Our systematic review of the incidence of delirium after non-cardiac surgery in elderly Chinese patients revealed a high incidence of postoperative delirium. Except for cardiac surgery, the incidence of postoperative delirium was higher for hip fracture surgery than for other types of surgery. However, this finding must be further explored in future large-sample studies. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: PROSPERO CRD42023397883.
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Affiliation(s)
- Xiao-Yan Gong
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Dong-Jiang Hou
- School of Medicine and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jing Yang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jia-li He
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ming-Jin Cai
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Wei Wang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xian-Ying Lu
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jing Gao
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Preoperative Risk Factors Associated with Increased Incidence of Postoperative Delirium: Systematic Review of Qualified Clinical Studies. Geriatrics (Basel) 2023; 8:geriatrics8010024. [PMID: 36826366 PMCID: PMC9956273 DOI: 10.3390/geriatrics8010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/20/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Postoperative delirium (POD) is an acute alteration of mental state, characterized by reduced awareness and attention, occurring up to five postoperative days after recovery from anesthesia. Several original studies and reviews have identified possible perioperative POD risk factors; however, there is no comprehensive review of the preoperative risk factors in patients diagnosed with POD using only validated diagnostic scales. The aim of this systematic review was to report the preoperative risk factors associated with an increased incidence of POD in patients undergoing non-cardiac and non-brain surgery. The reviewed studies included original research papers that used at least one validated diagnostic scale to identify POD occurrence for more than 24 h. A total of 6475 references were retrieved from the database search, with only 260 of them being suitable for further review. Out of the 260 reviewed studies, only 165 that used a validated POD scale reported one or more preoperative risk factors. Forty-one risk factors were identified, with various levels of statistical significance. The extracted risk factors could serve as a preoperative POD risk assessment workup. Future studies dedicated to the further evaluation of the specific preoperative risk factors' contributions to POD could help with the development of a weighted screening tool.
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Ormseth CH, LaHue SC, Oldham MA, Josephson SA, Whitaker E, Douglas VC. Predisposing and Precipitating Factors Associated With Delirium: A Systematic Review. JAMA Netw Open 2023; 6:e2249950. [PMID: 36607634 PMCID: PMC9856673 DOI: 10.1001/jamanetworkopen.2022.49950] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Despite discrete etiologies leading to delirium, it is treated as a common end point in hospital and in clinical trials, and delirium research may be hampered by the attempt to treat all instances of delirium similarly, leaving delirium management as an unmet need. An individualized approach based on unique patterns of delirium pathophysiology, as reflected in predisposing factors and precipitants, may be necessary, but there exists no accepted method of grouping delirium into distinct etiologic subgroups. OBJECTIVE To conduct a systematic review to identify potential predisposing and precipitating factors associated with delirium in adult patients agnostic to setting. EVIDENCE REVIEW A literature search was performed of PubMed, Embase, Web of Science, and PsycINFO from database inception to December 2021 using search Medical Subject Headings (MeSH) terms consciousness disorders, confusion, causality, and disease susceptibility, with constraints of cohort or case-control studies. Two reviewers selected studies that met the following criteria for inclusion: published in English, prospective cohort or case-control study, at least 50 participants, delirium assessment in person by a physician or trained research personnel using a reference standard, and results including a multivariable model to identify independent factors associated with delirium. FINDINGS A total of 315 studies were included with a mean (SD) Newcastle-Ottawa Scale score of 8.3 (0.8) out of 9. Across 101 144 patients (50 006 [50.0%] male and 49 766 [49.1%] female patients) represented (24 015 with delirium), studies reported 33 predisposing and 112 precipitating factors associated with delirium. There was a diversity of factors associated with delirium, with substantial physiological heterogeneity. CONCLUSIONS AND RELEVANCE In this systematic review, a comprehensive list of potential predisposing and precipitating factors associated with delirium was found across all clinical settings. These findings may be used to inform more precise study of delirium's heterogeneous pathophysiology and treatment.
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Affiliation(s)
- Cora H. Ormseth
- Department of Emergency Medicine, University of California, San Francisco
| | - Sara C. LaHue
- Department of Neurology, University of California, San Francisco
| | - Mark A. Oldham
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | | | - Evans Whitaker
- University of California, San Francisco, School of Medicine
| | - Vanja C. Douglas
- Department of Neurology, University of California, San Francisco
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Qi YM, Li YJ, Zou JH, Qiu XD, Sun J, Rui YF. Risk factors for postoperative delirium in geriatric patients with hip fracture: A systematic review and meta-analysis. Front Aging Neurosci 2022; 14:960364. [PMID: 35992597 PMCID: PMC9382199 DOI: 10.3389/fnagi.2022.960364] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/18/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives This systematic review and meta-analysis was conducted to identify the potential risk factors for postoperative delirium in geriatric patients with hip fracture. Methods PubMed, EMBASE, and Cochrane Library were searched from inception until December 31st, 2021. A combined searching strategy of subject words and free words was adopted. Studies involving risk factors for postoperative delirium in elderly patients undergoing hip fracture surgeries were reviewed. Qualities of included studies were assessed using the Newcastle–Ottawa Scale. Data were pooled and a meta-analysis was performed using Review Manager 5.3. Results A total of 37 studies were included. The following risk factors were significant: advanced age (per year increase) (OR: 1.05, 95% CI 1.04–1.07), age>80 years (OR: 2.26, 95% CI 1.47–3.47), male (OR: 1.53, 95% CI 1.37–1.70), preoperative cognitive impairment (OR:3.20, 95% CI 2.12–4.83), preoperative dementia (OR: 2.74, 95% CI 2.18–3.45), preoperative delirium (OR: 9.23, 95% CI 8.26–10.32), diabetes (OR: 1.18, 95% CI 1.05–1.33), preoperative functional dependence (OR: 1.31, 95% CI 1.11–1.56), ASA level (per level increase) (OR: 1.63, 95% CI 1.04–2.57), ASA level≥3(OR: 1.76, 95% CI 1.39–2.24), low albumin (OR: 3.30, 95% CI 1.44–7.55), medical comorbidities (OR: 1.15, 95% CI 1.06–1.25), Parkinson's disease (OR: 4.17, 95% CI 1.68–10.31) and surgery delay>48 h (OR: 1.90, 95% CI 1.36–2.65). Conclusions Clinicians should be alert to patients with those risk factors. To identify the risk factors more precisely, more research studies with larger sample size and better design should be conducted.
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Affiliation(s)
- Yi-ming Qi
- Department of Orthopaedics, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
- Orthopaedic Trauma Institute, Southeast University, Nanjing, China
- School of Medicine, Southeast University, Nanjing, China
| | - Ying-juan Li
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
- School of Medicine, Southeast University, Nanjing, China
- Department of Geriatrics, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Ji-hong Zou
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
- School of Medicine, Southeast University, Nanjing, China
- Department of Geriatrics, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Xiao-dong Qiu
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
- School of Medicine, Southeast University, Nanjing, China
- Department of Anesthesiology, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Jie Sun
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
- School of Medicine, Southeast University, Nanjing, China
- Department of Anesthesiology, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
- Jie Sun
| | - Yun-feng Rui
- Department of Orthopaedics, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
- Orthopaedic Trauma Institute, Southeast University, Nanjing, China
- School of Medicine, Southeast University, Nanjing, China
- Trauma Center, Zhongda Hospital, Southeast University, Nanjing, China
- *Correspondence: Yun-feng Rui
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Jing GW, Xie Q, Tong J, Liu LZ, Jiang X, Si L. Early Intervention of Perioperative Delirium in Older Patients (>60 years) with Hip Fracture: A Randomized Controlled Study. Orthop Surg 2022; 14:885-891. [PMID: 35441485 PMCID: PMC9087462 DOI: 10.1111/os.13244] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/13/2022] [Accepted: 02/18/2022] [Indexed: 12/05/2022] Open
Abstract
Objective To explore the effect of early intervention for perioperative delirium in older (> 60 years) hip fracture patients. Methods This prospective study enrolled hip fracture patients aged ≥60 years who were admitted into our hospital between July 2011 and August 2019. Hip fractures were classified according to the Arbeitsgemeinschaft für Osteo‐synthesefragen (AO) classification. This study included patients with isolated hip fracture and excluded patients with pathological or peri prosthetic fracture or patients with multiple traumatic injuries and high‐energy trauma. They were randomized to receive conventional orthopedic care group (n = 65) or comprehensive orthopedic care group including preoperative psychological counseling and preventative risperidone (n = 63). Daily assessment was based on patient interview with the CAM‐CR, and delirium was diagnosed by the Delirium Rating Scale (DRS‐R‐98). The rate, severity and duration of perioperative delirium and the length of postoperative stay were analyzed. Results Totally 200 patients were screened for eligibility. Twenty patients were excluded due to alcohol abuse and 40 were excluded because of brain lesions on head CT. In addition, 12 patients were excluded because of impaired cognition. Finally 128 patients were enrolled. Their mean age was 75.3 ± 2.2 years for the comprehensive orthopedic care group and 73.5 ± 6.1 years for the conventional orthopedic care group, and 53.9% of the patients were female. Sixty‐eight (53.1%) patients had intertrochanteric fracture, 39.8% patients had femoral head fracture, and 7.0% patients had subtrochanteric fracture. In addition, 58.6% patients underwent internal fixation and 41.4% patients received arthroplasty. In this study, 63 patients were randomized to the comprehensive orthopedic care group and 65 patients to the conventional orthopedic care group. The two groups were comparable in demographic and baseline characteristics (P > 0.05). The rate of perioperative delirium was significantly lower in the comprehensive care group vs the conventional care group (15.9% vs. 30.8%; P < 0.05). The comprehensive care group had significantly reduced length of postoperative hospital stay vs the conventional care group (11.3 ± 2.5 days vs. 14.2 ± 2.2 days, P < 0.01). The mean DRS‐R‐98 score was 7.1 ± 2.7 for the comprehensive care group, and was significantly lower than that of the conventional orthopedic care group (11.2 ± 3.0; P < 0.05). Conclusions Our early intervention may reduce the incidence of perioperative delirium in elderly hip fracture patients (>60 years).
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Affiliation(s)
- Guang-Wu Jing
- Department of Orthopedics, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, China
| | - Qin Xie
- Wuhan Mental Health Center, Wuhan, China
| | - Jie Tong
- Department of Orthopedics, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, China
| | | | - Xue Jiang
- Wuhan Mental Health Center, Wuhan, China
| | - Liang Si
- Wuhan Mental Health Center, Wuhan, China
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Cano-Escalera G, Graña M, Irazusta J, Labayen I, Besga A. Survival of Frail Elderly with Delirium. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042247. [PMID: 35206439 PMCID: PMC8872606 DOI: 10.3390/ijerph19042247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 02/01/2023]
Abstract
This study aims to determine when frailty increases the risks of delirium mortality. Hospital patients falling into the elderly frail or pre-frail category were recruited, some without delirium, some with delirium at admission, and some who developed delirium during admission. We screened for frailty, cognitive status, and co-morbidities whenever possible and extracted drug information and mortality data from electronic health records. Kaplan–Meier estimates of survival probability functions were computed at four times, comparing delirium versus non delirium patients. Differences in survival were assessed by a log-rank test. Independent Cox’s regression was carried out to identify significant hazard risks (HR) at 1 month, 6 months, 1 year, and 2 years. Delirium predicted mortality (log-rank test, p < 0.0001) at all four censoring points. Variables with significant HRs were frailty indicators, comorbidities, polypharmacy, and the use of specific drugs. For the delirium cohort, variables with the most significant 2-year hazard risks (HR(95%CI)) were: male gender (0.43 20 (0.26,0.69)), weight loss (0.45 (0.26,0.74)), sit and stand up test (0.67 (0.49,0.92)), readmission within 30 days of discharge (0.50 (0.30,0.80)), cerebrovascular disease (0.45 (0.27,0.76)), head trauma (0.54 22 (0.29,0.98)), number of prescribed drugs (1.10 (1.03,1.18)), and the use of diuretics (0.57 (0.34,0.96)). These results suggest that polypharmacy and the use of diuretics increase mortality in frail elderly patients with delirium.
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Affiliation(s)
- Guillermo Cano-Escalera
- Department of Computer Science and Artificial Intelligence, University of the Basque Country (UPV/EHU), Paseo Manuel de Lardizabal, 1, 20018 Donostia-San Sebastian, Spain;
- Computational Intelligence Group, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
- Correspondence:
| | - Manuel Graña
- Department of Computer Science and Artificial Intelligence, University of the Basque Country (UPV/EHU), Paseo Manuel de Lardizabal, 1, 20018 Donostia-San Sebastian, Spain;
- Computational Intelligence Group, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
| | - Jon Irazusta
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48013 Bilbao, Spain;
- BioCruces Health Research Institute, 48903 Barakaldo, Spain
| | - Idoia Labayen
- Institute for Innovation & Sustainable Development in Food Chain (IS-FOOD), Public University of Navarra, 31006 Pamplona, Spain;
| | - Ariadna Besga
- BioAraba, Health Research Institute, Hospital Universitario de Araba, Department of Medicine, 01004 Vitoria, Spain;
- Biomedical Research Centre in Mental Health Network (CIBERSAM) G10, Spain
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14
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Association of Nutritional Status with New-Onset Delirium in Elderly, Acute Care, Orthopaedic Trauma Patients: A Single-Center Observational Study. J Orthop Trauma 2022; 36:67-72. [PMID: 35061654 DOI: 10.1097/bot.0000000000002213] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether nutritional status at hospital admission is independently associated with new-onset delirium (NOD) in elderly, orthopaedic trauma patients. DESIGN Single-center, retrospective, cross-sectional study. SETTING Data from patients at a large teaching hospital in Boston, MA, were analyzed. PATIENTS All patients were ≥65 years and hospitalized for acute surgical management of their major fractures after trauma. INTERVENTION None. MAIN OUTCOME MEASUREMENT Nutritional status was assessed at admission using the Mini Nutritional Assessment-Short Form (MNA-SF). Delirium was assessed using the Confusion Assessment Method within 24 hours of admission and daily throughout hospitalization. RESULTS The incidence of delirium was 20% (94/471). Each unit decrement in MNA-SF was associated with a 14% higher risk of NOD (adjusted OR 1.14; 95% CI 1.05-1.28). Moreover, malnourished patients (MNA-SF score 0-7) were twice as likely to develop NOD (adjusted OR 2.07; 95% CI 1.01-4.35) compared with patients who were not malnourished (MNA-SF score 8-14). CONCLUSIONS In hospitalized, elderly, orthopaedic trauma patients, poor nutritional status may be a modifiable risk factor for NOD. Future studies are needed to determine whether aggressive nutritional interventions can reduce the incidence of NOD and improve outcomes in this cohort of patients. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Kim H, Park H, Kim EK. Risk factors for postoperative delirium in patients with colorectal cancer. J Clin Nurs 2022; 31:174-183. [PMID: 34096659 DOI: 10.1111/jocn.15894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022]
Abstract
AIM The purpose of this study was to identify the incidence of postoperative delirium in PCC (patients with colorectal cancer) and the related factors of postoperative delirium by analysing the differences in the general, disease-related and operation-related characteristics. BACKGROUND Previous studies had some limitations in generalising the risk factors for postoperative delirium in PCC due to the lack of relevant factors, such as disease- and operation-related characteristics. There is a need to investigate the factors of postoperative delirium by including cancer and surgical characteristics. DESIGN The current study is a cross-sectional study to investigate the correlated factors of postoperative delirium in PCC. METHODS A total of 196 patients who underwent colorectal cancer surgery at the Keimyung University Dongsan Hospital in Korea participated in the study. Data collection was performed from 15 August 2018 to 10 July 2019. Patients' general, disease-related and operation-related characteristics were collected from questionnaires and electronic medical records. Data analysis was performed using descriptive statistics, t test, Chi-square test and logistic regression using SPSS/WIN 22.0. The STROBE checklist has been used to report this study. RESULTS The results of this study showed that 26 (13.2%) PCC exhibited postoperative delirium and the risk factors for postoperative delirium were physical activity (OR = 2.94, p = .001), infection (OR = 2.17, p = .001) and nutritional status (OR = 1.10, p = .028). CONCLUSION To reduce and prevent the occurrence of postoperative delirium in PCC, encouraging participation in physical activity before and after surgery are required, and regular monitoring of the infection symptoms and nutritional status. RELEVANCE TO CLINICAL PRACTICE Based on the results of this study, postoperative delirium in PCC could be decreased by encouraging physical activity immediately following operation, monitoring the signs and symptoms of infection using diverse objective laboratory findings and maintaining the nutritional status within the normal range.
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Affiliation(s)
- Hyunhwa Kim
- Keimyung University College of Nursing, Research Institute of Nursing Science, Daegu, Korea.,Keimyung University Dongsan Hospital, Daegu, Korea
| | - Heeok Park
- Keimyung University College of Nursing, Research Institute of Nursing Science, Daegu, Korea
| | - Eun Kyung Kim
- Keimyung University College of Nursing, Research Institute of Nursing Science, Daegu, Korea
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Inciong JFB, Chaudhary A, Hsu HS, Joshi R, Seo JM, Trung LV, Ungpinitpong W, Usman N, Pradelli L, Omaralsaleh AJ. Economic burden of hospital malnutrition: A cost-of-illness model. Clin Nutr ESPEN 2022; 48:342-350. [DOI: 10.1016/j.clnesp.2022.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 02/07/2023]
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Méndez-Martínez C, Fernández-Martínez MN, García-Suárez M, Martínez-Isasi S, Fernández-Fernández JA, Fernández-García D. Related Factors and Treatment of Postoperative Delirium in Old Adult Patients: An Integrative Review. Healthcare (Basel) 2021; 9:healthcare9091103. [PMID: 34574877 PMCID: PMC8470646 DOI: 10.3390/healthcare9091103] [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: 06/27/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 11/28/2022] Open
Abstract
“Postoperative delirium” is defined as delirium occurring in the hospital up to one week after a procedure or before discharge (whichever occurs first) that meets the DSM-5 diagnostic criteria. Objectives: To describe the risk factors related to this pathology and identify effective non-pharmacological forms of treatment. An integrative review of the available literature was performed. The search results considered included all quantitative studies published between 2011 and 2019 in both English and Spanish. A total of 117 studies were selected. Advanced age was identified as the principal risk factor for postoperative delirium. Nursing interventions appear to be the key to preventing or reducing the seriousness of delirium after an anaesthetic episode. The aetiology of postoperative delirium remains unknown, and no treatment exists to eliminate this pathology. The role of nursing staff is fundamental in the prevention, diagnosis, and management of the pathology.
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Affiliation(s)
- Carlos Méndez-Martínez
- Department of Nursing and Physiotherapy, University of León, 24071 León, Spain; (M.G.-S.); (J.A.F.-F.); (D.F.-G.)
- University Hospital of León, 24071 León, Spain
- Correspondence:
| | - María Nélida Fernández-Martínez
- Department of Biomedical Sciences, Institute of Biomedicine (IBIOMED), Veterinary Faculty, University of Leon, 24071 Leon, Spain;
| | - Mario García-Suárez
- Department of Nursing and Physiotherapy, University of León, 24071 León, Spain; (M.G.-S.); (J.A.F.-F.); (D.F.-G.)
- University Hospital of León, 24071 León, Spain
| | - Santiago Martínez-Isasi
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, 15705 Santiago de Compostela, Spain;
- Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela CHUS, 15706 Santiago de Compostela, Spain
| | - Jesús Antonio Fernández-Fernández
- Department of Nursing and Physiotherapy, University of León, 24071 León, Spain; (M.G.-S.); (J.A.F.-F.); (D.F.-G.)
- University Hospital of León, 24071 León, Spain
| | - Daniel Fernández-García
- Department of Nursing and Physiotherapy, University of León, 24071 León, Spain; (M.G.-S.); (J.A.F.-F.); (D.F.-G.)
- University Hospital of León, 24071 León, Spain
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Yang Y, Zhao X, Gao L, Wang Y, Wang J. Incidence and associated factors of delirium after orthopedic surgery in elderly patients: a systematic review and meta-analysis. Aging Clin Exp Res 2021; 33:1493-1506. [PMID: 32772312 DOI: 10.1007/s40520-020-01674-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/27/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND A total of 4.5-41.2% of orthopedic surgery patients experience delirium. Until now, no formal systematic review or meta-analysis was performed to summarize the risk factors of delirium after orthopedic surgery. AIMS The present study aimed to comprehensively and quantitatively conclude the risk factors of delirium after orthopedic surgery in elderly patients. METHODS A search was applied to Medline, Chinese National Knowledge Infrastructure (CNKI), Embase, and Cochrane central database (all up to February 2020). All studies on the risk factors of delirium after orthopedic surgery in elderly patients without language restriction were reviewed, and qualities of included studies were assessed using the Newcastle-Ottawa Scale. Data were pooled and a meta-analysis was completed. RESULTS A total of 15 studies altogether included 10,053 patients with orthopedic surgery, 825 cases of delirium occurred after surgery, suggesting the accumulated incidence of 8.2%. Results of meta-analyses showed that age > 70 years (odds ratio (OR) 3.78, 95% confidence interval (CI) 2.97-4.80), advanced age (standardized mean difference 0.82, 95% CI 0.54-1.09), male sex (OR 1.78, 95% CI 1.13-2.79), medical comorbidities (OR 2.18, 95% CI 1.23-3.88), malnutrition (OR 3.10, 95% CI 2.19-4.38), preoperative and postoperative haemoglobin (SMD - 0.37, 95% CI - 0.54 to - 0.19; SMD - 0.33, 95% CI - 0.55 to - 0.11), postoperative sodium (SMD - 0.52, 95% CI - 0.74 to - 0.29) and longer hospitalization after surgery (SMD 0.27, 95% CI 0.11-0.43), hearing impairment (OR 2.78, 95% CI 1.98-3.90), multiple medications (OR 1.36, 95% CI 1.21-1.52), psychotic drugs(OR 4.27, 95% CI 1.37-13.24), morphine (OR 1.97, 95% CI 1.11-3.51), cognitive impairment (OR 2.72, 95% CI 1.96-3.78), length of stay (SMD 0.26, 95% CI 0.14-0.39) and hip surgery (OR 1.63, 95% CI 1.08-2.48) were more likely to sustain delirium after hip surgery in elderly patients. ASA I and II was less likely to develop delirium after orthopedic surgery (OR 0.52, 95% CI 0.34-0.79). CONCLUSIONS Related prophylaxis strategies should be implemented in the elderly involved with above-mentioned risk factors to prevent delirium after orthopedic surgery.
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Preoperative Nutritional Status and Risk for Subsyndromal Delirium in Older Adults Following Joint Replacement Surgery. Orthop Nurs 2020; 39:384-392. [PMID: 33234908 DOI: 10.1097/nor.0000000000000710] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Subsyndromal delirium following surgery in older adults is related to increased lengths of hospital stay and increased admissions to long-term care. Impaired nutrition increases risk for delirium, but its relationship to subsyndromal delirium remains unclear. PURPOSE This correlational study examined the relationship between nutritional status and subsyndromal delirium in older adults. METHODS Assessments for subsyndromal delirium in 53 adults 65 years or older were completed for three consecutive days following joint replacement surgery. Relationships between nutritional status and subsyndromal delirium were analyzed. Level of significance for all tests was set at p ≤ .05. RESULTS Participants' scores from the Mini Nutritional Assessment screen were significantly related (p = .05) to subsyndromal delirium severity after accounting for variability posed by age and cognition status. CONCLUSION When preoperative risk assessment of older adults indicates nutritional risk, preoperative optimization may improve effectiveness of delirium prevention efforts.
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Liang CK, Chu CS, Hsu YH, Chou MY, Wang YC, Lin YT, Renn JH, Liu TY, Yang CC. Effects of modified version of the Hospital Elder Life Program on post-discharge cognitive function and activities of daily living among older adults undergoing total knee arthroplasty. Arch Gerontol Geriatr 2020; 93:104284. [PMID: 33157357 DOI: 10.1016/j.archger.2020.104284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This study aimed to investigate the effects of a modified Hospital Elder Life Program (mHELP) on post-discharge cognition and physical function among older adults undergoing total knee arthroplasty (TKA), and to evaluate the incidence of postoperative delirium. DESIGN Non-randomized intervention trial. SETTING AND PARTICIPANTS A total of 140 patients aged 60 years and older scheduled for elective orthopedic surgery at our institution between August 2017 and December 2018 were included. METHODS Ward-level stratification was used with one surgical ward receiving mHELP (intervention group), including orientation communication, early mobilization, vision/hearing impairment equipment, and dehydration prevention, and another ward providing usual care (control group). All participants were assigned to two surgical wards. Outcome measures were collected using MMSE telephone version (tMMSE), activities of daily living (ADL) and instrumental activities of daily living (IADL) instruments at 1, 6, and 12 months after discharge. Multiple linear regression analysis was used to measure effects of mHELP intervention on mean differences in tMMSE, ADL and IADL scores from baseline to 1-, 6- and 12-months. RESULTS Effects of mHELP intervention significantly preserved cognitive function at 1 and 12 months, but not at 6 months, compared with controls, regardless of adjustments for confounders. However, no intervention effects were noted in ADL and IADL scores. Postoperative delirium in the whole cohort was 3.6 % (2.5 % in intervention group, 5.1 % in control group, P = 0.41). CONCLUSIONS mHELP intervention preserves post-discharge cognitive function, but has no notable effect on ADL and IADL function in older adults undergoing elective TKA surgery.
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Affiliation(s)
- Chih-Kuang Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming University, Taipei, Taiwan; Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Che-Sheng Chu
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ying-Hsin Hsu
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
| | - Yu-Chun Wang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jenn-Huei Renn
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Medical Affair Administration, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Tsung-Yun Liu
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Chen-Chang Yang
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming University, Taipei, Taiwan; Division of Clinical Toxicology & Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
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Silva AR, Regueira P, Albuquerque E, Baldeiras I, Cardoso AL, Santana I, Cerejeira J. Estimates of Geriatric Delirium Frequency in Noncardiac Surgeries and Its Evaluation Across the Years: A Systematic Review and Meta-analysis. J Am Med Dir Assoc 2020; 22:613-620.e9. [PMID: 33011097 DOI: 10.1016/j.jamda.2020.08.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/26/2020] [Accepted: 08/13/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Delirium is an acute neuropsychiatric syndrome associated with poor outcomes. Older adults undergoing surgery have a higher risk of manifesting perioperative delirium, particularly those having associated comorbidities. It remains unclear whether delirium frequency varies across surgical settings and if it has remained stable across the years. We conducted a systematic review to (1) determine the overall frequency of delirium in older people undergoing noncardiac surgery; (2) explore factors explaining the variability of the estimates; and (3) determine the changing of the estimates over the past 2 decades. DESIGN Systematic review and meta-analysis. Literature search was performed in MEDLINE, PubMed, ISI Web of Science, EBSCO, ISRCTN registry, ScienceDirect, and Embase in January 2020 for studies published from 1995 to 2020. SETTING Noncardiac surgical settings. PARTICIPANTS Forty-nine studies were included with a total of 26,865 patients screened for delirium. METHODS We included observational and controlled trials reporting incidence, prevalence, or proportion of delirium in adults aged ≥60 years undergoing any noncardiac surgery requiring hospitalization. Data extracted included sample size, reported delirium frequencies, surgery type, anesthesia type, delirium diagnosis method, length of hospitalization, and year of assessment. (PROSPERO registration no.: CRD42020160045). RESULTS We found an overall pooled frequency of preoperative delirium of 17.9% and postoperative delirium (POD) of 23.8%. The POD estimates increased between 1995 and 2020 at an average rate of 3% per year. Pooled estimates of POD were significantly higher in studies not excluding patients with lower cognitive performance before surgery (28% vs 16%) and when general anesthesia was used in comparison to local, spinal, or epidural anesthesia (28% vs 20%). CONCLUSIONS AND IMPLICATIONS Type of anesthesia and preoperative cognitive status were significant moderators of delirium frequency. POD in noncardiac surgery has been increasing across the years, suggesting that more resources should be allocated to delirium prevention and management.
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Affiliation(s)
- Ana Rita Silva
- Centre for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal
| | - Patrícia Regueira
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal; Department of Psychiatry, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Elisabete Albuquerque
- Department of Psychiatry, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Inês Baldeiras
- Centre for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Ana Luísa Cardoso
- Centre for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal
| | - Isabel Santana
- Centre for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal; Department of Neurology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Joaquim Cerejeira
- Centre for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal; Department of Psychiatry, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal.
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Elevated Level of Serum C-reactive Protein Predicts Postoperative Delirium among Patients Receiving Cervical or Lumbar Surgery. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5480148. [PMID: 32851079 PMCID: PMC7436286 DOI: 10.1155/2020/5480148] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 12/28/2022]
Abstract
Objective To explore the relationship between elevated serum C-reactive protein (CRP) level and postoperative delirium (POD). Methods 206 patients scheduled to receive cervical or lumbar vertebra surgery under general anesthesia for more than 2 hours in a single medical center were observed and analyzed. Patients' serum CRP, delirious status (using the confusion assessment method (CAM)), and delirious score (using the memorial delirium assessment scale (MDAS)) were examined before surgery and 1-2 days after surgery. The association of a serum CRP elevation value from before to after surgery (D-CRP) with delirium occurrence within 2 days after surgery was assessed with a binary logistic regression model, while the association of D-CRP with the postoperative delirious score was assessed with a linear regression model. The effect of D-CRP on predicting delirium occurrence was evaluated with the area under the receiver operating characteristic (ROC) curve (AUC). Results D-CRP was significantly positively associated with postoperative delirium occurrence (OR = 1.047, 95%CI = 1.013, 1.082), and D-CRP was also significantly linearly associated with the postoperative delirious score (β = 0.014, 95%CI = 0.006, 0.023). AUC of ROC was 0.711 (P = 0.014), suggesting that D-CRP had moderate efficacy on predicting postoperative delirium occurrence (P < 0.05). Conclusions Elevated serum CRP after surgery may be a risk factor for and a predictor of postoperative delirium.
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Zhao Y, Xia X, Xie D, Liao Y, Wang Y, Chen L, Ge N, Yue J. Geriatric Nutritional Risk Index can predict postoperative delirium and hospital length of stay in elderly patients undergoing non-cardiac surgery. Geriatr Gerontol Int 2020; 20:759-764. [PMID: 32570290 PMCID: PMC7496996 DOI: 10.1111/ggi.13963] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 05/01/2020] [Accepted: 05/18/2020] [Indexed: 02/05/2023]
Abstract
AIM Malnutrition is common in older patients and is associated with adverse outcomes. The Geriatric Nutritional Risk Index (GNRI) has been developed as an objective index to assess nutritional risk in these patients. However, there is limited evidence regarding the association between GNRI and postoperative delirium (POD) as well as length of stay (LOS) in surgical older patients. Therefore, our goal was to examine the impact of poor nutrition, evaluated by the GNRI, on POD and length of stay in older patients undergoing non-cardiac surgery. METHODS In this prospective cohort study, older patients undergoing non-cardiac surgery from April to June of 2015 were included. Preoperative nutritional status was assessed by the GNRI within the first 48 h after hospital admission. The outcomes were POD and LOS. Multivariable logistic regression and linear regression analyses were used to assess the role of GNRI in predicting these outcomes. RESULTS In the whole sample (N = 288), the prevalence of severe/moderate (GNRI <92) and low (GNRI 92-98) nutritional risk was 15.6% and 29.5%, respectively. The median length of hospital stay was 14 days. Delirium was present in 49 patients (17%). A linear regression analysis showed that low (β = 4.56, 95% confidence interval [CI]: 2.18-6.94) and severe/moderate (β = 3.70, 95% CI: 0.74-6.65) nutritional risk were associated with prolonged LOS. Moreover, a multivariate analysis revealed that patients with severe/moderate nutritional risk were more likely to develop POD compared with those without (odds ratio = 2.56, 95% CI: 1.11-5.89). CONCLUSION Preoperative malnutrition, as assessed using the GNRI, predicted LOS and the development of POD in elderly non-cardiac surgical patients. Geriatr Gerontol Int 2020; 20: 759-764.
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Affiliation(s)
- Yanli Zhao
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Xin Xia
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Dongmei Xie
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Yulin Liao
- Department of Respiratory Diseases, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yanyan Wang
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Ling Chen
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Ning Ge
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Jirong Yue
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
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Zhao Y, Ge N, Xie D, Gao L, Wang Y, Liao Y, Yue J. The geriatric nutrition risk index versus the mini-nutritional assessment short form in predicting postoperative delirium and hospital length of stay among older non-cardiac surgical patients: a prospective cohort study. BMC Geriatr 2020; 20:107. [PMID: 32183760 PMCID: PMC7077017 DOI: 10.1186/s12877-020-1501-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/02/2020] [Indexed: 02/08/2023] Open
Abstract
Backgrounds Malnutrition has been shown to be associated with poor prognosis in older surgical patients. Several tools are available for detecting malnutrition. But little is known about their ability to assess risks of postoperative adverse outcomes. The study aimed to compare the ability of the Geriatric Nutritional Risk Index (GNRI) and the Mini-Nutritional Assessment Short Form (MNA-SF) in predicting postoperative delirium (POD) and length of stay (LOS) among older non-cardiac surgical patients. Methods Prospective study of 288 older non-cardiac surgical patients from the West China Hospital of Sichuan University. Preoperative nutritional status was assessed using the GNRI and MNA-SF, and patients were followed for the occurrence of POD and LOS. Multivariable logistic regression and linear regression analyses were used to identify predictors of these outcomes. The relative performance of the GNRI and MNA-SF as predictors of these outcomes were determined by Receiver Operating Characteristic curves (ROC) analyses and the area under the curve (AUC). Results Multivariable analysis revealed that preoperative malnutrition by the MNA-SF was significantly associated with POD. Linear regression analysis showed that preoperative low/high nutritional risk of the GNRI and malnutrition by the MNA-SF were independent predictors of prolonged LOS. Moreover, the area under the curve (AUC) of MNA-SF scores for POD was better than GNRI scores (AUC = 0.718, 95%CI: 0.64–0.80, P < 0.001 vs AUC = 0.606, 95%CI: 0.52–0.69, P = 0.019; Delong’s test, P = 0.006), but the AUC of GNRI scores and MNA-SF scores have no significant difference when predicting prolonged LOS (AUC = 0.611, 95%CI: 0.54–0.69, P = 0.006 vs AUC = 0.533, 95%CI: 0.45–0.62, P = 0.421; Delong’s test, P = 0.079). Conclusion The MNA-SF was more effective than the GNRI at predicting the development of POD, but the two nutrition screening methods have similar performance in predicting prolonged LOS among older non-cardiac surgical patients.
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Affiliation(s)
- Yanli Zhao
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ning Ge
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Dongmei Xie
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Langli Gao
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yanyan Wang
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yulin Liao
- Department of Respiratory Diseases, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Jirong Yue
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
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Kim LH, Chen YR. Risk Adjustment Instruments in Administrative Data Studies: A Primer for Neurosurgeons. World Neurosurg 2019; 128:477-500. [DOI: 10.1016/j.wneu.2019.04.179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 11/25/2022]
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Wang YC, Liang CK, Hsu YH, Peng LN, Chu CS, Liao MC, Shen HC, Chou MY, Lin YT. Synergistic effect of low handgrip strength and malnutrition on 4-year all-cause mortality in older males: A prospective longitudinal cohort study. Arch Gerontol Geriatr 2019; 83:217-222. [DOI: 10.1016/j.archger.2019.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 12/11/2022]
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Preoperative Age and Prognostic Nutritional Index Are Useful Factors for Evaluating Postoperative Delirium Among Patients With Adult Spinal Deformity. Spine (Phila Pa 1976) 2019; 44:472-478. [PMID: 30234814 DOI: 10.1097/brs.0000000000002872] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study of postoperative delirium after adult spinal deformity (ASD) surgery. OBJECTIVE To identify the risk factors of post-ASD surgery delirium, including nutritional state before surgery. SUMMARY OF BACKGROUND DATA Recently, malnutrition was reported as one of the risk factors of delirium. The prognostic nutritional index (PNI) and controlling nutritional status index (CONUT) scores are simple methods of nutritional evaluation. However, there are no reports that verify that delirium is related to the PNI and CONUT score in patients who have undergone ASD surgery. METHODS A consecutive 319 patients who underwent ASD surgery were divided into a delirium group (group D) or nondelirium group (group ND). Preoperative risk factors, including PNI, were assessed. RESULTS Group D consisted of 30 patients and group ND consisted of 289 patients. There was significant difference in age (group D:group ND = 73:62, P = 0.000), serum albumin (4.2:4.3, P = 0.028), operative time (422:395 min, P = 0.029), PNI score (49:52, P = 0.011), and CONUT score (1.7:1.1, P = 0.046). Using multiple logistic regression analysis, we found significant risk factors for delirium to be age (P = 0.006, odds ratio = 1.11, 95% confidence interval = 1.03-1.19) and PNI (P = 0.003, odds ratio = 0.87, 95% confidence interval = 0.79-0.96). A receiver operating characteristic curve showed that the cut-off value of PNI and age for delirium were 49.7 and 68.5 years, respectively. CONCLUSION The risk factors of postoperative delirium after ASD surgery were PNI less than 49.7 and age more than 68.5 years. Patients who undergo ASD surgery beyond these preoperative cut-off values should be cautioned about delirium and be required to provide adequate informed consent. LEVEL OF EVIDENCE 3.
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Wada S, Inoguchi H, Sadahiro R, Matsuoka YJ, Uchitomi Y, Sato T, Shimada K, Yoshimoto S, Daiko H, Shimizu K. Preoperative Anxiety as a Predictor of Delirium in Cancer Patients: A Prospective Observational Cohort Study. World J Surg 2019; 43:134-142. [PMID: 30128769 DOI: 10.1007/s00268-018-4761-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Postoperative delirium is a common and important complication in cancer patients. We need to identify patients at high risk of postoperative delirium such that it can be prevented preoperatively or in early postoperative phase. The aim of this study was to investigate whether preoperative anxiety predicted onset of postoperative delirium in cancer patients, not only in order to identify high-risk groups but also to help develop new preventive approaches. METHODS This was a prospective observational cohort study of cancer patients undergoing tumor resections. Postoperative delirium was assessed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Preoperative anxiety was evaluated with the Hospital Anxiety and Depression Scale-Anxiety (HADS-A), and we defined HADS-A > 7 as clinical anxiety. We conducted multivariate logistic regression to determine which factors were predictors of delirium. RESULTS The final analysis included 91 patients, 29 of whom met the criteria for postoperative delirium. In multivariable logistic regression, age (5-year increments; odds ratio (OR) = 1.565, 95% confidence interval (CI) = 1.057-2.317, p = 0.025) and HADS-A > 7 (OR = 4.370, 95% CI = 1.051-18.178, p = 0.043) predicted delirium onset. These variables explained 74.2% of the variance. CONCLUSIONS Preoperative anxiety strongly predicted postoperative delirium in cancer patients. Our findings suggest that preoperative anxiety may be a new target for prevention of postoperative delirium. Trial registration number This study was registered at UMIN000018980.
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Affiliation(s)
- Saho Wada
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
- Division of Health Care Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Hironobu Inoguchi
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Ryoichi Sadahiro
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
- Division of Health Care Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Yutaka J Matsuoka
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
- Division of Health Care Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Yosuke Uchitomi
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
- Division of Health Care Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
- Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Tetsufumi Sato
- Department of Anesthesia and Intensive Care, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Kazuaki Shimada
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Seichi Yoshimoto
- Department of Head and Neck Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Hiroyuki Daiko
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Ken Shimizu
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan.
- Division of Health Care Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan.
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan.
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Hsu YH, Chou MY, Chu CS, Liao MC, Wang YC, Lin YT, Chen LK, Liang CK. Predictive Effect of Malnutrition on Long-Term Clinical Outcomes among Older Men: A Prospectively Observational Cohort Study. J Nutr Health Aging 2019; 23:876-882. [PMID: 31641739 DOI: 10.1007/s12603-019-1246-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To determine whether nutritional status can predict 3-year cognitive and functional decline, as well as 4-year all-cause mortality in older adults. DESIGN Prospectively longitudinal cohort study. SETTING AND PARTICIPANTS The study recruited 354 men aged 65 years and older in the veteran's retirement community. MEASURES Baseline nutritional status was evaluated using the Mini-Nutritional Assessment-Short Form (MNA-SF). Cognitive function and Activities of Daily Living (ADL) function were determined by the Mini-Mental State Examination (MMSE) and the Barthel Index, respectively. Three-year cognitive and functional decline were respectively defined as a >3 point decrease in the MMSE scores and lower ADL scores than at baseline. Univariate and multivariable logistic regression analyses were conducted to identify nutritional status as a risk factor in poor outcome. The Kaplan-Meier method and Cox proportional regression models were used to estimate the effect of malnutrition risk on the mortality. RESULTS According to MNS-SF, the prevalence of risk of malnutrition was 53.1% (188/354). Multivariate logistic regression found risk of malnutrition significantly associated with 3-year cognitive decline (Adjusted odds ratio [OR] 2.07, 95% Confidence Interval [CI] 1.05-4.08, P =0.036) and functional decline (Adjusted OR 1.83, 95% CI 1.01-3.34, P =0.047) compared with normal nutritional status. The hazard ratio (HR) for all-cause mortality was 1.8 times higher in residents at risk of malnutrition (Adjusted HR 1.82, 95% CI 1.19-2.79, P =0.006). CONCLUSIONS Our results provide strong evidence that risk of malnutrition can predict not only cognitive and functional decline but also risk of all-cause mortality in older men living in a veteran retirement's community. Further longitudinal studies are needed to explore the causal relationship among nutrition, clinical outcomes, and the effect of an intervention for malnutrition.
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Affiliation(s)
- Y-H Hsu
- Chih-Kuang Liang, Address: Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City 81362, Taiwan (R.O.C.), Phone: 886-7-3422526, E-mail:
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Zou C, Chen S, Shen J, Zheng X, Wang L, Guan L, Liu Q, Yang Y. Prevalence and associated factors of depressive symptoms among elderly inpatients of a Chinese tertiary hospital. Clin Interv Aging 2018; 13:1755-1762. [PMID: 30271130 PMCID: PMC6145362 DOI: 10.2147/cia.s170346] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Depression in the elderly is a serious and often underdiagnosed psychiatric disorder that has been linked to adverse outcomes in the hospital setting. This study aims to evaluate the prevalence of depressive symptoms and associated factors among elderly hospital inpatients. METHODS The cross-sectional study included 411 consecutively hospitalized patients aged 60 years and older. Participants were evaluated within 48 hours of admission using an interviewer-administered questionnaire including the Geriatric Depression Scale and comprehensive geriatric assessment to provide basic demographic and clinical information. RESULTS Most of the participants were male (64.5%), with a mean (SD) age of 75.9 (8.1) years between 60 and 97 years. The prevalence of depressive symptoms was 32.8%. Univariate analysis showed significant associations between depressive symptoms and older age, female gender, lower body mass index, number of chronic diseases, impaired family function, impaired cognition, malnutrition, increased frailty, and decreased ability to perform activities of daily living. After logistic regression, variables that remained significantly associated with depression were cognitive decline (odds ratio =1.97, 95% CI: 1.09-3.55), poor family function (odds ratio =2.01, 95% CI: 1.10-3.66), and frailty (odds ratio =5.07, 95% CI: 1.95-13.20). Depressive symptoms were independently associated with prolonged hospital length. CONCLUSION Depressive symptoms were prevalent among hospitalized elderly and independently associated with cognitive decline, poor family function, and frailty. Therefore, it is essential to screen for depression and perform a comprehensive geriatric assessment in these patients to identify and manage depressive symptoms.
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Affiliation(s)
- Chuan Zou
- Department of Gerontology and Geriatrics, Chengdu Fifth People's Hospital, Chengdu-Montpellier Geriatric Research Center, Chengdu, China,
| | - Shanping Chen
- Department of Gerontology and Geriatrics, Chengdu Fifth People's Hospital, Chengdu-Montpellier Geriatric Research Center, Chengdu, China,
| | - Jing Shen
- Department of Gerontology and Geriatrics, Chengdu Fifth People's Hospital, Chengdu-Montpellier Geriatric Research Center, Chengdu, China,
| | - Xiaomei Zheng
- Department of Gerontology and Geriatrics, Chengdu Fifth People's Hospital, Chengdu-Montpellier Geriatric Research Center, Chengdu, China,
| | - Lingxiao Wang
- Department of Gerontology and Geriatrics, Chengdu Fifth People's Hospital, Chengdu-Montpellier Geriatric Research Center, Chengdu, China,
| | - Lijuan Guan
- Department of Gerontology and Geriatrics, Chengdu Fifth People's Hospital, Chengdu-Montpellier Geriatric Research Center, Chengdu, China,
| | - Qian Liu
- Department of Gerontology and Geriatrics, Chengdu Fifth People's Hospital, Chengdu-Montpellier Geriatric Research Center, Chengdu, China,
| | - Yongxue Yang
- Department of Gerontology and Geriatrics, Chengdu Fifth People's Hospital, Chengdu-Montpellier Geriatric Research Center, Chengdu, China,
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Chu CS, Liang CK, Chou MY, Lu T, Lin YT, Chu CL. Mini-Nutritional Assessment Short-Form as a useful method of predicting poor 1-year outcome in elderly patients undergoing orthopedic surgery. Geriatr Gerontol Int 2017; 17:2361-2368. [PMID: 28581701 DOI: 10.1111/ggi.13075] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 02/28/2017] [Accepted: 03/07/2017] [Indexed: 11/28/2022]
Abstract
AIM The present study aimed to determine whether the Mini-Nutritional Assessment Short-Form (MNA-SF) can predict the 1-year outcome of orthopedic fracture surgery in elderly patients. METHODS This 1-year prospective study assessed nutrition using the MNA-SF at baseline, and postoperatively at 6 and 12 months. Repeated measures analysis of covariance was used to examine functional change over time for two MNA-SF categories. Multivariable logistic regression analysis with forward stepwise modeling was carried out to identify risk factors of functional decline, emergency department visit, hospital readmission and mortality at follow up. RESULTS There were 312 participants, 11 of whom died (3.53%) during 1-year follow up. The mean age was 74.04 ± 7.65 years. A total of 88.1% and 11.9% of the participants were well nourished (MNA-SF 12-14 points) or at risk of undernutrition (0-11 points), respectively. For MNA-SF as a continuous variable, lower MNA-SF scores were associated with a significantly higher risk of emergency department visit at 6-month follow up, and mortality at 12-month follow up (emergency room visit, adjusted odds ratio 0.78, 95% CI 0.63-0.96, P < 0.05; mortality, adjusted odds ratio 0.73, 95% CI 0.57-0.94, P < 0.05). No association was found between functional decline and hospital readmission, and MNA-SF scores. For MNA-SF categories, functional decline was more profound in patients at risk of undernutrition than in well-nourished patients, especially 6-12 months postoperatively. CONCLUSIONS The MNA-SF could be an effective and non-invasive preoperative screening tool to predict functional decline, emergency department visit and mortality during the year after surgery. Geriatr Gerontol Int 2017; 17: 2361-2368.
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Affiliation(s)
- Che-Sheng Chu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Geriatric Medicine Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chih-Kuang Liang
- Department of Geriatric Medicine Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ming-Yueh Chou
- Department of Geriatric Medicine Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ti Lu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yu-Te Lin
- Department of Geriatric Medicine Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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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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Mazzola P, Ward L, Zazzetta S, Broggini V, Anzuini A, Valcarcel B, Brathwaite JS, Pasinetti GM, Bellelli G, Annoni G. Association Between Preoperative Malnutrition and Postoperative Delirium After Hip Fracture Surgery in Older Adults. J Am Geriatr Soc 2017; 65:1222-1228. [PMID: 28263371 DOI: 10.1111/jgs.14764] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 11/01/2016] [Accepted: 11/07/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine whether poor nutritional status can predict postoperative delirium in elderly adults undergoing hip fracture surgery. DESIGN Prospective observational cohort study. SETTING Italian orthogeriatric unit. PARTICIPANTS Individuals aged 70 and older (mean age 84.0 ± 6.6, 74.5% female) consecutively admitted for surgical repair of a proximal femur fracture between September 2012 and April 2016 (N = 415). MEASUREMENTS Participants underwent a comprehensive geriatric assessment including nutritional status, which was evaluated using the Mini Nutritional Assessment Short Form (MNA-SF). The MNA-SF-based three-class stratification was tested using multivariable logistic regression to assess its role in predicting postoperative delirium (outcome). RESULTS Seventy-eight malnourished individuals (MNA-SF score 0-7), 185 at risk of malnutrition (MNA-SF score 8-11), and 152 who were well nourished (MNA-SF score 12-14) were compared. On average, individuals with poor nutritional status were more disabled and more cognitively impaired than those who were well nourished and those at risk of malnutrition. Moreover, those who were malnourished were more likely to have postoperative delirium. Multivariate regression analysis adjusted for age, sex, comorbidity, functional impairment, preoperative cognitive status, and American Society of Anesthesiologists score showed that those who were at risk of malnutrition (odds ratio (OR) = 2.42, 95% confidence interval (CI) = 1.29-4.53) and those who were overtly malnourished (OR = 2.98, 95% CI = 1.43-6.19) were more likely to develop postoperative delirium. CONCLUSION This is the first study in a Western population showing that risk of malnutrition and overt malnutrition, as assessed using the MNA-SF, are independent predictors of postoperative delirium. Accordingly, nutritional status should be assessed in individuals with hip fracture before surgery to determine risk of developing delirium.
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Affiliation(s)
- Paolo Mazzola
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,NeuroMI-Milan Center for Neuroscience, Clinical Neurosciences Research Area, Monza, Italy
| | - Libby Ward
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sara Zazzetta
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Valentina Broggini
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Alessandra Anzuini
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Breanna Valcarcel
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Justin S Brathwaite
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Giulio M Pasinetti
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Geriatric Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,NeuroMI-Milan Center for Neuroscience, Clinical Neurosciences Research Area, Monza, Italy.,Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy
| | - Giorgio Annoni
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,NeuroMI-Milan Center for Neuroscience, Clinical Neurosciences Research Area, Monza, Italy.,Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy
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Guo Y, Jia P, Zhang J, Wang X, Jiang H, Jiang W. Prevalence and risk factors of postoperative delirium in elderly hip fracture patients. J Int Med Res 2016; 44:317-27. [PMID: 26920926 PMCID: PMC5580064 DOI: 10.1177/0300060515624936] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 12/07/2015] [Indexed: 12/15/2022] Open
Abstract
Objective To explore the risk factors associated with postoperative delirium (PD) in elderly patients following total hip arthroplasty (THA) for hip fracture. Methods This prospective study enrolled elderly patients (≥ 65 years) with hip fractures who underwent THA under general anaesthesia, and who had a complete set of postoperative observations. Detailed medical history and perioperative characteristics were recorded. During the postoperative period, patients were assessed twice daily for PD using the Confusion Assessment Method. Results A total of 572 patients were eligible for inclusion in the study. Of these, 120 patients (21.0%) were diagnosed with PD and 452 patients (79.0%) did not experience PD. Multivariate stepwise logistic regression analyses showed that older age, a history of stroke, lower albumin, higher blood glucose, higher total bilirubin, higher C-reactive protein, longer surgery duration and higher volume of red blood cell transfusions were independent risk factors for PD. Conclusions Correcting the modifiable risk factors might help prevent PD. Strategies might include nutritional support, tight blood glucose control, improvement of liver function, preoperative infection control and minimizing surgical injury or blood loss.
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Affiliation(s)
- Yong Guo
- Department of Anaesthesiology and Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China Department of Anaesthesiology and Critical Care Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peiyu Jia
- Department of Anaesthesiology and Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Junfeng Zhang
- Department of Anaesthesiology and Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xuemin Wang
- Department of Anaesthesiology and Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hong Jiang
- Department of Anaesthesiology and Critical Care Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Jiang
- Department of Anaesthesiology and Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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