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Li Y, Li Z, Lv Q, Gu Y, Qi Y, Li J, Liu Y, Ma G. Prevalence and risk factors of postoperative delirium in tumor patients after free flap reconstruction: A systematic review and meta-analysis of case-control studies. Surgery 2024:S0039-6060(24)00306-4. [PMID: 38910046 DOI: 10.1016/j.surg.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/12/2024] [Accepted: 05/06/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Postoperative delirium is a severe complication of flap transplantation surgery, adversely affecting surgical prognoses. The intricate pathophysiology of postoperative delirium renders the elucidation of its risk factors challenging. This research aims to delineate the prevalence and the specific risk factors of postoperative delirium in patients with cancer undergoing free flap reconstruction through a systematic review and meta-analysis to enlighten proactive prevention measures. METHODS The researchers systematically queried both the international and Chinese databases. Searches were performed for publications from inception until September 14, 2023, using the terms "free tissue flaps," "delirium," "neoplasms," and "risk factors." Data synthesis and statistical analysis were conducted using Stata SE (version 15.0) to calculate the combined effect size for identified risk factors. Reported outcomes included weighted mean differences or odds ratios with their respective 95% confidence intervals. RESULTS Twelve case-control studies were included (ntotal = 3,256). Among them, 515 patients developed postoperative delirium after free flap surgery, compared with 2,741 patients who did not. The outcomes suggest that the risk factors include but are not limited to age, male, late neoplasm staging, use of hypnotic or antipsychotic, history of background diseases, psychiatric review, tracheotomy, and impaired wound healing. In contrast, early neoplasm staging and others are the protective factors with statistical significance. Multivariate analysis further identified significant correlations between preoperative albumin, perioperative blood transfusion, sleep disturbance, postoperative visual analog scale, postoperative albumin, smoking, and the appearance of postoperative delirium. CONCLUSION The determined risk factors were grouped into preoperative, intraoperative, and postoperative categories substantiated by current data to present instructions for postoperative delirium prevention.
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Affiliation(s)
- Yifei Li
- Department of General Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhifeng Li
- First Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Qianwen Lv
- Department of Fat Grafting, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yunpeng Gu
- Department of Fat Grafting, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yue Qi
- Department of Fat Grafting, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jiyang Li
- Department of Fat Grafting, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yicheng Liu
- Department of General Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Guie Ma
- Department of General Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
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Deblier I, Dossche K, Vanermen A, Mistiaen W. Dementia Development during Long-Term Follow-Up after Surgical Aortic Valve Replacement with a Biological Prosthesis in a Geriatric Population. J Cardiovasc Dev Dis 2024; 11:136. [PMID: 38786959 PMCID: PMC11122102 DOI: 10.3390/jcdd11050136] [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: 03/19/2024] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024] Open
Abstract
Surgical aortic valve replacement (SAVR) with a biological heart valve prosthesis (BHV) is often used as a treatment in elderly patients with symptomatic aortic valve disease. This age group is also at risk for the development of dementia in the years following SAVR. The research question is "what are the predictors for the development of dementia?". In 1500 patients undergoing SAVR with or without an associated procedure, preoperative (demographic, cardiac and non-cardiac comorbid conditions), perioperative (associated procedures, cross-clamp and cardiopulmonary bypass time) and postoperative 30-day adverse events (bleeding, thromboembolism, heart failure, conduction defects, arrhythmias, delirium, renal and pulmonary complications) were investigated for their effect on the occurrence of dementia by univariate analyses. Significant factors were entered in a multivariate analysis. The sum of the individual follow-up of the patients was 10,182 patient-years, with a mean follow-up of 6.8 years. Data for the development of dementia could be obtained in 1233 of the 1406 patients who left the hospital alive. Dementia during long-term follow-up developed in 216/1233 (17.2%) of the patients at 70 ± 37 months. Development of dementia reduced the mean survival from 123 (119-128) to 109 (102-116) months (p < 0.001). Postoperative delirium was the dominant predictor (OR = 3.55 with a 95%CI of 2.41-4.93; p < 0.00), followed by age > 80 years (2.38; 1.78-3.18; p < 0.001); preoperative atrial fibrillation (1.47; 1.07-2.01; p = 0.018); cardiopulmonary bypass time > 120 min (1.34; 1.02-1.78; p = 0.039) and postoperative thromboembolism (1.94; 1.02-3.70; p = 0.044). Postoperative delirium, as a marker for poor condition, and an age of 80 or more were the dominant predictors.
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Affiliation(s)
- Ivo Deblier
- Faculty of Medicine, University of Antwerp, 2610 Antwerp, Belgium; (I.D.); (K.D.); (A.V.)
| | - Karl Dossche
- Faculty of Medicine, University of Antwerp, 2610 Antwerp, Belgium; (I.D.); (K.D.); (A.V.)
| | - Anthony Vanermen
- Faculty of Medicine, University of Antwerp, 2610 Antwerp, Belgium; (I.D.); (K.D.); (A.V.)
| | - Wilhelm Mistiaen
- Department Cardiovascular Surgery, ZNA Middelheim General Hospital, 2020 Antwerp, Belgium
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Pecorella G, De Rosa F, Licchelli M, Panese G, Carugno JT, Morciano A, Tinelli A. Postoperative cognitive disorders and delirium in gynecologic surgery: Which surgery and anesthetic techniques to use to reduce the risk? Int J Gynaecol Obstet 2024. [PMID: 38557928 DOI: 10.1002/ijgo.15464] [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: 04/17/2023] [Revised: 02/13/2024] [Accepted: 02/25/2024] [Indexed: 04/04/2024]
Abstract
Despite their general good health, an increasing proportion of elderly individuals require surgery due to an increase in average lifespan. However, because of their increased vulnerability, these patients need to be handled carefully to make sure that surgery does not cause more harm than good. Age-related postoperative cognitive disorders (POCD) and postoperative delirium (POD), two serious consequences that are marked by adverse neuropsychologic alterations after surgery, are particularly dangerous for the elderly. In the context of gynecologic procedures, POCD and POD are examined in this narrative review. The main question is how to limit the rates of POCD and POD in older women undergoing gynecologic procedures by maximizing the risk-benefit balance. Three crucial endpoints are considered: (1) surgical procedures to lower the rates of POCD and POD, (2) anesthetic techniques to lessen the occurrence and (3) the identification of individuals at high risk for post-surgery cognitive impairments. Risks associated with laparoscopic gynecologic procedures include the Trendelenburg posture and CO2 exposure during pneumoperitoneum, despite statistical similarities in POD and POCD frequency between laparoscopic and laparotomy techniques. Numerous risk factors are associated with surgical interventions, such as blood loss, length of operation, and position holding, all of which reduce the chance of complications when they are minimized. In order to emphasize the essential role that anesthesia and surgery play in patient care, anesthesiologists are vital in making sure that anesthesia is given as sparingly and quickly as feasible. In addition, people who are genetically predisposed to POCD may be more susceptible to the disorder. The significance of a thorough strategy combining surgical and anesthetic concerns is highlighted in this article, in order to maximize results for senior patients having gynecologic surgery.
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Affiliation(s)
- Giovanni Pecorella
- Department of Gynecology, Obstetrics and Reproduction Medicine, Saarland University, Homburg, Germany
| | - Filippo De Rosa
- Department of Anesthesia and Intensive Care, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy
| | - Martina Licchelli
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy
| | - Gaetano Panese
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy
| | - Josè Tony Carugno
- Obstetrics and Gynecology Department, Minimally Invasive Gynecology Division, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Andrea Morciano
- Panico Pelvic Floor Center, Department of Gynecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy
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Kim SY, Lee J, Na HS, Koo BW, Lee KO, Shin HJ. The Impact of Regional Nerve Blocks on Postoperative Delirium or Cognitive Dysfunction following Thoracic Surgery: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:7576. [PMID: 38137648 PMCID: PMC10743822 DOI: 10.3390/jcm12247576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Regional nerve blocks (NBs) mitigate the occurrence of postoperative cognitive dysfunction (POCD) and postoperative delirium (POD) in adult patients undergoing thoracic surgery. This study aimed to determine the exact effect of NBs on POCD and POD. Electronic databases, including PubMed, EMBASE, CINAHL, Scopus, and Web of Science, were searched for studies. The primary outcome was the incidence of POD or POCD. The secondary outcome was pain scores assessed 24 and 48 h postoperatively. We calculated the log odds ratio (LOR) and standardized mean difference (SMD) with 95% confidence intervals (CIs). The LOR was converted to an odds ratio (OR). In the analysis of 1010 patients from seven randomized controlled trials, POD and POCD rates were 14.1% and 16.7%, respectively, in the NB group, and higher, at 27.3% and 35.2%, in the control group. NBs reduced the incidence of POD (OR, 0.44; 95%CI 0.30 to 0.64; p < 0.001; I2 = 0.00%) and POCD (OR, 0.43; 95%CI 0.24 to 0.76; p < 0.001; I2 = 0.00%). NBs reduced pain scores at 24 h (SMD, -2.60; 95%CI -3.90 to -1.30, p < 0.001; I2 = 97.68%) and 48 h (SMD, -1.80; 95%CI -3.18 to -0.41, p = 0.01; I2 = 98.14%) postoperatively. NBs mitigated the occurrence of POD and POCD in adult patients after thoracic surgery.
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Affiliation(s)
| | | | | | | | | | - Hyun-Jung Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul 13620, Republic of Korea; (S.Y.K.); (J.L.); (H.-S.N.); (B.-W.K.); (K.O.L.)
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Kinoshita H, Saito J, Kushikata T, Oyama T, Takekawa D, Hashiba E, Sawa T, Hirota K. The Perioperative Frontal Relative Ratio of the Alpha Power of Electroencephalography for Predicting Postoperative Delirium After Highly Invasive Surgery: A Prospective Observational Study. Anesth Analg 2023; 137:1279-1288. [PMID: 36917508 DOI: 10.1213/ane.0000000000006424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
BACKGROUND We investigated the associations between postoperative delirium (POD) and both the relative ratio of the alpha (α)-power of electroencephalography (EEG) and inflammatory markers in a prospective, single-center observational study. METHODS We enrolled 84 patients who underwent radical cancer surgeries with reconstruction for esophageal cancer, oral floor cancer, or pharyngeal cancer under total intravenous anesthesia. We collected the perioperative EEG data and the perioperative data of the inflammatory markers, including neutrophil gelatinase-associated lipocalin, presepsin, procalcitonin, C-reactive protein, and the neutrophil-lymphocyte ratio (NLR). The existence of POD was evaluated based on the Intensive Care Delirium Screening Checklist. We compared the time-dependent changes in the relative ratio of the EEG α-power and inflammatory markers between the patients with and without POD. RESULTS Four of the 84 patients were excluded from the analysis. Of the remaining 80 patients, 25 developed POD and the other 55 did not. The relative ratio of the α-power at baseline was significantly lower in the POD group than the non-POD group (0.18 ± 0.08 vs 0.28 ± 0.11, P < .001). A time-dependent decline in the relative ratio of α-power in the EEG during surgery was observed in both groups. There were significant differences between the POD and non-POD groups in the baseline, 3-h, 6-h, and 9-h values of the relative ratio of α-power. The preoperative NLR of the POD group was significantly higher than that of the non-POD group (2.88 ± 1.04 vs 2.22 ± 1.00, P < .001), but other intraoperative inflammatory markers were comparable between the groups. Two multivariable logistic regression models demonstrated that the relative ratio of the α-power at baseline was significantly associated with POD. CONCLUSIONS Intraoperative frontal relative ratios of the α-power of EEG were associated with POD in patients who underwent radical cancer surgery. Intraoperative EEG monitoring could be a simple and more useful tool for predicting the development of postoperative delirium than measuring perioperative acute inflammatory markers. A lower relative ratio of α-power might be an effective marker for vulnerability of brain and ultimately for the development of POD.
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Affiliation(s)
- Hirotaka Kinoshita
- From the Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Junichi Saito
- From the Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tetsuya Kushikata
- From the Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tasuku Oyama
- From the Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daiki Takekawa
- From the Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiji Hashiba
- Division of Intensive Care, Hirosaki University Medical Hospital, Hirosaki, Japan
| | - Teiji Sawa
- Department of Anesthesiology, School of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuyoshi Hirota
- From the Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Ooms M, Schooß R, Puladi B, Steiner T, Hölzle F, Bickenbach J, Rieg A, Modabber A. Identification of risk factors for postoperative delirium in patients following intraoral reconstruction with microvascular free flaps: a matched-pair analysis. Int J Oral Maxillofac Surg 2023; 52:1127-1136. [PMID: 37045611 DOI: 10.1016/j.ijom.2023.03.013] [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: 10/02/2022] [Revised: 03/08/2023] [Accepted: 03/24/2023] [Indexed: 04/14/2023]
Abstract
Postoperative delirium (POD) following microvascular head and neck reconstruction negatively impacts patient outcomes, and only a few risk factors have been identified. The aim of this study was to identify additional risk factors for POD after intraoral reconstruction with microvascular free flaps. Data from 377 patients who underwent intraoral microvascular free flap reconstruction between 2011 and 2019 were analysed retrospectively. Preoperative, intraoperative, and postoperative variables were compared between 40 patients with POD and 40 patients without POD who were matched for previously identified risk factors (i.e., sex, age, American Society of Anesthesiologists class, preoperative arterial hypertension, tracheotomy, operation time, and blood transfusion). A multivariable regression analysis was then performed to identify risk factors associated with POD. POD occurred in 50 (13.3%) of the 377 cases studied; the median time of onset was postoperative day 2. Excessive preoperative alcohol consumption (odds ratio 9.22, 95% confidence interval 1.09-77.97; P = 0.041) and postoperative transplant revision (odds ratio 25.72, 95% confidence interval 1.26-525.43; P = 0.035) were identified as risk factors for POD. The identification of patients at high risk of POD based on these two risk factors may allow early adjustment of diagnostic and therapeutic modalities to improve outcomes and reduce healthcare costs.
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Affiliation(s)
- M Ooms
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany.
| | - R Schooß
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - B Puladi
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - T Steiner
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - F Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - J Bickenbach
- Department of Intensive Care Medicine, Uniklinik RWTH Aachen, Aachen, Germany
| | - A Rieg
- Department of Anaesthesiology, Uniklinik RWTH Aachen, Aachen, Germany
| | - A Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
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Yan E, Veitch M, Saripella A, Alhamdah Y, Butris N, Tang-Wai DF, Tartaglia MC, Nagappa M, Englesakis M, He D, Chung F. Association between postoperative delirium and adverse outcomes in older surgical patients: A systematic review and meta-analysis. J Clin Anesth 2023; 90:111221. [PMID: 37515876 DOI: 10.1016/j.jclinane.2023.111221] [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: 01/27/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023]
Abstract
STUDY OBJECTIVE To assess the incidence of postoperative delirium and its outcomes in older non-cardiac surgical patients. DESIGN A systematic review and meta-analysis with multiple databases searched from inception to February 22, 2022. SETTING Postoperative assessments. PATIENTS Non-cardiac and non-neurological surgical patients aged ≥60 years with and without postoperative delirium. Included studies must report ≥1 postoperative outcome. Studies with a small sample size (N < 100 subjects) were excluded. MEASUREMENTS Outcomes comprised the pooled incidence of postoperative delirium and its postoperative outcomes, including mortality, complications, unplanned intensive care unit admissions, length of stay, and non-home discharge. For dichotomous and continuous outcomes, OR and difference in means were computed, respectively, with a 95% CI. MAIN RESULTS Fifty-four studies (20,988 patients, 31 elective studies, 23 emergency studies) were included. The pooled incidence of postoperative delirium was 19% (95% CI: 16%, 23%) after elective surgery and 32% (95% CI: 25%, 39%) after emergency surgery. In elective surgery, postoperative delirium was associated with increased mortality at 1-month (OR: 6.60; 95% CI: 1.58, 27.66), 6-month (OR: 5.69; 95% CI: 2.33, 13.88), and 1-year (OR: 2.87; 95% CI: 1.63, 5.06). The odds of postoperative complications, unplanned intensive care unit admissions, prolonged length of hospital stay, and non-home discharge were also higher in delirium cases. In emergency surgery, patients with postoperative delirium had greater odds of mortality at 1-month (OR: 3.56; 95% CI: 1.77, 7.15), 6-month (OR: 2.60; 95% CI: 1.88, 3.61), and 1-year (OR: 2.30; 95% CI: 1.77, 3.00). CONCLUSIONS Postoperative delirium was associated with higher odds of mortality, postoperative complications, unplanned intensive care unit admissions, length of hospital stay, and non-home discharge. Prevention and perioperative management of delirium may optimize surgical outcomes.
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Affiliation(s)
- Ellene Yan
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Matthew Veitch
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Aparna Saripella
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Yasmin Alhamdah
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Nina Butris
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - David F Tang-Wai
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Maria Carmela Tartaglia
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, ON, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mahesh Nagappa
- Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Marina Englesakis
- Library & Information Services, University Health Network, Toronto, ON, Canada
| | - David He
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Frances Chung
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, ON, Canada.
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Wu X, Zhang N, Zhou B, Liu S, Wang F, Wang J, Tang X, Lin X, Wang B, Bi Y. Alcohol consumption may be associated with postoperative delirium in the elderly: the PNDABLE study. BMC Anesthesiol 2023; 23:222. [PMID: 37353780 PMCID: PMC10290379 DOI: 10.1186/s12871-023-02178-x] [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: 01/16/2023] [Accepted: 06/13/2023] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVES This study aimed to reveal the relationship between alcohol consumption and Postoperative delirium (POD) in the elderly. METHODS We selected 252 patients from the Perioperative Neurocognitive Disorder And Biomarker Lifestyle (PNDABLE ) study. Patients in the PNDABLE database have been measured for Alzheimer-related biomarkers in CSF (Aβ40, Aβ42, P-tau, and tau protein). Mini-Mental State Examination (MMSE) was used to assess the preoperative mental status of patients. POD was diagnosed using the Confusion Assessment Method (CAM) and assessed for severity using the Memorial Delirium Assessment Scale (MDAS). Logistic regression analysis was utilized to explore the association of alcohol consumption with POD. Linear regression analysis was used to study the relationship between alcohol consumption and CSF biomarkers. Mediation analyses with 10,000 bootstrapped iterations were used to explore the mediation effects. Finally, we constructed the receiver operating characteristic (ROC) curve and the nomogram model to evaluate the efficacy of alcohol consumption and CSF biomarkers in predicting POD. RESULT: The incidence of POD was 17.5%. Logistic regression showed that alcohol consumption (OR = 1.016, 95%CI 1.009-1.024, P < 0.001) is a risk factor for POD. What's more, Aβ42 is a protective factor for POD (OR = 0.993, 95%CI 0.989-0.997, P < 0.05), and P-Tau was a risk factor for POD (OR = 1.093, 95%CI 1.022-1.168, P < 0.05). Linear regression analysis revealed that alcohol consumption was negatively associated with CSF Aβ42 (β = -0.638, P < 0.001) in POD patients. Mediation analyses showed that alcohol consumption is likely to partially mediate POD through Aβ42 (proportion:14.21%). ROC curve showed that alcohol consumption (AUC = 0.904; P < 0.001) exhibited a relatively better discriminatory ability in POD prediction compared to Aβ42 (AUC = 0.798; P < 0.001). The calibration curve indicated a good nomogram prediction (P = 0.797). CONCLUSION Alcohol consumption is a risk factor for POD (particularly for those with > 24 g a day on average) in the elderly, and contributes to POD through the mediation of Aβ42.
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Affiliation(s)
- Xiaoyue Wu
- Department of Anesthesiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), 5, Dong-Hai Middle Road, Shi-Nan District, 266000, Qingdao, China
| | - Ning Zhang
- Department of Anesthesiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), 5, Dong-Hai Middle Road, Shi-Nan District, 266000, Qingdao, China
| | - Bin Zhou
- Department of Anesthesiology, Qingdao Eighth People's Hospital, Qingdao, China
| | - Siyu Liu
- Department of Anesthesiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), 5, Dong-Hai Middle Road, Shi-Nan District, 266000, Qingdao, China
| | - Fei Wang
- Department of Anesthesiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), 5, Dong-Hai Middle Road, Shi-Nan District, 266000, Qingdao, China
| | - Jiahan Wang
- Department of Anesthesiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), 5, Dong-Hai Middle Road, Shi-Nan District, 266000, Qingdao, China
| | - Xinhui Tang
- Department of Anesthesiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), 5, Dong-Hai Middle Road, Shi-Nan District, 266000, Qingdao, China
| | - Xu Lin
- Department of Anesthesiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), 5, Dong-Hai Middle Road, Shi-Nan District, 266000, Qingdao, China.
| | - Bin Wang
- Department of Anesthesiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), 5, Dong-Hai Middle Road, Shi-Nan District, 266000, Qingdao, China.
| | - Yanlin Bi
- Department of Anesthesiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), 5, Dong-Hai Middle Road, Shi-Nan District, 266000, Qingdao, China.
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Shin HJ, Park JI, Lee S, Hwang JW, Na HS. Intraoperative 5-HT 3 receptor antagonists decrease the prevalence of postoperative delirium in older adults undergoing hip fracture surgery: a single-center retrospective study. J Anesth 2023; 37:379-386. [PMID: 36745237 DOI: 10.1007/s00540-023-03169-5] [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: 10/25/2022] [Accepted: 01/27/2023] [Indexed: 02/07/2023]
Abstract
PURPOSE Postoperative delirium (POD) occurs commonly in older adults, resulting in unfavorable outcomes. Several recent clinical studies have suggested that 5-hydroxytryptamine 3 (5-HT3) receptor antagonists can treat and prevent POD. In this retrospective study, the association between 5-HT3 receptor antagonists and POD was investigated in older adults who underwent hip fracture surgery. METHODS The electronic medical records of older adults aged ≥ 65 years who underwent hip fracture surgery between January 2011 and June 2018 were reviewed retrospectively. Multivariable logistic regression analysis was used to investigate the association between 5-HT3 receptor antagonists and the occurrence of POD. In addition to the incidence of POD, anesthesia-, surgery-, and patient-related factors related to POD were evaluated. RESULTS Of the 1025 patients included, 813 (79.3%) were administered 5-HT3 receptor antagonists intraoperatively; 471 (45.9%) were administered ramosetron, and 342 (33.4%) were administered palonosetron. POD was identified in 242 patients (23.6%). Ramosetron and palonosetron reduced the POD incidence by 53% (odds ratio [OR] 0.47; 95% confidence interval [CI] 0.32‒0.71; P < 0.001) and 41% (OR 0.59; 95% CI 0.39‒0.89; P = 0.011), respectively. Additionally, age, American Society of Anesthesiologists physical status class 4, and male were confirmed as risk factors for POD. CONCLUSION Intraoperative 5-HT3 receptor antagonists may be associated with a reduced risk of POD and can be considered one of the preventive strategies for POD in older adults undergoing hip fracture surgery.
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Affiliation(s)
- Hyun-Jung Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji In Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
| | - Sohyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
| | - Jung-Won Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyo-Seok Na
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea. .,Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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10
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Shin HJ, Woo Nam S, Kim H, Yim S, Han SH, Hwang JW, Do SH, Na HS. Postoperative Delirium after Dexmedetomidine versus Propofol Sedation in Healthy Older Adults Undergoing Orthopedic Lower Limb Surgery with Spinal Anesthesia: A Randomized Controlled Trial. Anesthesiology 2023; 138:164-171. [PMID: 36534899 DOI: 10.1097/aln.0000000000004438] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Delirium is a critical postoperative complication in older patients. Based on the hypothesis that intraoperative dexmedetomidine sedation would lower postoperative delirium than propofol sedation would, the authors compared the incidence of postoperative delirium in older adults, using the mentioned sedatives. METHODS This double-blinded, randomized controlled study included 748 patients, aged 65 yr or older, who were scheduled for elective lower extremity orthopedic surgery, between June 2017 and October 2021. Patients were randomized equally into two groups in a 1:1 ratio according to the intraoperative sedative used (dexmedetomidine vs. propofol). The postoperative delirium incidence was considered the primary outcome measure; it was determined using the confusion assessment method, on the first three postoperative days. The mean arterial pressure and heart rate were evaluated as secondary outcomes. RESULTS The authors enrolled 732 patients in the intention-to-treat analyses. The delirium incidence was lower in the dexmedetomidine group than in the propofol group (11 [3.0%] vs. 24 [6.6%]; odds ratio, 0.42; 95% CI, 0.201 to 0.86; P = 0.036). During sedation, the mean arterial pressure (median [interquartile range] mmHg) was higher in the dexmedetomidine group (77 [71 to 84]) than in the propofol group (74 [69 to 79]; P < 0.001); however, it significantly fell lower (74 [68 to 80]) than that of the propofol group (80 [74 to 87]) in the postanesthesia care unit (P < 0.001). Lower heart rates (beats/min) were recorded with the use of dexmedetomidine than with propofol, both during sedation (60 [55 to 66] vs. 63 [58 to 70]) and in the postanesthesia care unit (64 [58 to 72] vs. 68 [62-77]; P < 0.001). CONCLUSIONS Dexmedetomidine showed a lower incidence of postoperative delirium than propofol in healthy older adults undergoing lower extremity orthopedic surgery. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Hyun-Jung Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea; and Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Woo Nam
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Heeyeon Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Subin Yim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung-Hee Han
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea; and Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Won Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea; and Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hwan Do
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea; and Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo-Seok Na
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea; and Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
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11
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Association between preoperative dementia and hospital mortality in old old patients undergoing elective gastrointestinal surgery. Aging Clin Exp Res 2022; 34:2381-2386. [DOI: 10.1007/s40520-022-02197-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 07/03/2022] [Indexed: 11/01/2022]
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12
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Jaatinen R, Luukkaala T, Hongisto MT, Helminen H, Nuotio MS. In-Hospital Delirium as a Prognostic Factor for New Cognitive Disorder in a 1-Year Post-Hip Fracture Follow-Up. Dement Geriatr Cogn Disord 2021; 50:296-302. [PMID: 34515089 DOI: 10.1159/000518487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Older hip fracture patients are at high risk of delirium during acute hospital care. Pre-fracture dementia is known to increase the risk of in-hospital delirium. Data on the development of new cognitive disorders in patients with delirium are scarce. OBJECTIVE The objective of this study is to evaluate the prognostic significance of in-hospital delirium on the development of new cognitive disorders in a 1-year follow-up in older hip fracture patients. MATERIAL AND METHODS Data consisted of 476 hip fracture patients aged 65 years or more with no known cognitive disorder on admission. Delirium was assessed using the Confusion Assessment Method (CAM). Cognitive disorders were diagnosed following the national guidelines. Information on the new diagnoses of cognitive disorders (NDCD) at 1-year follow-up was elicited in a telephone interview and confirmed from the electronic patient files. Logistic regression analyses were conducted to examine the association of delirium with NDCDs. RESULTS Of the 476 patients, 87 (18%) had delirium during hospital stay. Patients with delirium were older, they had poorer nutritional status, lower mobility level, and more supported living arrangements than did patients without delirium. At the 1-year time point, 205 (43%) had NDCDs or were strongly suspected of this. CAM result was statistically significantly associated with development of NDCD in multivariable-adjusted analysis (odds ratio [OR] 2.29; 95% confidence interval [CI]: 1.39-3.79). Also, poor nutritional status continued to be associated with NDCDs (multivariable-adjusted OR 1.58; 95% CI: 1.03-2.43). CONCLUSION Delirium during hospitalization and poor nutritional status on admission are independent prognostic factors for development of subsequent cognitive disorders in older hip fracture patients.
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Affiliation(s)
- Roope Jaatinen
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Division of Geriatric Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Tiina Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland.,Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Markus T Hongisto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Orthopaedics, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Heli Helminen
- Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Maria S Nuotio
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Division of Geriatric Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland.,Research Services and Department of Clinical Medicine, Turku University Hospital, Turku, Finland.,Turku University Hospital and University of Turku, Turku, Finland
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13
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Cognitive Impairment Level and Elderly Hip Fracture: Implications in Rehabilitation Nursing. Rehabil Nurs 2021; 45:147-157. [PMID: 29985871 DOI: 10.1097/rnj.0000000000000159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The aim of the study was to determine the cognitive impairment level influence in descriptive characteristics, comorbidities, complications, and pharmacological features of older adults with hip fracture. DESIGN Cross-sectional study. METHOD Five hundred fifty-seven older adults with hip fracture were recruited and divided into cognitive impairment levels (severe/moderate, mild, no impairment). Descriptive characteristics, comorbidities, complications, and pharmacological data were collected. FINDINGS Significant differences (p < .05, R = .012-.475) between cognitive impairment levels were shown. Shorter presurgery hospital length of stay and lower depression and Parkinson comorbidities; delirium complication; and antidepressants, antiparkinsonians, and neuroleptics use were shown for the no-impairment group. With regard to the cognitive impairment groups, lower presence of cardiopathy and hypertension; higher presence of dementia; antihypertensives, antiplatelets, and antidementia medication; infection/respiratory insufficiency complications; and lower constipation complications were shown. CONCLUSION Cognitive impairment levels may determine the characteristics, comorbidities, pharmacology, and complications of older adults with hip fracture. CLINICAL RELEVANCE Cognitive impairment level may impact rehabilitation nursing practice, education, and care coordination.
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14
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Oh ES, Leoutsakos JM, Rosenberg PB, Pletnikova AM, Khanuja HS, Sterling RS, Oni JK, Sieber FE, Fedarko NS, Akhlaghi N, Neufeld KJ. Effects of Ramelteon on the Prevention of Postoperative Delirium in Older Patients Undergoing Orthopedic Surgery: The RECOVER Randomized Controlled Trial. Am J Geriatr Psychiatry 2021; 29:90-100. [PMID: 32532654 PMCID: PMC8809889 DOI: 10.1016/j.jagp.2020.05.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Postoperative delirium, associated with negative consequences including longer hospital stays and worse cognitive and physical outcomes, is frequently accompanied by sleep-wake disturbance. Our objective was to evaluate the efficacy and short-term safety of ramelteon, a melatonin receptor agonist, for the prevention of postoperative delirium in older patients undergoing orthopedic surgery. DESIGN A quadruple-masked randomized placebo-controlled trial (Clinical Trials.gov NCT02324153) conducted from March 2017 to June 2019. SETTING Tertiary academic medical center. PARTICIPANTS Patients aged 65 years or older, undergoing elective primary or revision hip or knee replacement. INTERVENTION Ramelteon (8 mg) or placebo MEASUREMENTS: Eighty participants were randomized to an oral gel cap of ramelteon or placebo for 3 consecutive nights starting the night before surgery. Trained research staff conducted delirium assessments for 3 consecutive days starting on postoperative day (POD) 0, after recovery from anesthesia, and on to POD2. A delirium diagnosis was based upon DSM-5 criteria determined by expert panel consensus. RESULTS Of 80 participants, five withdrew consent (one placebo, four ramelteon) and four were excluded (four ramelteon) after randomization. Delirium incidence during the 2 days following surgery was 7% (5 of 71) with no difference between the ramelteon versus placebo: 9% (3 of 33) and 5% (2 of 38), respectively. The adjusted odds ratio for postoperative delirium as a function of assignment to the ramelteon treatment arm was 1.28 (95% confidence interval: 0.21-7.93; z-value 0.27; p-value = 0.79). Adverse events were similar between the two groups. CONCLUSION In older patients undergoing elective primary or revision hip or knee replacement, ramelteon was not efficacious in preventing postoperative delirium.
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Affiliation(s)
- Esther S Oh
- Departments of Medicine (ESO, AP, NSF, NA), Johns Hopkins University School of Medicine, Baltimore, MD; Departments of Psychiatry and Behavioral Sciences (ESO, JML, PBR, KJN), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pathology (ESO), Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins University School of Nursing (ESO, KJN), Baltimore, MD.
| | - Jeannie-Marie Leoutsakos
- Departments of Psychiatry and Behavioral Sciences (ESO, JML, PBR, KJN), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Paul B Rosenberg
- Departments of Psychiatry and Behavioral Sciences (ESO, JML, PBR, KJN), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alexandra M Pletnikova
- Departments of Medicine (ESO, AP, NSF, NA), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Harpal S Khanuja
- Departments of Orthopedic Surgery (HSK, RSS, JKO), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert S Sterling
- Departments of Orthopedic Surgery (HSK, RSS, JKO), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Julius K Oni
- Departments of Orthopedic Surgery (HSK, RSS, JKO), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Frederick E Sieber
- Departments of Anesthesiology and Critical Care Medicine (FES), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Neal S Fedarko
- Departments of Medicine (ESO, AP, NSF, NA), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Narjes Akhlaghi
- Departments of Medicine (ESO, AP, NSF, NA), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Karin J Neufeld
- Departments of Psychiatry and Behavioral Sciences (ESO, JML, PBR, KJN), Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins University School of Nursing (ESO, KJN), Baltimore, MD
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15
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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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16
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Smith P, Thompson JC, Perea E, Wasserman B, Bohannon L, Racioppi A, Choi T, Gasparetto C, Horwitz ME, Long G, Lopez R, Rizzieri DA, Sarantopoulos S, Sullivan KM, Chao NJ, Sung AD. Clinical and Neuroimaging Correlates of Post-Transplant Delirium. Biol Blood Marrow Transplant 2020; 26:2323-2328. [PMID: 32961373 DOI: 10.1016/j.bbmt.2020.09.016] [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: 04/20/2020] [Revised: 08/14/2020] [Accepted: 09/06/2020] [Indexed: 11/27/2022]
Abstract
Delirium is common among adults undergoing hematopoietic stem cell transplantation (HCT), although the clinical and neuroimaging correlates of post-HCT delirium have not been adequately delineated. We therefore examined the frequency of delirium and neuroimaging correlates of post-transplant delirium in a retrospective cohort of 115 adults undergoing neuroimaging after allogeneic HCT. Delirium was established using previously validated methods for retrospective identification of chart-assessed postprocedural delirium. Chart reviews were independently conducted by a multidisciplinary team with expertise in HCT, psychiatry, and psychology on consecutive allogeneic HCT patients who underwent neuroimaging assessments and transplantation at a single center between January 2009 and December 2016. Neuroimaging markers of white matter damage and brain volume loss were also recorded. In total, 115 patients were included, ranging in age from 20 to 74 years (mean [SD] age, 49 [13]). Fifty-three patients (46%) developed post-HCT delirium. In an adjusted model, delirium incidence was associated with older age (odds ratio [OR], 1.92 [1.28, 2.87] per decade, P = .002), greater severity of white matter hyperintensities (OR, 1.95 [1.06, 3.57], P = .031), and conditioning intensity (OR, 6.37 [2.20, 18.45], P < .001) but was unrelated to cortical atrophy (P = .777). Delirium was associated with fewer hospital-free days (P = .023) but was not associated with overall survival (hazard ratio, 0.95 [0.56, 1.61], P = .844). Greater incidence of delirium following HCT was associated with greater age, microvascular burden, and conditioning intensity. Pre-HCT consideration of microvascular burden and other neuroimaging biomarkers of risk may be warranted.
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Affiliation(s)
- Patrick Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.
| | - Jillian C Thompson
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Elena Perea
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Brian Wasserman
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Lauren Bohannon
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Alessandro Racioppi
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Taewoong Choi
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Cristina Gasparetto
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Mitchell E Horwitz
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Gwynn Long
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Richard Lopez
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - David A Rizzieri
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Stefanie Sarantopoulos
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Keith M Sullivan
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Nelson J Chao
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Anthony D Sung
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
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17
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Chen H, Jiang H, Chen B, Fan L, Shi W, Jin Y, Ren X, Lang L, Zhu F. The Incidence and Predictors of Postoperative Delirium After Brain Tumor Resection in Adults: A Cross-Sectional Survey. World Neurosurg 2020; 140:e129-e139. [PMID: 32376378 DOI: 10.1016/j.wneu.2020.04.195] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Postoperative delirium (POD) describes a multifactorial disease process occurring after surgery. However, few studies have focused on patients undergoing brain tumor resection, and its influencing factors are unclear. METHODS We performed a 1-year, single-center, cross-sectional, retrospective survey at Huashan Hospital. Patients were screened using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), Confusion Assessment Method, and Richmond Agitation Sedation Scale by trained bedside nurses. Perioperative data were collected using demographic and disease-related questionnaires. The primary outcome measures were the incidence of POD and subtype of POD. Independent predictors of POD were estimated from multivariate logistic regression models, and receiver operating characteristic analysis was used to compare the predictive performance of the models. RESULTS Of the 916 patients included in the study, 893 were analyzed. The overall incidence was 14.78%, 67 had hyperactive delirium (50.76%), 55 had hypoactive delirium (41.67%), and 10 had mixed delirium (7.57%). Age, sex, working status, tobacco use history, comorbidities, physical restraint, axillary temperature (>38.5°C), electrolyte disturbances, duration of anesthesia, pathologic diagnosis, tumor site, length of disease, and duration of operation were risk factors for POD. Conversely, saddle area mass was a protective factor. Age, tobacco use history, electrolyte disturbances, physical restraint, and duration of operation were included in the model. CONCLUSIONS POD is harmful to patients undergoing brain tumor resection, increasing length of stay in the intensive care unit and hospitalization costs. Intraoperative factors and postoperative factors, in addition to older age and tobacco use history, are associated with POD.
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Affiliation(s)
- Hong Chen
- Department of Nursing, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hong Jiang
- Department of Nursing, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Beini Chen
- Department of Nursing, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Liuliu Fan
- Department of Nursing, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weilin Shi
- Department of Nursing, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yufeng Jin
- Department of Nursing, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xuefang Ren
- Department of Nursing, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Liwei Lang
- Department of Nursing, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fengping Zhu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
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18
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Kijima E, Kayama T, Saito M, Kurosaka D, Ikeda R, Hayashi H, Kubota D, Hyakutake T, Marumo K. Pre-operative hemoglobin level and use of sedative-hypnotics are independent risk factors for post-operative delirium following total knee arthroplasty. BMC Musculoskelet Disord 2020; 21:279. [PMID: 32359366 PMCID: PMC7196215 DOI: 10.1186/s12891-020-03206-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/11/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Delirium is a well-known complication following surgery, especially with the increasing age of patients undergoing surgery. The increasing demands resulting from a prolonged healthy life expectancy has resulted in more arthroplasties despite their age and existing comorbidities. The purpose of this study is to explore the various risk factors that may contribute to delirium in unilateral and bilateral total knee arthroplasties in the elderly population. METHODS 170 patients who underwent unilateral or bilateral total knee arthroplasties were analyzed retrospectively for delirium. Age, sex, comorbidities, use of sedative-hypnotics, peri-operative blood loss, pre- and post-operative laboratory blood test results were investigated and analyzed. RESULTS The incidence of post-operative delirium was 6.5% (11 out of 170 patients) with a mean age of 79.5 (± 6.9) years, compared to 73.0 (± 9.0) years in the non-delirium group. Higher age, use of sedative-hypnotics, low pre-operative Hb and Ht, low post-operative Hb, Ht and BUN were observed in the delirium group. Multivariate logistic regression analysis identified that the use of sedative-hypnotics and pre-operative Hb level were independent risk factors for post-operative delirium after TKA. The odds ratios for the use of sedative-hypnotics and pre-operative Hb level were 4.6 and 0.53, respectively. Receiver operating characteristic curve analysis showed that pre-operative Hb of less than 11.1 g/dL was a predictor for the development of delirium, with a sensitivity of 54.6% and a specificity of 91.6%. CONCLUSION Patients with a pre-operative Hb level of < 11.1 g/dL or those using sedative-hypnotics are associated with post-operative delirium. Peri-operative management and preventative measures are therefore needed to reduce the risks of post-operative delirium in such patients.
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Affiliation(s)
- Eiji Kijima
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Tomohiro Kayama
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Daisaburo Kurosaka
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Ryo Ikeda
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroteru Hayashi
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Daisuke Kubota
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takashi Hyakutake
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Keishi Marumo
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
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Knaak C, Brockhaus WR, Spies C, Borchers F, Piper SK, Radtke FM, Lachmann G. Presurgical cognitive impairment is associated with postoperative delirium and postoperative cognitive dysfunction. Minerva Anestesiol 2020; 86:394-403. [DOI: 10.23736/s0375-9393.20.13903-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Personalized risk prediction of postoperative cognitive impairment – rationale for the EU-funded BioCog project. Eur Psychiatry 2020; 50:34-39. [DOI: 10.1016/j.eurpsy.2017.10.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/09/2017] [Accepted: 10/09/2017] [Indexed: 12/21/2022] Open
Abstract
AbstractPostoperative cognitive impairment is among the most common medical complications associated with surgical interventions – particularly in elderly patients. In our aging society, it is an urgent medical need to determine preoperative individual risk prediction to allow more accurate cost–benefit decisions prior to elective surgeries. So far, risk prediction is mainly based on clinical parameters. However, these parameters only give a rough estimate of the individual risk. At present, there are no molecular or neuroimaging biomarkers available to improve risk prediction and little is known about the etiology and pathophysiology of this clinical condition. In this short review, we summarize the current state of knowledge and briefly present the recently started BioCog project (Biomarker Development for Postoperative Cognitive Impairment in the Elderly), which is funded by the European Union. It is the goal of this research and development (R&D) project, which involves academic and industry partners throughout Europe, to deliver a multivariate algorithm based on clinical assessments as well as molecular and neuroimaging biomarkers to overcome the currently unsatisfying situation.
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Daiello LA, Racine AM, Gou RY, Marcantonio ER, Xie Z, Kunze LJ, Vlassakov KV, Inouye SK, Jones RN. Postoperative Delirium and Postoperative Cognitive Dysfunction: Overlap and Divergence. Anesthesiology 2019; 131:477-491. [PMID: 31166241 PMCID: PMC6692220 DOI: 10.1097/aln.0000000000002729] [Citation(s) in RCA: 173] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Postoperative delirium and postoperative cognitive dysfunction share risk factors and may co-occur, but their relationship is not well established. The primary goals of this study were to describe the prevalence of postoperative cognitive dysfunction and to investigate its association with in-hospital delirium. The authors hypothesized that delirium would be a significant risk factor for postoperative cognitive dysfunction during follow-up. METHODS This study used data from an observational study of cognitive outcomes after major noncardiac surgery, the Successful Aging after Elective Surgery study. Postoperative delirium was evaluated each hospital day with confusion assessment method-based interviews supplemented by chart reviews. Postoperative cognitive dysfunction was determined using methods adapted from the International Study of Postoperative Cognitive Dysfunction. Associations between delirium and postoperative cognitive dysfunction were examined at 1, 2, and 6 months. RESULTS One hundred thirty-four of 560 participants (24%) developed delirium during hospitalization. Slightly fewer than half (47%, 256 of 548) met the International Study of Postoperative Cognitive Dysfunction-defined threshold for postoperative cognitive dysfunction at 1 month, but this proportion decreased at 2 months (23%, 123 of 536) and 6 months (16%, 85 of 528). At each follow-up, the level of agreement between delirium and postoperative cognitive dysfunction was poor (kappa less than .08) and correlations were small (r less than .16). The relative risk of postoperative cognitive dysfunction was significantly elevated for patients with a history of postoperative delirium at 1 month (relative risk = 1.34; 95% CI, 1.07-1.67), but not 2 months (relative risk = 1.08; 95% CI, 0.72-1.64), or 6 months (relative risk = 1.21; 95% CI, 0.71-2.09). CONCLUSIONS Delirium significantly increased the risk of postoperative cognitive dysfunction in the first postoperative month; this relationship did not hold in longer-term follow-up. At each evaluation, postoperative cognitive dysfunction was more common among patients without delirium. Postoperative delirium and postoperative cognitive dysfunction may be distinct manifestations of perioperative neurocognitive deficits.
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Affiliation(s)
- Lori A. Daiello
- Alzheimer’s Disease and Memory Disorders Center, Rhode Island Hospital, Providence, RI
- Department of Neurology, Brown University Warren Alpert Medical School, Providence RI
| | - Annie M. Racine
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Harvard Medical School, Boston, MA
| | - Ray Yun Gou
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Edward R. Marcantonio
- Harvard Medical School, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Zhongcong Xie
- Harvard Medical School, Boston, MA
- Department of Anesthesia, Massachusetts General Hospital, Boston, MA
| | - Lisa J Kunze
- Harvard Medical School, Boston, MA
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA
| | - Kamen V. Vlassakov
- Harvard Medical School, Boston, MA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Sharon K. Inouye
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence RI
- Department of Neurology, Brown University Warren Alpert Medical School, Providence RI
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White S, Griffiths R, Baxter M, Beanland T, Cross J, Dhesi J, Docherty AB, Foo I, Jolly G, Jones J, Moppett IK, Plunkett E, Sachdev K. Guidelines for the peri-operative care of people with dementia. Anaesthesia 2019; 74:357-372. [DOI: 10.1111/anae.14530] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2018] [Indexed: 12/24/2022]
Affiliation(s)
- S. White
- Royal Sussex County Hospital; Co-Chair, Association of Anaesthetists Working Party; Brighton UK
| | - R. Griffiths
- Peterborough and Stamford Hospitals Foundation NHS Trust; Co-Chair, Association of Anaesthetists Working Party; Peterborough UK
| | - M. Baxter
- University Hospital Southampton; British Geriatrics Society; UK
| | | | - J. Cross
- Guy's and St. Thomas’ Hospitals NHS Trust; Royal College of Nursing; London UK
| | - J. Dhesi
- Guy's and St. Thomas’ Hospitals NHS Trust; British Geriatrics Society; London UK
| | - A. B. Docherty
- Department of Anaesthesia and Critical Care; University of Edinburgh; UK
| | - I. Foo
- Western General Hospital; Age Anaesthesia Association; Edinburgh UK
| | | | | | - I. K. Moppett
- Anaesthesia and Peri-operative Medicine; University of Nottingham; Royal College of Anaesthetists; UK
| | - E. Plunkett
- University Hospitals Birmingham; Association of Anaesthetists Trainees; UK
| | - K. Sachdev
- Homerton University Hospital NHS Foundation Trust; London UK
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Luan Erfe BM, Boehme J, Erfe JM, Brovman EY, Bader AM, Urman RD. Postoperative Outcomes in Primary Total Knee Arthroplasty Patients With Preexisting Cognitive Impairment: A Systematic Review. Geriatr Orthop Surg Rehabil 2018; 9:2151459318816482. [PMID: 30622833 PMCID: PMC6304705 DOI: 10.1177/2151459318816482] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/08/2018] [Accepted: 11/05/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION To evaluate the body of evidence on the predictive value of preoperative cognitive impairment on in-hospital, short-term, and midterm postoperative outcomes for elderly patients undergoing total knee arthroplasty (TKA). SIGNIFICANCE With an aging population, an increasing percentage of the U.S. patient population will be living with cognitive impairment. There is currently no systematic review that assesses postoperative outcomes of patients with mild cognitive impairment (MCI) or preexisting diagnosis of dementia while undergoing elective primary TKA. RESULTS A database search between January 1, 1997, and November 1, 2017 in EMBASE, MEDLINE, and PubMed was conducted to identify articles that compared postoperative outcomes after TKA between patients aged 60 years with and without cognitive impairment. Cognitive impairment included preexisting diagnosis of dementia or MCI identified during preoperative assessment. Eligible articles were selected using dual reviewer and third-party arbitrator. The quality of the studies was evaluated using the Newcastle-Ottawa Scale. The strength of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. A total of 6163 abstracts were screened. Only 11 full text articles met inclusion criteria, including 1 case-control, 5 prospective cohort, and 5 retrospective cohort studies. Two studies were of poor quality. Overall, there is moderate strength of evidence for increased risk of postoperative delirium, increased length of stay, and discharge to health-care facility among patients with preoperative MCI or preexisting dementia. The body of evidence is weak for other outcomes of interest including mortality, functionality and complications while in-hospital and in the short- and midterm. CONCLUSION This review highlights the need for additional good quality studies to provide more information about MCI and dementia as risk factors in primary TKA.
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Affiliation(s)
| | - Jacqueline Boehme
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
| | | | - Ethan Y. Brovman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Angela M. Bader
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Richard D. Urman
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
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Susano MJ, Vasconcelos L, Lemos T, Amorim P, Abelha FJ. Adverse postoperative cognitive disorders: a national survey of portuguese anesthesiologists. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 30049480 PMCID: PMC9391822 DOI: 10.1016/j.bjane.2018.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background and objectives Postoperative delirium and postoperative cognitive dysfunction are some of the most common complications in older surgical patients and are associated with adverse outcomes. The aim of this study was to evaluate portuguese anesthesiologists’ perspectives and knowledge about adverse postoperative cognitive disorders, and routine clinical practice when caring for older surgical patients. Methods We used a prospective online survey with questions using a Likert scale from 1 to 5 (completely disagree to completely agree), or yes/no/don’t know answer types. Potential participants were portuguese anesthesiologists working in hospitals affiliated with the portuguese national health system and private hospitals. Results We analyzed 234 surveys (17.7% of total potential respondents). The majority believed that the risk of cognitive side effects should be considered when choosing the type of anesthesia (87.6%) and that preoperative cognitive function should be routinely assessed (78.6%). When caring for an agitated and confused patient postoperatively, 62.4% would first administer an analgesic and 11.1% an anxiolytic. Protocols to screen and manage postoperative cognitive disorders are rarely used. Nearly all respondents believe that postoperative delirium and postoperative cognitive dysfunction are neglected areas in anesthesiology. Conclusions Overall, participants perceive postoperative cognitive disorders as important adverse outcomes following surgery and anesthesia are aware of the main risk factors for their development but may lack information on prevention and management of postoperative delirium. The majority of hospitals do not have protocols regarding preoperative cognitive assessment, diagnosis, management or follow-up of patients with delirium and postoperative cognitive dysfunction.
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Affiliation(s)
- Maria J Susano
- Centro Hospitalar do Porto, Departamento de Anestesiologia, Porto, Portugal; Centro Hospitalar do Porto, Centro de Investigação Clínica em Anestesiologia, Departamento de Anestesiologia, Porto, Portugal.
| | | | - Tiago Lemos
- Centro Hospitalar do Porto, Departamento de Anestesiologia, Porto, Portugal
| | - Pedro Amorim
- Centro Hospitalar do Porto, Departamento de Anestesiologia, Porto, Portugal; Centro Hospitalar do Porto, Centro de Investigação Clínica em Anestesiologia, Departamento de Anestesiologia, Porto, Portugal
| | - Fernando J Abelha
- Universidade do Porto, Faculdade de Medicina, Centro Hospitalar de São João, Departamento de Anestesiologia e de Cirurgia e Fisiologia, Porto, Portugal
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Susano MJ, Vasconcelos L, Lemos T, Amorim P, Abelha FJ. [Adverse postoperative cognitive disorders: a national survey of portuguese anesthesiologists]. Rev Bras Anestesiol 2018; 68:472-483. [PMID: 30049480 DOI: 10.1016/j.bjan.2018.02.009] [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: 10/09/2017] [Accepted: 02/27/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Postoperative delirium and postoperative cognitive dysfunction are some of the most common complications in older surgical patients and are associated with adverse outcomes. The aim of this study was to evaluate portuguese anesthesiologists' perspectives and knowledge about adverse postoperative cognitive disorders, and routine clinical practice when caring for older surgical patients. METHODS We used a prospective online survey with questions using a Likert scale from 1 to 5 (completely disagree to completely agree), or yes/no/don't know answer types. Potential participants were portuguese anesthesiologists working in hospitals affiliated with the portuguese national health system and private hospitals. RESULTS We analyzed 234 surveys (17.7% of total potential respondents). The majority believed that the risk of cognitive side effects should be considered when choosing the type of anesthesia (87.6%) and that preoperative cognitive function should be routinely assessed (78.6%). When caring for an agitated and confused patient postoperatively, 62.4% would first administer an analgesic and 11.1% an anxiolytic. Protocols to screen and manage postoperative cognitive disorders are rarely used. Nearly all respondents believe that postoperative delirium and postoperative cognitive dysfunction are neglected areas in anesthesiology. CONCLUSIONS Overall, participants perceive postoperative cognitive disorders as important adverse outcomes following surgery and anesthesia are aware of the main risk factors for their development but may lack information on prevention and management of postoperative delirium. The majority of hospitals do not have protocols regarding preoperative cognitive assessment, diagnosis, management or follow-up of patients with delirium and postoperative cognitive dysfunction.
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Affiliation(s)
- Maria J Susano
- Centro Hospitalar do Porto, Departamento de Anestesiologia, Porto, Portugal; Centro Hospitalar do Porto, Centro de Investigação Clínica em Anestesiologia, Departamento de Anestesiologia, Porto, Portugal.
| | | | - Tiago Lemos
- Centro Hospitalar do Porto, Departamento de Anestesiologia, Porto, Portugal
| | - Pedro Amorim
- Centro Hospitalar do Porto, Departamento de Anestesiologia, Porto, Portugal; Centro Hospitalar do Porto, Centro de Investigação Clínica em Anestesiologia, Departamento de Anestesiologia, Porto, Portugal
| | - Fernando J Abelha
- Universidade do Porto, Faculdade de Medicina, Centro Hospitalar de São João, Departamento de Anestesiologia e de Cirurgia e Fisiologia, Porto, Portugal
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Spiegel R, Kalla R, Mantokoudis G, Maire R, Mueller H, Hoerr R, Ihl R. Ginkgo biloba extract EGb 761 ® alleviates neurosensory symptoms in patients with dementia: a meta-analysis of treatment effects on tinnitus and dizziness in randomized, placebo-controlled trials. Clin Interv Aging 2018; 13:1121-1127. [PMID: 29942120 PMCID: PMC6005330 DOI: 10.2147/cia.s157877] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Tinnitus and dizziness are frequent in old age and often seen as concomitant symptoms in patients with dementia. In earlier clinical trials, Ginkgo biloba extract EGb 761® was found to alleviate tinnitus and dizziness in elderly patients. Consequently, a meta-analysis was conducted to evaluate the effects of EGb 761® at a daily dose of 240 mg on tinnitus and dizziness associated with dementia. Methods Randomized, placebo-controlled clinical trials of G. biloba extract EGb 761® identified by a systematic database search were included in a meta-analysis if they met all of the following selection criteria: 1) diagnosis of dementia according to generally accepted criteria, 2) treatment period of at least 20 weeks, 3) outcome measures covering at least two of the three conventional domains of assessment, 4) presence and severity of dizziness and tinnitus were assessed, and 5) assessment was done before and after randomized treatment. Results Five trials that met the inclusion criteria were included in the meta-analysis. The risk of bias was judged as low, with Jadad scores of 3 and 5. In all trials, 11-point box scales were used to assess the severity of tinnitus and dizziness. Overall, EGb 761® was superior to placebo, with weighted mean differences for change from baseline, calculated in meta-analyses using random effects models, of -1.06 (95% CI: -1.77, -0.36) for tinnitus (p = 0.003) and -0.77 (95% CI: -1.44, -0.09) for dizziness (p = 0.03). Conclusion Our findings support the notion that EGb 761® is also effective in alleviating concomitant neurosensory symptoms in patients with dementia.
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Affiliation(s)
- Rainer Spiegel
- Division of Internal Medicine, Basel University Hospital, University of Basel, Basel, Switzerland
| | - Roger Kalla
- Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | | | - Heiko Mueller
- Clinical Research Department, Dr Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
| | - Robert Hoerr
- Clinical Research Department, Dr Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
| | - Ralf Ihl
- Department of Psychiatry, University of Duesseldorf, Alexian Research Center Krefeld, Krefeld, Germany
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O’ Brien H, O’ Leary N, Scarlett S, O’ Hare C, Kenny RA. Hospitalisation and surgery: are there hidden cognitive consequences? Evidence from The Irish Longitudinal study on Ageing (TILDA). Age Ageing 2018; 47:408-415. [PMID: 29546387 DOI: 10.1093/ageing/afy020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 02/18/2018] [Indexed: 11/12/2022] Open
Abstract
Background the dramatic shift in the global population demographic has led to increasing numbers of older people undergoing hospitalisation and surgical procedures. Objectives to determine whether hospitalisation or hospitalisation with surgery under general anaesthesia is associated with poorer cognitive performance in adults over the age of 50. Methods cognitive function in the domains of global cognition, memory and executive function was assessed in 8,023 individuals at waves 1 and 2 of The Irish Longitudinal Study on Ageing (TILDA), 2 years apart. Mixed-effects models were used to investigate the hypothesis after adjustment for risk factors for cognitive decline and potential confounders. Results during the 12 months preceding wave 1, 472 participants were hospitalised (mean age 67.0, 54.9% female) and a further 560 participants (mean age 64.6, 52.1% female) were hospitalised and underwent surgery with general anaesthesia; 6,938 (mean age 63.5, 54.5% female) were not hospitalised. There was a 14% higher error rate (IRR[95% CI] = 1.14[1.06, 1.22]) in the MMSE in the hospitalisation group and a 6% higher error rate (IRR[95% CI] = 1.06[0.99, 1.13]) in the surgery group compared to those with no hospitalisation. Poorer cognitive performance in the memory tasks was evident in both hospitalisation and hospitalisation with surgery groups (immediate recall: [95% CI] = -0.13 words[-0.22,-0.04] versus -0.13 words[-0.21,-0.04] and delayed recall: -0.20 words[-0.33,-0.06] versus -0.20[-0.32, -0.07]) compared to those with no hospitalisation. Increased error in the time-based prospective memory task was observed in the hospitalisation group and the surgery group (OR[95% CI] = 1.32[1.08, 1.60] versus 1.29[1.07, 1.55]). Conclusion hospitalisation and hospitalisation with surgery and general anaesthesia are associated with poorer global and domain specific cognitive performance.
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Affiliation(s)
- Helen O’ Brien
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland
- Mercer's Institute for Successful Ageing, Department of Medical Gerontology, St. James's Hospital, Dublin 8, Ireland
| | - Neil O’ Leary
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland
- Clinical Research Facility Galway, National University of Ireland, Galway
| | - Siobhan Scarlett
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland
| | - Celia O’ Hare
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland
- Mercer's Institute for Successful Ageing, Department of Medical Gerontology, St. James's Hospital, Dublin 8, Ireland
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Abstract
This study aimed to assess perioperative morbidity and mortality in elderly patients following colorectal cancer resection and to investigate risk factors for postoperative complications. This study reviewed 697 consecutive patients who underwent elective colorectal cancer resection between 2005 and 2013 at our institution. Patients were divided into 3 groups according to their age: ≤74 (n = 420), 75 to 89 (n = 261), and ≥90 years (n = 16). Clinical findings, morbidity, and mortality were compared among these groups. Univariate and multivariate logistic regression analyses were performed with clinically relevant variables for the complications that increased with aging. Postoperative delirium and pneumonia showed significant increases with aging. There were no significant differences in mortality and morbidity among the 3 groups, except for the 2 aforementioned diseases. Multiple logistic regression analysis showed that dementia and laparoscopic surgery were independent determinants of postoperative delirium and that age and American Society of Anesthesiologists (ASA) score were independent risk factors for postoperative pneumonia. Dementia, high ASA score, and age were the risk factors for higher postoperative morbidity in elderly patients. Our results demonstrated the effectiveness of laparoscopic surgery for the prevention of postoperative delirium after colorectal resection.
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Abstract
OBJECTIVE The aim of this study was to highlight the vulnerability of the aging brain to surgery and anesthesia, examine postoperative cognitive outcomes, and recommend possible interventions. BACKGROUND Surgeons are facing increasingly difficult ethical and clinical decisions given the rapidly expanding aging demographic. Cognitive function is not routinely assessed either preoperatively or postoperatively. Potential short and long-term cognitive implications are rarely discussed with the patient despite evidence that postoperative cognitive impairment occurs in up to 65% of older patients. Furthermore, surgery may accelerate the trajectory of cognitive decline and dementia. METHODS An electronic search was conducted using Pubmed/Medline. References from selected studies were cross-referenced and relevant articles retrieved. Data were summarized in a narrative format. RESULTS There is a hidden epidemic of cognitive dysfunction in the perioperative setting. Up to 40% of patients who develop postoperative delirium (POD) never return to their preoperative cognitive baseline. POD can lead to postoperative cognitive dysfunction (POCD), a more prolonged cognitive impairment associated with longer length of hospital stay and cost, premature withdrawal from the workforce, and greater 1-year mortality. Standardized perioperative cognitive assessment is needed to enable progress. Improving outcomes will depend on a multifaceted approach, including correction of modifiable preoperative risk factors and prompt treatment of POD. Risk factors are discussed and possible interventional strategies are presented. CONCLUSION Closer preoperative collaboration between surgeons, geriatricians, and anesthetists will enable identification of complex at-risk older patients. A paradigm shift in the approach to management of the older surgical patient is critical to improve postoperative cognitive outcomes in modern surgery.
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Anesthesia, brain changes, and behavior: Insights from neural systems biology. Prog Neurobiol 2017; 153:121-160. [PMID: 28189740 DOI: 10.1016/j.pneurobio.2017.01.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/19/2017] [Accepted: 01/22/2017] [Indexed: 02/08/2023]
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Cortese GP, Burger C. Neuroinflammatory challenges compromise neuronal function in the aging brain: Postoperative cognitive delirium and Alzheimer's disease. Behav Brain Res 2016; 322:269-279. [PMID: 27544872 DOI: 10.1016/j.bbr.2016.08.027] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 08/08/2016] [Accepted: 08/11/2016] [Indexed: 12/19/2022]
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disease that targets memory and cognition, and is the most common form of dementia among the elderly. Although AD itself has been extensively studied, very little is known about early-stage preclinical events and/or mechanisms that may underlie AD pathogenesis. Since the majority of AD cases are sporadic in nature, advancing age remains the greatest known risk factor for AD. However, additional environmental and epigenetic factors are thought to accompany increasing age to play a significant role in the pathogenesis of AD. Postoperative cognitive delirium (POD) is a behavioral syndrome that primarily occurs in elderly patients following a surgical procedure or injury and is characterized by disruptions in cognition. Individuals that experience POD are at an increased risk for developing dementia and AD compared to normal aging individuals. One way in which cognitive function is affected in cases of POD is through activation of the inflammatory cascade following surgery or injury. There is compelling evidence that immune challenges (surgery and/or injury) associated with POD trigger the release of pro-inflammatory cytokines into both the periphery and central nervous system. Thus, it is possible that cognitive impairments following an inflammatory episode may lead to more severe forms of dementia and AD pathogenesis. Here we will discuss the inflammation associated with POD, and highlight the advantages of using POD as a model to study inflammation-evoked cognitive impairment. We will explore the possibility that advancing age and immune challenges may provide mechanistic evidence correlating early life POD with AD. We will review and propose neural mechanisms by which cognitive impairments occur in cases of POD, and discuss how POD may augment the onset of AD.
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Affiliation(s)
- Giuseppe P Cortese
- Department of Neurology, University of Wisconsin-Madison, Medical Sciences Center, 1300 University Ave, Room 73 Bardeen Madison, WI 53706, USA.
| | - Corinna Burger
- Department of Neurology, University of Wisconsin-Madison, Medical Sciences Center, 1300 University Ave, Room 73 Bardeen Madison, WI 53706, USA
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Skvarc DR, Dean OM, Byrne LK, Gray LJ, Ives K, Lane SE, Lewis M, Osborne C, Page R, Stupart D, Turner A, Berk M, Marriott AJ. The Post-Anaesthesia N-acetylcysteine Cognitive Evaluation (PANACEA) trial: study protocol for a randomised controlled trial. Trials 2016; 17:395. [PMID: 27502769 PMCID: PMC4977889 DOI: 10.1186/s13063-016-1529-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/26/2016] [Indexed: 12/18/2022] Open
Abstract
Background Some degree of cognitive decline after surgery occurs in as many as one quarter of elderly surgical patients, and this decline is associated with increased morbidity and mortality. Cognition may be affected across a range of domains, including memory, psychomotor skills, and executive function. Whilst the exact mechanisms of cognitive change after surgery are not precisely known, oxidative stress and subsequent neuroinflammation have been implicated. N-acetylcysteine (NAC) acts via multiple interrelated mechanisms to influence oxidative homeostasis, neuronal transmission, and inflammation. NAC has been shown to reduce oxidative stress and inflammation in both human and animal models. There is clinical evidence to suggest that NAC may be beneficial in preventing the cognitive decline associated with both acute physiological insults and dementia-related disorders. To date, no trials have examined perioperative NAC as a potential moderator of postoperative cognitive changes in the noncardiac surgery setting. Methods and design This is a single-centre, randomised, double-blind, placebo-controlled clinical trial, with a between-group, repeated-measures, longitudinal design. The study will recruit 370 noncardiac surgical patients at the University Hospital Geelong, aged 60 years or older. Participants are randomly assigned to receive either NAC or placebo (1:1 ratio), and groups are stratified by age and surgery type. Participants undergo a series of neuropsychological tests prior to surgery, 7 days, 3 months, and 12 months post surgery. It is hypothesised that the perioperative administration of NAC will reduce the degree of postoperative cognitive changes at early and long-term follow-up, as measured by changes on individual measures of the neurocognitive battery, when compared with placebo. Serum samples are taken on the day of surgery and on day 2 post surgery to quantitate any changes in levels of biomarkers of inflammation and oxidative stress. Discussion The PANACEA trial aims to examine the potential efficacy of perioperative NAC to reduce the severity of postoperative cognitive dysfunction in an elderly, noncardiac surgery population. This is an entirely novel approach to the prevention of postoperative cognitive dysfunction and will have high impact and translatable outcomes if NAC is found to be beneficial. Trial registration The PANACEA trial has been registered with the Therapeutic Goods Administration, and the Australian New Zealand Clinical Trials Registry: ACTRN12614000411640; registered on 15 April 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1529-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David R Skvarc
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, 3215, VIC, Australia.,Innovations in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, Deakin University/Barwon Health Clinical School, Pigdons Road, Waurn Ponds, 3216, VIC, Australia.,School of Medicine, Deakin University, Pigdons Road, Waurn Ponds, 3216, VIC, Australia
| | - Olivia M Dean
- Innovations in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, Deakin University/Barwon Health Clinical School, Pigdons Road, Waurn Ponds, 3216, VIC, Australia.,School of Medicine, Deakin University, Pigdons Road, Waurn Ponds, 3216, VIC, Australia
| | - Linda K Byrne
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, 3215, VIC, Australia
| | - Laura J Gray
- School of Medicine, Deakin University, Pigdons Road, Waurn Ponds, 3216, VIC, Australia
| | - Kathryn Ives
- Department of Anaesthesia, Perioperative Medicine and Pain Management, Barwon Health, Bellarine Street, Geelong, 3220, VIC, Australia
| | - Stephen E Lane
- School of Medicine, Deakin University, Pigdons Road, Waurn Ponds, 3216, VIC, Australia.,Biostatistics Unit, Barwon Health, Bellarine Street, Geelong, 3220, VIC, Australia
| | - Matthew Lewis
- Aged Psychiatry Service, Caulfield Hospital, Alfred Health, 260 Kooyong Road, Caulfield, 3162, Victoria, Australia
| | - Cameron Osborne
- Department of Anaesthesia, Perioperative Medicine and Pain Management, Barwon Health, Bellarine Street, Geelong, 3220, VIC, Australia
| | - Richard Page
- School of Medicine, Deakin University, Pigdons Road, Waurn Ponds, 3216, VIC, Australia.,Barwon Orthopaedic Research Unit, Bellarine Street, Geelong, 3220, VIC, Australia
| | - Douglas Stupart
- Department of General Surgery, Barwon Health, Bellarine Street, Geelong, 3220, VIC, Australia
| | - Alyna Turner
- Innovations in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, Deakin University/Barwon Health Clinical School, Pigdons Road, Waurn Ponds, 3216, VIC, Australia.,School of Medicine, Deakin University, Pigdons Road, Waurn Ponds, 3216, VIC, Australia
| | - Michael Berk
- Innovations in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, Deakin University/Barwon Health Clinical School, Pigdons Road, Waurn Ponds, 3216, VIC, Australia.,School of Medicine, Deakin University, Pigdons Road, Waurn Ponds, 3216, VIC, Australia
| | - Andrew J Marriott
- Department of Anaesthesia, Perioperative Medicine and Pain Management, Barwon Health, Bellarine Street, Geelong, 3220, VIC, Australia. .,Innovations in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, Deakin University/Barwon Health Clinical School, Pigdons Road, Waurn Ponds, 3216, VIC, Australia. .,School of Medicine, Deakin University, Pigdons Road, Waurn Ponds, 3216, VIC, Australia.
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Bilotta F, Qeva E, Matot I. Anesthesia and cognitive disorders: a systematic review of the clinical evidence. Expert Rev Neurother 2016; 16:1311-1320. [DOI: 10.1080/14737175.2016.1203256] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Federico Bilotta
- Department of Anesthesiology, Critical Care and Pain Medicine, ‘Sapienza’ University of Rome, Rome, Italy
| | - Ega Qeva
- Department of Anesthesiology, Critical Care and Pain Medicine, ‘Sapienza’ University of Rome, Rome, Italy
| | - Idit Matot
- Department of Anesthesiology, Intensive Care and Pain Medicine, Tel Aviv Medical Center, Tel Aviv, Israel
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Bouwyn JP, Derrey S, Lefaucheur R, Fetter D, Rouille A, Le Goff F, Maltête D. Age Limits for Deep Brain Stimulation of Subthalamic Nuclei in Parkinson’s Disease. JOURNAL OF PARKINSONS DISEASE 2016; 6:393-400. [DOI: 10.3233/jpd-150742] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jean-Paul Bouwyn
- Department of Neurology, Rouen University Hospital and University of Rouen, France
| | - Stéphane Derrey
- Department of Neurosurgery, Rouen University Hospital and University of Rouen, France
| | - Romain Lefaucheur
- Department of Neurology, Rouen University Hospital and University of Rouen, France
| | - Damien Fetter
- Department of Neurology, Rouen University Hospital and University of Rouen, France
| | - Audrey Rouille
- Department of Neurology, Rouen University Hospital and University of Rouen, France
| | - Floriane Le Goff
- Department of Neurology, Rouen University Hospital and University of Rouen, France
| | - David Maltête
- Department of Neurology, Rouen University Hospital and University of Rouen, France
- Department of Neurosurgery, Rouen University Hospital and University of Rouen, France
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Wang R, Chen J, Wu G. Variable lung protective mechanical ventilation decreases incidence of postoperative delirium and cognitive dysfunction during open abdominal surgery. Int J Clin Exp Med 2015; 8:21208-21214. [PMID: 26885056 PMCID: PMC4723901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 10/25/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Postoperative cognitive dysfunction (POCD) is a subtle impairment of cognitive abilities and can manifest on different neuropsychological features in the early postoperative period. It has been proved that the use of mechanical ventilation (MV) increased the development of delirium and POCD. However, the impact of variable and conventional lung protective mechanical ventilation on the incidence of POCD still remains unknown, which was the aim of this study. METHODS 162 patients scheduled to undergo elective gastrointestinal tumor resection via laparotomy in Ningbo No. 2 hospital with expected duration >2 h from June, 2013 to June, 2015 were enrolled in this study. Patients included were divided into two groups according to the scheme of lung protective MV, variable ventilation group (VV group, n=79) and conventional ventilation group (CV group, n=83) by randomization performed by random block randomization. The plasma levels of inflammatory cytokines, characteristics of the surgical procedure, incidence of delirium and POCD were collected and compared. RESULTS Postoperative delirium was detected in 36 of 162 patients (22.2%) and 12 patients of these (16.5%) belonged to the VV group while 24 patients (28.9%) were in the CV group (P=0.036). POCD on the seventh postoperative day in CV group (26/83, 31.3%) was increased in comparison with the VV group (14/79, 17.7%) with significant statistical difference (P=0.045). The levels of inflammatory cytokines were all significantly higher in CV group than those in VV group on the 1st postoperative day (P<0.05). On 7th postoperative day, the levels of IL-6 and TNF-α in CV group remained much higher compared with VV group (P<0.05). CONCLUSIONS Variable vs conventional lung protective MV decreased the incidence of postoperative delirium and POCD by reducing the systemic proinflammatory response.
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Affiliation(s)
- Ruichun Wang
- Department of Anesthesiology, Ningbo No. 2 Hospital No. 41 Xibei Street, Ningbo 315000, Zhejiang Province, China
| | - Junping Chen
- Department of Anesthesiology, Ningbo No. 2 Hospital No. 41 Xibei Street, Ningbo 315000, Zhejiang Province, China
| | - Guorong Wu
- Department of Anesthesiology, Ningbo No. 2 Hospital No. 41 Xibei Street, Ningbo 315000, Zhejiang Province, China
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Tan CB, Ng J, Jeganathan R, Kawai F, Pan CX, Pollock S, Turner J, Cohen S, Chorost M. Cognitive changes after surgery in the elderly: does minimally invasive surgery influence the incidence of postoperative cognitive changes compared to open colon surgery? Dement Geriatr Cogn Disord 2015; 39:125-31. [PMID: 25471533 DOI: 10.1159/000357804] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Postoperative delirium in the elderly is a growing concern. Data regarding significant differences in postoperative cognitive dysfunction (POCD) in elderly persons undergoing laparoscopic versus open colon resection are not well established. OBJECTIVES The goal of this study was to compare the incidence of POCD in laparoscopic versus open colon surgery in an elderly population. DESIGN AND SETTING A prospective nonrandomized pilot study was conducted at an urban tertiary care hospital. PARTICIPANTS The study included patients aged 65 years and above, without documented dementia who underwent elective colon surgery. MEASUREMENTS We collected demographic and clinical data, including age, sex, polypharmacy, and comorbidities. The subjects underwent pre- and postoperative Cambridge Neuropsychological Test Automated Battery (CANTAB) testing. Worsening individual scores from the Paired Associated Learning (PAL) and Spatial Working Memory (SWM) portions of CANTAB determined the presence of POCD. Inflammatory cytokine (i.e., IL-6) levels were measured pre- and postoperatively. RESULTS We enrolled 44 subjects (26 laparoscopic and 18 open surgery). The two groups did not differ significantly in age, sex, polypharmacy, and comorbidities. The average incidence of POCD was 47%. PAL scores worsened in 12/23 (52%) in the laparoscopic group and in 7/15 (47%) in the open group. These group differences lacked statistical significance (p = 0.75). SWM scores worsened in 14/25 (56%) in the laparoscopic group and in 6/18 (33%) in the open group, which was also not statistically significant (p = 0.12). No age difference occurred between the 'worsened scores' group and 'stable scores' group, and older age was not associated with POCD. IL-6 levels were higher in the open versus the laparoscopic group (p < 0.0001). CONCLUSION In this pilot study, the average incidence of POCD was not statistically different between elderly subjects undergoing open versus laparoscopic surgery. Age did not influence the occurrence of POCD. Although inflammatory markers were significantly higher in the open group, consistent with a higher degree of stress response, this group did not have higher rates of delirium. This association is worth to be investigated in a larger sample.
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Affiliation(s)
- Christopher B Tan
- Division of Geriatrics and Palliative Care Medicine, New York Hospital Queens, New York, N.Y., USA
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The American Geriatrics Society/National Institute on Aging Bedside-to-Bench Conference: Research Agenda on Delirium in Older Adults. J Am Geriatr Soc 2015; 63:843-52. [PMID: 25834932 PMCID: PMC5407494 DOI: 10.1111/jgs.13406] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Borden A, Wallon D, Lefaucheur R, Derrey S, Fetter D, Verin M, Maltête D. Does early verbal fluency decline after STN implantation predict long-term cognitive outcome after STN-DBS in Parkinson's disease? J Neurol Sci 2014; 346:299-302. [DOI: 10.1016/j.jns.2014.07.063] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 07/16/2014] [Accepted: 07/29/2014] [Indexed: 11/27/2022]
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Heo DY, Hwang BM. Intravenous Patient-controlled Analgesia Has a Positive Effect on the Prognosis of Delirium in Patients Undergoing Orthopedic Surgery. Korean J Pain 2014; 27:271-7. [PMID: 25031814 PMCID: PMC4099241 DOI: 10.3344/kjp.2014.27.3.271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/17/2014] [Accepted: 06/10/2014] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Postoperative delirium is relatively common. However, the relationship between intravenous patient-controlled analgesia (IV-PCA) and delirium has not been thoroughly investigated. The aim of this study was to evaluate the effects of IV-PCA on the prognosis of postoperative delirium in patients undergoing orthopedic surgery. METHODS Medical records of 129 patients with postoperative delirium were reviewed. Patients were divided into two groups according to whether they used IV-PCA with fentanyl and ketorolac. The IV-PCA group consisted of 73 patients who were managed with IV-PCA; the NO-PCA group consisted of 56 patients who were managed without PCA. RESULTS Incidences of multiple psychiatric consultations and prolonged delirium were significantly lower in patients using IV-PCA with fentanyl and ketorolac than in those without PCA. CONCLUSIONS We recommend the use of IV-PCA for pain control and management of delirium in patients with postoperative delirium.
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Affiliation(s)
- Dae Young Heo
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Byeong Mun Hwang
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Korea
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Deiner S, Lin HM, Bodansky D, Silverstein J, Sano M. Do stress markers and anesthetic technique predict delirium in the elderly? Dement Geriatr Cogn Disord 2014; 38:366-74. [PMID: 25171689 PMCID: PMC4201865 DOI: 10.1159/000363762] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Postoperative delirium (PD) is a prevalent complication of elderly surgical patients, which predisposes to worsened cognitive recovery and dementia. Risk of PD has been associated with increasing magnitude of the hypothalamic-pituitary-adrenal stress response (serum cortisol, epinephrine and norepinephrine) to surgery. Anesthetics suppress this response; however, some (total intravenous anesthesia, TIVA) more than others (anesthetic gases). Prior comparisons of anesthetics have been equivocal but have not included stress markers. We hypothesized that TIVA would decrease serum stress markers and the incidence of PD. METHODS We performed a prospective cohort study of 76 elderly major surgical patients. Patients received TIVA or sevoflurane gas, and blood was drawn for serum markers pre-, intra-, and postoperatively. PD was assessed with the Confusion Assessment Method. We compared stress markers and PD between patients who received TIVA versus sevoflurane, and then modeled PD including stress and anesthetic. RESULTS The group that received TIVA during surgery demonstrated lower levels of all stress markers compared to the gas group, but no difference in PD. However, across groups, the postoperative norepinephrine level was much higher in patients who developed PD. Other markers and other times had no effect. CONCLUSION The development of PD depends more on postoperative stress than intraoperative stress or anesthetic.
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Affiliation(s)
- Stacie Deiner
- Department of Anesthesiology, the Icahn School of Medicine at Mount Sinai, New York, New York,Department of Neurosurgery, the Icahn School of Medicine at Mount Sinai, New York, New York,Department of Geriatrics & Palliative Care, the Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hung-Mo Lin
- Department of Health Evidence and Policy, the Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniella Bodansky
- Department of Anesthesiology, the Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeffrey Silverstein
- Department of Anesthesiology, the Icahn School of Medicine at Mount Sinai, New York, New York,Department of Geriatrics & Palliative Care, the Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mary Sano
- Department of Psychiatry, the Icahn School of Medicine at Mount Sinai, New York, New York
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Zhang H, Lu Y, Liu M, Zou Z, Wang L, Xu FY, Shi XY. Strategies for prevention of postoperative delirium: a systematic review and meta-analysis of randomized trials. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:R47. [PMID: 23506796 PMCID: PMC3672487 DOI: 10.1186/cc12566] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 03/12/2013] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The ideal measures to prevent postoperative delirium remain unestablished. We conducted this systematic review and meta-analysis to clarify the significance of potential interventions. METHODS The PRISMA statement guidelines were followed. Two researchers searched MEDLINE, EMBASE, CINAHL and the Cochrane Library for articles published in English before August 2012. Additional sources included reference lists from reviews and related articles from 'Google Scholar'. Randomized clinical trials (RCTs) on interventions seeking to prevent postoperative delirium in adult patients were included. Data extraction and methodological quality assessment were performed using predefined data fields and scoring system. Meta-analysis was accomplished for studies that used similar strategies. The primary outcome measure was the incidence of postoperative delirium. We further tested whether interventions effective in preventing postoperative delirium shortened the length of hospital stay. RESULTS We identified 38 RCTs with interventions ranging from perioperative managements to pharmacological, psychological or multicomponent interventions. Meta-analysis showed dexmedetomidine sedation was associated with less delirium compared to sedation produced by other drugs (two RCTs with 415 patients, pooled risk ratio (RR)=0.39; 95% confidence interval (CI)=0.16 to 0.95). Both typical (three RCTs with 965 patients, RR=0.71; 95% CI=0.54 to 0.93) and atypical antipsychotics (three RCTs with 627 patients, RR=0.36; 95% CI=0.26 to 0.50) decreased delirium occurrence when compared to placebos. Multicomponent interventions (two RCTs with 325 patients, RR=0.71; 95% CI=0.58 to 0.86) were effective in preventing delirium. No difference in the incidences of delirium was found between: neuraxial and general anesthesia (four RCTs with 511 patients, RR=0.99; 95% CI=0.65 to 1.50); epidural and intravenous analgesia (three RCTs with 167 patients, RR=0.93; 95% CI=0.61 to 1.43) or acetylcholinesterase inhibitors and placebo (four RCTs with 242 patients, RR=0.95; 95% CI=0.63 to 1.44). Effective prevention of postoperative delirium did not shorten the length of hospital stay (10 RCTs with 1,636 patients, pooled SMD (standard mean difference)=-0.06; 95% CI=-0.16 to 0.04). CONCLUSIONS The included studies showed great inconsistencies in definition, incidence, severity and duration of postoperative delirium. Meta-analysis supported dexmedetomidine sedation, multicomponent interventions and antipsychotics were useful in preventing postoperative delirium.
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