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Zhang GB, Lv JM, Yu WJ, Li HY, Wu L, Zhang SL, Shi GZ, Huang HW. The associations of post-stroke delirium with outcomes: a systematic review and meta-analysis. BMC Med 2024; 22:470. [PMID: 39407191 PMCID: PMC11475888 DOI: 10.1186/s12916-024-03689-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 10/07/2024] [Indexed: 10/20/2024] Open
Abstract
BACKGROUND Published data on whether post-stroke delirium (PSD) is an independent predictor of outcomes in patients with acute stroke are inconsistent and have not yet been synthesized and quantified via meta-analyses. METHODS This systematic review and meta-analysis followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The study protocol involved a search of the PubMed, Embase, PsycINFO, and Medline databases from 1946 to November 1, 2023, of which prospective observational and case-control studies were included. The quality of the included studies was rated using the Newcastle Ottawa Scale. Pooled effect estimates calculated using a random-effects model were expressed as the odds ratios (ORs), hazard ratios (HRs), and standardized mean differences (SMDs) with 95% confidence intervals (CIs). The protocol was registered in PROSPERO (CRD42023472551). RESULTS The search yielded 39 eligible articles comprising 3295 and 9643 patients with and without PSD, respectively. Thirty studies were high quality, while 9 had moderate quality. The primary analyses, adequately adjusting for predefined confounders, showed that PSD was significantly associated with mortality risk (average follow-up of 19.50 months; OR, 3.47; 95% CI, 2.35-5.12; I2, 26.0%) and poor neurological function (average follow-up of 21.75 months; OR, 3.62; 95% CI, 2.15-6.09; I2, 0). Secondary analyses, with or without inadequate adjustment, showed that PSD was significantly associated with prolonged hospital length of stay, increased risk of institutionalization, poor cognitive outcomes, and quality of life after discharge. CONCLUSIONS This systematic review and meta-analysis provides evidence that PSD was independently associated with mortality and poor neurological function after controlling for pre-specified confounders. The prevention of PSD remains a high clinical and research priority.
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Affiliation(s)
- Guo-Bin Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jia-Mei Lv
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei-Jie Yu
- Department of Neurosurgery, The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Hao-Yi Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lei Wu
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shao-Lan Zhang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guang-Zhi Shi
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Hua-Wei Huang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Boord MS, Feuerriegel D, Coussens SW, Davis DHJ, Psaltis PJ, Garrido MI, Bourke A, Keage HAD. Neurophysiological patterns reflecting vulnerability to delirium subtypes: a resting-state EEG and event-related potential study. Brain Commun 2024; 6:fcae298. [PMID: 39262826 PMCID: PMC11389613 DOI: 10.1093/braincomms/fcae298] [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: 09/27/2023] [Revised: 06/24/2024] [Accepted: 09/04/2024] [Indexed: 09/13/2024] Open
Abstract
Delirium is a common and acute neurocognitive disorder in older adults associated with increased risk of dementia and death. Understanding the interaction between brain vulnerability and acute stressors is key to delirium pathophysiology, but the neurophysiology of delirium vulnerability is not well defined. This study aimed to identify pre-operative resting-state EEG and event-related potential markers of incident delirium and its subtypes in older adults undergoing elective cardiac procedures. This prospective observational study included 58 older participants (mean age = 75.6 years, SD = 7.1; 46 male/12 female); COVID-19 restrictions limited recruitment. Baseline assessments were conducted in the weeks before elective cardiac procedures and included a 4-min resting-state EEG recording (2-min eyes open and 2-min eyes closed), a 5-min frequency auditory oddball paradigm recording, and cognitive and depression examinations. Periodic peak power, peak frequency and bandwidth measures, and aperiodic offsets and exponents were derived from resting-state EEG data. Event-related potentials were measured as mean component amplitudes (first positive component, first negative component, early third positive component, and mismatch negativity) following standard and deviant auditory stimuli. Incident delirium occurred in 21 participants: 10 hypoactive, 6 mixed, and 5 hyperactive. Incident hyperactive delirium was associated with higher pre-operative eyes open (P = 0.045, d = 1.0) and closed (P = 0.036, d = 1.0) aperiodic offsets. Incident mixed delirium was associated with significantly larger pre-operative first positive component amplitudes to deviants (P = 0.037, d = 1.0) and larger third positive component amplitudes to standards (P = 0.025, d = 1.0) and deviants (P = 0.041, d = 0.9). Other statistically non-significant but moderate-to-large effects were observed in relation to all subtypes. We report evidence of neurophysiological markers of delirium risk weeks prior to elective cardiac procedures in older adults. Despite being underpowered due to COVID-19-related recruitment impacts, these findings indicate pre-operative dysfunction in neural excitation/inhibition balance associated with different delirium subtypes and warrant further investigation on a larger scale.
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Affiliation(s)
- Monique S Boord
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, 5072, South Australia, Australia
- College of Education, Psychology and Social Work, Flinders University, Adelaide, 5042, South Australia, Australia
| | - Daniel Feuerriegel
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, 3052, Victoria, Australia
| | - Scott W Coussens
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, 5072, South Australia, Australia
| | - Daniel H J Davis
- MRC Unit for Lifelong Health and Ageing, UCL, London, WC1E 6BT, UK
| | - Peter J Psaltis
- Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, 5000, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, 5005, South Australia, Australia
- Department of Cardiology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, 5000, South Australia, Australia
| | - Marta I Garrido
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, 3052, Victoria, Australia
- Graeme Clark Institute for Biomedical Engineering, University of Melbourne, Melbourne, 3052, Victoria, Australia
| | - Alice Bourke
- Aged Care, Rehabilitation and Palliative Care (Medical), Northern Adelaide Local Health Network, Adelaide, 5092, South Australia, Australia
| | - Hannah A D Keage
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, 5072, South Australia, Australia
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3
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Acker L, Xu K, Ginsberg JP. The brain-heart-immune axis: a vago-centric framework for predicting and enhancing resilient recovery in older surgery patients. Bioelectron Med 2024; 10:21. [PMID: 39218887 PMCID: PMC11367755 DOI: 10.1186/s42234-024-00155-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 07/19/2024] [Indexed: 09/04/2024] Open
Abstract
Nearly all geriatric surgical complications are studied in the context of a single organ system, e.g., cardiac complications and the heart; delirium and the brain; infections and the immune system. Yet, we know that advanced age, physiological stress, and infection all increase sympathetic and decrease parasympathetic nervous system function. Parasympathetic function is mediated through the vagus nerve, which connects the heart, brain, and immune system to form, what we have termed, the brain-heart-immune axis. We hypothesize that this brain-heart-immune axis plays a critical role in surgical recovery among older adults. In particular, we hypothesize that the brain-heart-immune axis plays a critical role in the most common surgical complication among older adults: postoperative delirium. Further, we present heart rate variability as a measure that may eventually become a multi-system vital sign evaluating brain-heart-immune axis function. Finally, we suggest the brain-heart-immune axis as a potential interventional target for bio-electronic neuro-immune modulation to enhance resilient surgical recovery among older adults.
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Affiliation(s)
- Leah Acker
- Department of Anesthesiology, Duke University School of Medicine, 136 Sands Building, 303 Research Drive, Durham, NC, 27710, USA.
- Department of Neurobiology, Duke University School of Medicine, Durham, NC, USA.
- Pratt School of Engineering, Duke University, Durham, NC, USA.
- Duke Center for the Study of Aging and Human Development, Durham, NC, USA.
- Claude D Pepper Older Americans Independence Center at Duke, Durham, NC, USA.
- Duke Center for Cognitive Neuroscience, Durham, NC, USA.
| | - Kevin Xu
- Department of Anesthesiology, Duke University School of Medicine, 136 Sands Building, 303 Research Drive, Durham, NC, 27710, USA
- Pratt School of Engineering, Duke University, Durham, NC, USA
| | - J P Ginsberg
- William Jennings Bryan Dorn VA Healthcare System, Columbia, SC, USA
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4
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Wu P, Yang Y, Yuan A, Wang Y, Zhang Y. Postoperative delirium increases follow-up mortality following hip arthroplasty in older patients with femoral neck fracture. Australas J Ageing 2024. [PMID: 39186392 DOI: 10.1111/ajag.13366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 08/28/2024]
Abstract
OBJECTIVE This study aimed to identify independent perioperative risk factors and follow-up mortality associated with postoperative delirium in older patients undergoing hip arthroplasty at a large teaching hospital in South China. We aimed to establish a specialised model to predict the risk of postoperative delirium. METHODS This retrospective observational study was conducted in the orthopaedics department of the hospital between January 2018 and December 2022. Participants were stratified into two groups: those with and those without postoperative delirium. The study included demographics, clinical characteristics, surgery-related and laboratory specifics, as well as details on delirium. RESULTS In this study of 241 participants, the median age was 80 years (IQR, 74.5-85), with postoperative delirium observed in 43 individuals (18%). Multivariate logistic regression analysis identified age (OR, 1.07; 95% CI, 1.01-1.14; p = .03), arrhythmia (OR, 7.97; 95% CI, 2.25-28.29; p = .001), dementia (OR, 7.08; 95% CI, 1.73-28.95; p = .006) and a lower level of red blood cells (RBC) (OR, .33; 95% CI, .17-.64; p < .001) as independent factors associated with postoperative delirium after hip arthroplasty. Patients experiencing both preoperative and postoperative delirium had significantly higher follow-up mortality compared to those with postoperative delirium only and those without delirium (80% vs. 38% vs. 24%, p = .02). CONCLUSIONS The specialised model was established to effectively predict delirium following hip arthroplasty in patients with femoral neck fracture. Postoperative delirium strongly associates with follow-up mortality. Proactive management is crucial for minimising delirium occurrence after hip arthroplasty and improving patient outcomes.
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Affiliation(s)
- Penghuan Wu
- Department of Orthopaedics, Shaoguan First People's Hospital, Southern Medical University, Guangzhou, Guangdong, China
- The School of Medicine, Nankai University, Tianjin, China
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ying Yang
- Department of Orthopaedics, Shaoguan First People's Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Aidong Yuan
- Department of Orthopaedics, Shaoguan First People's Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yu Wang
- Department of Orthopaedics, Shaoguan First People's Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yingze Zhang
- The School of Medicine, Nankai University, Tianjin, China
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Chinese Academy of Engineering, Beijing, China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, China
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5
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Sun M, Chen WM, Wu SY, Zhang J. Association between postoperative hyperactive delirium and major complications in elderly patients undergoing emergency hip fracture surgery: A large-scale cohort study. Geriatr Gerontol Int 2024; 24:730-736. [PMID: 38775227 DOI: 10.1111/ggi.14894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/21/2024] [Accepted: 05/01/2024] [Indexed: 07/03/2024]
Abstract
AIM This cohort study aimed to explore the connection between postoperative hyperactive delirium and major complications in elderly patients undergoing emergency hip fracture surgery. METHODS Elderly patients aged 65 years and older undergoing emergency hip fracture surgery were included in the study. The presence of postoperative hyperactive delirium was assessed, and logistic regression analysis, following propensity score matching, was conducted to investigate the association between postoperative hyperactive delirium and major complications occurring 30 and 90 days post-surgery. The analysis controlled for potential confounding factors. RESULTS After propensity score matching, the analysis included 13 590 patients, equally distributed with 6795 in each group. The group experiencing postoperative hyperactive delirium exhibited a significantly elevated risk of 30-day postoperative complications, including acute renal failure, pneumonia, septicemia, and stroke, with adjusted odds ratios ranging from 1.64 to 2.39. Furthermore, this group displayed notably higher rates of 90-day postoperative complications, encompassing mortality, acute renal failure, pneumonia, septicemia, and stroke, with a significantly increased incidence of mortality within 90 days. CONCLUSION Postoperative hyperactive delirium in elderly patients undergoing emergency hip fracture surgery is significantly linked to an increased risk of major complications at both 30 and 90 days post-surgery. These findings underscore the critical importance of delirium prevention and management in this patient population, offering the potential to reduce the occurrence of postoperative complications. Geriatr Gerontol Int 2024; 24: 730-736.
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Affiliation(s)
- Mingyang Sun
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Wan-Ming Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Management, College of Management, Fo Guang University, Yilan, Taiwan
| | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
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Veronese N, Solimando L, Bolzetta F, Maggi S, Fiedorowicz JG, Gupta A, Fabiano N, Wong S, Boyer L, Fond G, Dragioti E, Dominguez LJ, Barbagallo M, Romagnoli S, Bellelli G, Solmi M. Interventions to prevent and treat delirium: An umbrella review of randomized controlled trials. Ageing Res Rev 2024; 97:102313. [PMID: 38677599 DOI: 10.1016/j.arr.2024.102313] [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: 12/22/2023] [Revised: 02/29/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Abstract
Delirium is a common condition across different settings and populations. The interventions for preventing and managing this condition are still poorly known. The aim of this umbrella review is to synthesize and grade all preventative and therapeutic interventions for delirium. We searched five databases from database inception up to March 15th, 2023 and we included meta-analyses of randomized controlled trials (RCTs) to decrease the risk of/the severity of delirium. From 1959 records after deduplication, we included 59 systematic reviews with meta-analyses, providing 110 meta-analytic estimates across populations, interventions, outcomes, settings, and age groups (485 unique RCTs, 172,045 participants). In surgery setting, for preventing delirium, high GRADE evidence supported dexmedetomidine (RR=0.53; 95%CI: 0.46-0.67, k=13, N=3988) and comprehensive geriatric assessment (OR=0.46; 95%CI=0.32-0.67, k=3, N=496) in older adults, dexmedetomidine in adults (RR=0.33, 95%CI=0.24-0.45, k=7, N=1974), A2-adrenergic agonists after induction of anesthesia (OR= 0.28, 95%CI= 0.19-0.40, k=10, N=669) in children. High certainty evidence did not support melatonergic agents in older adults for delirium prevention. Moderate certainty supported the effect of dexmedetomidine in adults and children (k=4), various non-pharmacological interventions in adults and older people (k=4), second-generation antipsychotics in adults and mixed age groups (k=3), EEG-guided anesthesia in adults (k=2), mixed pharmacological interventions (k=1), five other specific pharmacological interventions in children (k=1 each). In conclusion, our work indicates that effective treatments to prevent delirium differ across populations, settings, and age groups. Results inform future guidelines to prevent or treat delirium, accounting for safety and costs of interventions. More research is needed in non-surgical settings.
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Affiliation(s)
- Nicola Veronese
- Geriatric Unit, Department of Medicine, University of Palermo, Palermo 90127, Italy.
| | - Luisa Solimando
- Geriatric Unit, Department of Medicine, University of Palermo, Palermo 90127, Italy
| | - Francesco Bolzetta
- Medical Department, Geriatric Unit, Azienda ULSS (Unità Locale Socio Sanitaria), 3 "Serenissima", Dolo-Mirano District, Dolo, Venice, Italy
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Padua, Italy
| | - Jess G Fiedorowicz
- Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Department of Psychiatry, University of Ottawa, Ontario, Canada; Ottawa Hospital Research Institute (OHRI) Ottawa, Ontario,Canada
| | - Arnav Gupta
- College of Public Health, Kent State University, Kent, OH, United States; Department of Medicine, University of Calgary, Calgary, AB, United States
| | - Nicholas Fabiano
- Department of Mental Health, The Ottawa Hospital, Ontario, Canada
| | - Stanley Wong
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Laurent Boyer
- AP-HM, Aix-Marseille Univ, CEReSS, Health Service Research and Quality of Life Centre, School of Medicine-La Timone Medical, Marseille, France; FondaMental Fondation, Créteil, France
| | - Guillaume Fond
- AP-HM, Aix-Marseille Univ, CEReSS, Health Service Research and Quality of Life Centre, School of Medicine-La Timone Medical, Marseille, France; FondaMental Fondation, Créteil, France
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping 581 85, Sweden; Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina 45500, Greece
| | - Ligia J Dominguez
- Faculty of Medicine and Surgery, Kore University of Enna, Enna 94100, Italy
| | - Mario Barbagallo
- Geriatric Unit, Department of Medicine, University of Palermo, Palermo 90127, Italy
| | - Stefano Romagnoli
- Department of Health Science, Section of Anaesthesia and Intensive Care, University of Florence, Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan 20126, Italy; Acute Geriatric Unit, IRCCS San Gerardo, Monza 20900, Italy
| | - Marco Solmi
- Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Department of Psychiatry, University of Ottawa, Ontario, Canada; Ottawa Hospital Research Institute (OHRI) Ottawa, Ontario,Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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Zhang Y, Yu Y, Han Z, Diao L, Zhao R, Liu J, Luo Y, Wu H, Yang Y. Incidence and associated factors of delirium after primary total joint arthroplasty in elderly patients: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e38395. [PMID: 39259060 PMCID: PMC11142822 DOI: 10.1097/md.0000000000038395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND A total of 1.5% to 20.2% of total joint arthroplasty patients experience delirium. Until now, no formal systematic review or meta-analysis was performed to summarize the risk factors of delirium after primary total joint arthroplasty (TJA). METHODS A comprehensive search encompassing Medline, Embase, and the Cochrane central database was conducted, incorporating studies available up to June 2023. We systematically reviewed research on the risk factors contributing to delirium following TJA in elderly patients, without language restrictions. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa Scale. Data synthesis through pooling and a meta-analysis were performed to analyze the findings. RESULTS A total of 23 studies altogether included 71,095 patients with primary TJA, 2142 cases of delirium occurred after surgery, suggesting the accumulated incidence of 3.0%. The results indicated that age, current smoker, heavy drinker, mini-mental state examination score, hypertension, diabetes mellitus, chronic kidney disease, history of stroke, coronary arterial disease, dementia, history of psychiatric illness, American Society of Anesthesiologists physical status III-IV, general anesthesia, anesthesia time, operative time, intraoperative blood loss, blood transfusion, β-blockers, ACEI drugs, use of psychotropic drugs, preoperative C-reactive protein level, and preoperative albumin level were significantly associated with postoperative delirium after primary TJA. CONCLUSIONS Related prophylaxis strategies should be implemented in the elderly involved with above-mentioned risk factors to prevent delirium after primary TJA.
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Affiliation(s)
- Yanju Zhang
- Nursing Department, Cangzhou People’s Hospital, Cangzhou, Hebei, People’s Republic of China
| | - Yanjie Yu
- Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Ziyu Han
- Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Li Diao
- Pharmacy Department, Cangzhou People’s Hospital, Cangzhou, Hebei, People’s Republic of China
| | - Runping Zhao
- Nursing Department, Cangzhou People’s Hospital, Cangzhou, Hebei, People’s Republic of China
| | - Jinzhu Liu
- Nursing Department, Cangzhou People’s Hospital, Cangzhou, Hebei, People’s Republic of China
| | - Yuhong Luo
- Oncology Department, Cangzhou People’s Hospital, Cangzhou, Hebei, People’s Republic of China
| | - Huiyuan Wu
- Nursing Department, Cangzhou People’s Hospital, Cangzhou, Hebei, People’s Republic of China
| | - Yanjiang Yang
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
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Rössler J, Shah K, Medellin S, Turan A, Ruetzler K, Singh M, Sessler DI, Maheshwari K. Development and validation of delirium prediction models for noncardiac surgery patients. J Clin Anesth 2024; 93:111319. [PMID: 37984177 DOI: 10.1016/j.jclinane.2023.111319] [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: 09/04/2023] [Revised: 10/20/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023]
Abstract
STUDY OBJECTIVE Postoperative delirium is associated with morbidity and mortality, and its incidence varies widely. Using known predisposing and precipitating factors, we sought to develop postoperative delirium prediction models for noncardiac surgical patients. DESIGN Retrospective prediction model study. SETTING Major quaternary medical center. PATIENTS Our January 2016 to June 2020 training dataset included 51,677 patients of whom 2795 patients had delirium. Our July 2020 to January 2022 validation dataset included 14,438 patients of whom 912 patients had delirium. INTERVENTIONS None. MEASUREMENTS We trained and validated two static prediction models and one dynamic delirium prediction model. For the static models, we used random survival forests and traditional Cox proportional hazard models to predict postoperative delirium from preoperative variables, or from a combination of preoperative and intraoperative variables. We also used landmark modeling to dynamically predict postoperative delirium using preoperative, intraoperative, and postoperative variables before onset of delirium. MAIN RESULTS In the validation analyses, the static random forest model had a c-statistic of 0.81 (95% CI: 0.79, 0.82) and a Brier score of 0.04 with preoperative variables only, and a c-statistic of 0.86 (95% CI: 0.84, 0.87) and a Brier score of 0.04 when preoperative and intraoperative variables were combined. The corresponding Cox models had similar discrimination metrics with slightly better calibration. The dynamic model - using all available data, i.e., preoperative, intraoperative and postoperative data - had an overall c-index of 0.84 (95% CI: 0.83, 0.85). CONCLUSIONS Using preoperative and intraoperative variables, simple static models performed as well as a dynamic delirium prediction model that also included postoperative variables. Baseline predisposing factors thus appear to contribute far more to delirium after noncardiac surgery than intraoperative or postoperative variables. Improved postoperative data capture may help improve delirium prediction and should be evaluated in future studies.
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Affiliation(s)
- Julian Rössler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
| | - Karan Shah
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Cleveland Clinic, OH, USA
| | - Sara Medellin
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - Alparslan Turan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Kurt Ruetzler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Mriganka Singh
- Division of Geriatrics and Palliative Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Center on Innovation-Long Term Services and Supports, Providence Veterans Administration Medical Center, Providence, RI, USA
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - Kamal Maheshwari
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
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9
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Zhang L, Liu Y, Luo G, Chen C, Dou C, Du J, Xie H, Guan Y, Yang J, Ding Z, Huang Z, Chen Y, Hei Z, Zhang Z, Yao W. Upconversion-Mediated Optogenetics for the Treatment of Surgery-Induced Postoperative Neurocognitive Dysfunction. ACS NANO 2024; 18:11058-11069. [PMID: 38630984 DOI: 10.1021/acsnano.3c10829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Perioperative neurocognitive disorder (PND) is a common complication in surgical patients. While many interventions to prevent PND have been studied, the availability of treatment methods is limited. Thus, it is crucial to delve into the mechanisms of PND, pinpoint therapeutic targets, and develop effective treatment approaches. In this study, reduced dorsal tenia tecta (DTT) neuronal activity was found to be associated with tibial fracture surgery-induced PND, indicating that a neuronal excitation-inhibition (E-I) imbalance could contribute to PND. Optogenetics in the DTT brain region was conducted using upconversion nanoparticles (UCNPs) with the ability to convert 808 nm near-infrared light to visible wavelengths, which triggered the activation of excitatory neurons with minimal damage in the DTT brain region, thus improving cognitive impairment symptoms in the PND model. Moreover, this noninvasive intervention to modulate E-I imbalance showed a positive influence on mouse behavior in the Morris water maze test, which demonstrates that UCNP-mediated optogenetics is a promising tool for the treatment of neurological imbalance disorders.
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Affiliation(s)
- Linan Zhang
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou 510635, China
| | - Yilin Liu
- School of Materials Science and Engineering, Sun Yat-sen University, Guangzhou 510275, China
| | - Gangjian Luo
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou 510635, China
| | - Chaojin Chen
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou 510635, China
| | - Chaoxun Dou
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou 510635, China
| | - Jingyi Du
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou 510635, China
| | - Hanbin Xie
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou 510635, China
| | - Yu Guan
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou 510635, China
| | - Jing Yang
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou 510635, China
| | - Zhendong Ding
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou 510635, China
| | - Ziyan Huang
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou 510635, China
| | - Yongming Chen
- School of Materials Science and Engineering, Sun Yat-sen University, Guangzhou 510275, China
| | - Ziqing Hei
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou 510635, China
| | - Zhen Zhang
- School of Materials Science and Engineering, Sun Yat-sen University, Guangzhou 510275, China
| | - Weifeng Yao
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou 510635, China
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10
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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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11
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Yokoyama C, Yoshitnai K, Ogata S, Fukushima S, Matsuda H. Effect of postoperative delirium after cardiovascular surgery on 5-year mortality. JA Clin Rep 2023; 9:66. [PMID: 37831211 PMCID: PMC10575819 DOI: 10.1186/s40981-023-00658-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/20/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Postoperative delirium is a common complication after cardiovascular surgery. A meta-analysis revealed that postoperative delirium was associated with cognitive decline and dementia, which may affect long-term mortality. However, few studies have reported the association between postoperative delirium after cardiovascular surgery and long-term postoperative mortality. Therefore, we investigated the effect of postoperative delirium on 5-year survival rates of patients who underwent cardiovascular surgery. METHODS We retrospectively reviewed the records of patients who underwent cardiovascular surgery with cardiopulmonary bypass from January 2016 to December 2019. Postoperative delirium was defined as an Intensive Care Delirium Screening score ≥ 3, which might include subclinical delirium. Cox proportional hazards modeling was performed to assess the association between postoperative delirium and mortality. Postoperative mortality in patients with and without delirium was assessed using the Kaplan-Meier method and compared using the log-rank test. RESULTS Postoperative delirium was observed in 562 (31.9%) of 1731 patients. There were more elderly patients, more emergent surgery procedures, longer operative time, and larger transfusion volume in the postoperative delirium group. Cox regression analyses showed that delirium (hazard ratio (HR), 1.501; 95% confidence interval (CI), 1.053-2.140; p = 0.025) and emergent surgery (HR, 3.380; 95% CI, 2.231-5.122; p < 0.001) are significantly associated with 5-year mortality. Among patients who underwent elective surgery, postoperative delirium (HR, 1.987; 95% CI, 1.135-3.481; p = 0.016) is significantly associated with 5-year mortality. Kaplan-Meier survival analysis revealed that patients with postoperative delirium had significantly higher 5-year mortality. CONCLUSIONS Patients with postoperative delirium after cardiovascular surgery have significantly higher 5-year mortality.
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Affiliation(s)
- Chisaki Yokoyama
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, 6-1, Kishibeshinmachi, Suita, Osaka, Japan
| | - Kenji Yoshitnai
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, 6-1, Kishibeshinmachi, Suita, Osaka, Japan.
| | - Soshiro Ogata
- Department of, Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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12
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Amirfarzan H, Azocar RJ, Shapeton AD. "The Big Three" of geriatrics: A review of perioperative cognitive impairment, frailty and malnutrition. Saudi J Anaesth 2023; 17:509-516. [PMID: 37779565 PMCID: PMC10540988 DOI: 10.4103/sja.sja_532_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 10/03/2023] Open
Abstract
Cognitive impairment, frailty, and malnutrition are three of the most impactful pathologies facing an aging population, having dramatic effects on morbidity and mortality across nearly all facets of medical care and intervention. By 2050, the World Health Organization estimates that the population of individuals over the age of sixty worldwide will nearly double, and the public health toll of these demographic changes cannot be understated. With these changing demographics comes a need for a sharpened focus on the care and management of this vulnerable population. The average patient presenting for surgery is getting older, and this necessitates that clinicians understand the implications of these pathologies for both their immediate medical care needs and for appropriate procedural selection and prognostication of surgical outcomes. We believe it is incumbent on clinicians to consider the frailty, nutritional status, and cognitive function of each individual patient when offering a surgical intervention, as well as consider interventions that may delay the progression of these pathologies. Unfortunately, despite excellent evidence supporting things like routine pre-operative frailty screening and nutritional optimization, many interventions that would specifically benefit this population still have not been integrated into routine practice. In this review, we will synthesize the existing literature on these topics to provide a pragmatic approach and understanding for anesthesiologists and intensivists faced with this complex population.
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Affiliation(s)
- Houman Amirfarzan
- Department of Anesthesia, Critical Care and Pain Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Ruben J. Azocar
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alexander D. Shapeton
- Department of Anesthesia, Critical Care and Pain Medicine, Tufts University School of Medicine, Boston, MA, USA
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13
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Labaste F, Delort F, Ferré F, Bounes F, Reina N, Valet P, Dray C, Minville V. Postoperative delirium is a risk factor of institutionalization after hip fracture: an observational cohort study. Front Med (Lausanne) 2023; 10:1165734. [PMID: 37649978 PMCID: PMC10464946 DOI: 10.3389/fmed.2023.1165734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/10/2023] [Indexed: 09/01/2023] Open
Abstract
Introduction Hip fracture is a common clinical problem in geriatric patients often associated with poor postoperative outcomes. Postoperative delirium (POD) and postoperative neurocognitive disorders (NCDs) are particularly frequent. The consequences of these disorders on postoperative recovery and autonomy are not fully described. The aim of this study was to determine the role of POD and NCDs on the need for institutionalization at 3 months after hip fracture surgery. Method A population-based prospective cohort study was conducted on hip fracture patients between March 2016 and March 2018. The baseline interview, which included a Mini-Mental State Examination (MMSE), was conducted in the hospital after admission for hip fracture. NCDs were appreciated by MMSE scoring evolution (difference between preoperative MMSE and MMSE at day 5 >2 points). POD was evaluated using the Confusion Assessment Method. The primary endpoint was the rate of new institutionalization at 3 months. We used a multivariate analysis to assess the risk of new institutionalization. Results A total of 63 patients were included. Thirteen patients (20.6%) were newly institutionalized at 3 months. Two factors were significantly associated with the risk of postoperative institutionalization at 3 months: POD (OR = 5.23; 95% CI 1.1-27.04; p = 0.04) and IADL evolution (OR = 1.8; 95% CI 1.23-2.74; p = 0.003). Conclusion Only POD but not NCDs was associated with the risk of dependency and institutionalization after hip fracture surgery. The prevention of POD appears to be essential for improving patient outcomes and optimizing the potential for returning home.
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Affiliation(s)
- François Labaste
- Anesthesiology and Intensive Care Department CHU Toulouse, Toulouse, France
- Institut RESTORE UMR 1301-Inserm 5070-CNRS EFS Univ. P. Sabatier, Toulouse, France
| | - François Delort
- Anesthesiology and Intensive Care Department CHU Toulouse, Toulouse, France
| | - Fabrice Ferré
- Anesthesiology and Intensive Care Department CHU Toulouse, Toulouse, France
| | - Fanny Bounes
- Anesthesiology and Intensive Care Department CHU Toulouse, Toulouse, France
| | - Nicolas Reina
- Orthopedic Surgery Department, CHU Toulouse, Toulouse, France
| | - Philippe Valet
- Institut RESTORE UMR 1301-Inserm 5070-CNRS EFS Univ. P. Sabatier, Toulouse, France
| | - Cédric Dray
- Institut RESTORE UMR 1301-Inserm 5070-CNRS EFS Univ. P. Sabatier, Toulouse, France
| | - Vincent Minville
- Anesthesiology and Intensive Care Department CHU Toulouse, Toulouse, France
- Institut RESTORE UMR 1301-Inserm 5070-CNRS EFS Univ. P. Sabatier, Toulouse, France
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14
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Igwe EO, Nealon J, O'Shaughnessy P, Bowden A, Chang HCR, Ho MH, Montayre J, Montgomery A, Rolls K, Chou KR, Chen KH, Traynor V, Smerdely P. Incidence of postoperative delirium in older adults undergoing surgical procedures: A systematic literature review and meta-analysis. Worldviews Evid Based Nurs 2023. [PMID: 37128953 DOI: 10.1111/wvn.12649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/05/2023] [Accepted: 03/11/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND With the increase in life expectancy around the globe, the incidence of postoperative delirium (POD) among older people (≥65 years) is growing. Previous studies showed a wide variation in the incidence of POD, from 4% to 53%, with a lack of specific evidence about the incidence of POD by specific surgery type among older people. The aim of this systematic review and meta-analysis was to determine the incidence of POD by surgery type within populations 65 years and over. METHODS Databases including PubMed, Cochrane library, Embase, and CINAHL were searched until October 2020. Due to the relatively higher number of meta-analyses undertaken in this area of research, a streamlined systematic meta-analysis was proposed. RESULTS A total of 28 meta-analyses (comprising 284 individual studies) were reviewed. Data from relevant individual studies (n = 90) were extracted and included in the current study. Studies were grouped into eight surgery types and the incidence of POD for orthopedic, vascular, spinal, cardiac, colorectal, abdominal, urologic, and mixed surgeries was 20%, 14%, 13%, 32%, 14%, 30%, 10%, and 26%, respectively. POD detection instruments were different across the studies, with Confusion Assessment Method (CAM & CAM-ICU) being the most frequently adopted. LINKING EVIDENCE TO ACTION This study showed that POD incidence in older people undergoing surgery varied widely across surgery type. The more complex surgeries like cardiac and abdominal surgeries were associated with a higher risk of POD. This highlights the need to include the level of surgery complexity as a risk factor in preoperative assessments.
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Affiliation(s)
- Ezinne Oyidia Igwe
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, New South Wales, Australia
| | - Jessica Nealon
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, New South Wales, Australia
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Pauline O'Shaughnessy
- School of Mathematics and Applied Statistics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Alera Bowden
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, New South Wales, Australia
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Hui-Chen Rita Chang
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, New South Wales, Australia
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Mu-Hsing Ho
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Jed Montayre
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR
| | - Amy Montgomery
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, New South Wales, Australia
| | - Kaye Rolls
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Kee-Hsin Chen
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Evidence-based Knowledge Translation Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Victoria Traynor
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, New South Wales, Australia
| | - Peter Smerdely
- School of Population Health, UNSW Medicine, Sydney, New South Wales, Australia
- St George Hospital, Kogarah, New South Wales, Australia
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15
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Kappen PR, Kappen HJ, Dirven CMF, Klimek M, Jeekel J, Andrinopoulou ER, Osse RJ, Vincent AJPE. Postoperative Delirium After Intracranial Surgery: A Retrospective Cohort Study. World Neurosurg 2023; 172:e212-e219. [PMID: 36608800 DOI: 10.1016/j.wneu.2022.12.132] [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: 08/10/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The clinical relevance of postoperative delirium (POD) in neurosurgery remains unclear and should be investigated because these patients are vulnerable. Hence, we investigated the impact of POD, by means of incidence and health outcomes, and identified independent risk factors. METHODS Adult patients undergoing an intracranial surgical procedure in the Erasmus Medical Center Rotterdam between June 2017 and September 2020 were retrospectively included. POD incidence, defined by a Delirium Observation Screening Scale (DOSS) ≥3 or antipsychotic treatment for delirium within 5 days after surgery, was calculated. Logistic regression analysis on the full data set was conducted for the multivariable risk factor and health outcome analyses. RESULTS After including 2901 intracranial surgical procedures, POD was present in 19.4% with a mean onset in days of 2.62 (standard deviation, 1.22) and associated with more intensive care unit admissions and more discharge toward residential care. Onset of POD was not associated with increased length of hospitalization or mortality. We identified several independent nonmodifiable risk factors such as age, preexisting memory problems, emergency operations, craniotomy compared with burr-hole surgery, and severe blood loss. Moreover, we identified modifiable risk factors such as low preoperative potassium and opioid and dexamethasone administration. CONCLUSIONS Our POD incidence rates and correlation with more intensive care unit admission and discharge toward residential care suggest a significant impact of POD on neurosurgical patients. We identified several modifiable and nonmodifiable risk factors, which shed light on the pathophysiologic mechanisms of POD in this cohort and could be targeted for future intervention studies.
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Affiliation(s)
- Pablo R Kappen
- Department of Neurosurgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Hilbert J Kappen
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Clemens M F Dirven
- Department of Neurosurgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Markus Klimek
- Department of Anesthesiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Johannes Jeekel
- Department of Neuroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Elrozy R Andrinopoulou
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Robert J Osse
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Arnaud J P E Vincent
- Department of Neurosurgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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16
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Rengel KF, Boncyk CS, DiNizo D, Hughes CG. Perioperative Neurocognitive Disorders in Adults Requiring Cardiac Surgery: Screening, Prevention, and Management. Semin Cardiothorac Vasc Anesth 2023; 27:25-41. [PMID: 36137773 DOI: 10.1177/10892532221127812] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neurocognitive changes are the most common complication after cardiac surgery, ranging from acute postoperative delirium to prolonged postoperative neurocognitive disorder. Changes in cognition are distressing to patients and families and associated with worse outcomes overall. This review outlines definitions and diagnostic criteria, risk factors for, and mechanisms of Perioperative Neurocognitive Disorders and offers strategies for preoperative screening and perioperative prevention and management of neurocognitive complications.
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Affiliation(s)
- Kimberly F Rengel
- Division of Anesthesia Critical Care Medicine, Department of Anesthesiology, 12328Vanderbilt University Medical Center, Nashville, TN, USA.,Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center and the Center for Health Services Research, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christina S Boncyk
- Division of Anesthesia Critical Care Medicine, Department of Anesthesiology, 12328Vanderbilt University Medical Center, Nashville, TN, USA.,Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center and the Center for Health Services Research, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Daniella DiNizo
- Scope Anesthesia of North Carolina, Charlotte, NC, USA.,Pulmonary and Critical Care Consultants, Carolinas Medical Center, 2351Atrium Health, Charlotte, NC, USA
| | - Christopher G Hughes
- Division of Anesthesia Critical Care Medicine, Department of Anesthesiology, 12328Vanderbilt University Medical Center, Nashville, TN, USA.,Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center and the Center for Health Services Research, 12328Vanderbilt University Medical Center, Nashville, TN, USA.,Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA
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17
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Horacek J, Janda R, Görnerova N, Jajcay L, Andrashko V. Several reasons why ketamine as a neuroplastic agent may have failed to prevent postoperative delirium: Implications for future protocols. Neurosci Lett 2023; 798:137095. [PMID: 36693556 DOI: 10.1016/j.neulet.2023.137095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 12/14/2021] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
Ketamine exerts anti-inflammatory, neuroprotective and neuroplastic activity, therefore it may counteract the neurotoxic processes underlying postoperative delirium. However, the majority of studies in this field failed. We identified several pharmacological reasons why these studies may have failed, together with suggestions of how to remediate them. Among them, the interaction with intravenous general anesthetics exerting the opposite effect on GABA interneurons than ketamine may be of principal importance. We suggest biomarkers which may elucidate the influence of this interaction on the different steps of neuroplastic pathways. We hypothesize that administering ketamine before or after general anesthesia could both prevent the interactions and strengthen the effect of ketamine by timing surgery within the climax of ketamine-induced neuroplastic changes or by stabilizing AMPA receptors. It is vital to deal with these questions because the protocols of ongoing studies are based again on the administration of ketamine during general anesthesia (the major identified pitfall).
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Affiliation(s)
- Jiri Horacek
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Robert Janda
- Intensive Care Unit, Karlovy Vary Regional Hospital, K. Vary, Czech Republic
| | - Natalie Görnerova
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lucia Jajcay
- National Institute of Mental Health, Klecany, Czech Republic; Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Veronika Andrashko
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic
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18
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López-Martín N, Escalera-Alonso J, Thuissard-Vasallo IJ, Andreu-Vázquez C, Bielza-Galindo R. [Result of the update of the clinical pathway for hip fracture in the elderly at a university hospital in Madrid]. Rev Esp Geriatr Gerontol 2023; 58:61-67. [PMID: 36804952 DOI: 10.1016/j.regg.2023.01.004] [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: 10/17/2022] [Revised: 12/13/2022] [Accepted: 01/18/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Orthogeriatric management with clinical pathways (CP) in hip fracture (HF) has been shown to be superior to other models. We studied whether updating the CP, through prioritization of admission and surgery, improvement in the prevention and treatment of delirium, management of anticoagulants and antiplatelet agents and the use of perioperative peripheral nerve block, modifies surgical delay, stay, readmissions, mortality, suffering delirium and functional status at discharge. MATERIAL AND METHOD A retrospective observational study of unicenter cohorts of 468 patients with HF, 220 from 2016 (old VC) and 248 from 2019 (new VC). The variables are: intervention in the first 48hours, surgical delay (hours), stay (days), stay less than 15 days, delirium, functional loss at discharge (Barthel prefracture scale less Barthel scale at discharge), readmission at one month, and mortality at admission, month and year. RESULTS Median age: 87.0 [interquartile range 8.0], mostly women (76.7%). Significantly, with the new VC, there was a greater number of patients operated on in the first 48hours (27,7% vs 36,8% p=0.036), less surgical delay (72.5 [47,5-110,5] vs 64.0 [42,0-88,0] p<0.001), shorter stay (10,0 [7,0-13,0] vs 8,0 [6,0-11,0] p<0.001), greater number of discharges in 15 days (78,2% vs 91,5% p<0.001), lower delirium (54,1% vs 43,5% p=0.023). No significant changes in readmissions, functional loss at discharge, mortality at admission, 3 months or year. CONCLUSIONS Updating the VC brings benefits to the patient (less surgical delay, equal functional status at discharge with fewer days of admission) and benefits in management (lower admission) without modifying mortality.
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Affiliation(s)
- Néstor López-Martín
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España.
| | - Javier Escalera-Alonso
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - Israel John Thuissard-Vasallo
- Facultad de Ciencias Biomédicas y de la Salud, Departamento de Medicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Cristina Andreu-Vázquez
- Facultad de Ciencias Biomédicas y de la Salud, Departamento de Medicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Rafael Bielza-Galindo
- Sección de Geriatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
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19
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Abraham J, Bartek B, Meng A, Ryan King C, Xue B, Lu C, Avidan MS. Integrating machine learning predictions for perioperative risk management: Towards an empirical design of a flexible-standardized risk assessment tool. J Biomed Inform 2023; 137:104270. [PMID: 36516944 DOI: 10.1016/j.jbi.2022.104270] [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: 07/13/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Surgical patients are complex, vulnerable, and prone to postoperative complications that can potentially be mitigated with quality perioperative risk assessment and management. Several institutions have incorporated machine learning (ML) into their patient care to improve awareness and support clinician decision-making along the perioperative spectrum. Recent research suggests that ML risk prediction can support perioperative patient risk monitoring and management across several situations, including the operating room (OR) to intensive care unit (ICU) handoffs. OBJECTIVES Our study objectives were threefold: (1) evaluate whether ML-generated postoperative predictions are concordant with clinician-generated risk rankings for acute kidney injury, delirium, pneumonia, deep vein thrombosis, and pulmonary embolism, and establish their associated risk factors; (2) ascertain clinician end-user suggestions to improve adoption of ML-generated risks and their integration into the perioperative workflow; and (3) develop a user-friendly visualization format for a tool to display ML-generated risks and risk factors to support postoperative care planning, for example, within the context of OR-ICU handoffs. METHODS Graphical user interfaces for postoperative risk prediction models were assessed for end-user usability through cognitive walkthroughs and interviews with anesthesiologists, surgeons, certified registered nurse anesthetists, registered nurses, and critical care physicians. Thematic analysis relying on an explanation design framework was used to identify feedback and suggestions for improvement. RESULTS 17 clinicians participated in the evaluation. ML estimates of complication risks aligned with clinicians' independent rankings, and related displays were perceived as valuable for decision-making and care planning for postoperative care. During OR-ICU handoffs, the tool could speed up report preparation and remind clinicians to address patient-specific complications, thus providing more tailored care information. Suggestions for improvement centered on electronic tool delivery; methods to build trust in ML models; modifiable risks and risk mitigation strategies; and additional patient information based on individual preferences (e.g., surgical procedure). CONCLUSIONS ML estimates of postoperative complication risks can provide anticipatory guidance, potentially increasing the efficiency of care planning. We have offered an ML visualization framework for designing future ML-augmented tools and anticipate the development of tools that recommend specific actions to the user based on ML model output.
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Affiliation(s)
- Joanna Abraham
- Institute for Informatics, School of Medicine, Washington University in St Louis, MO, United States; Department of Anesthesiology, School of Medicine, Washington University in St Louis, MO, United States.
| | - Brian Bartek
- Institute for Informatics, School of Medicine, Washington University in St Louis, MO, United States
| | - Alicia Meng
- Department of Anesthesiology, School of Medicine, Washington University in St Louis, MO, United States
| | - Christopher Ryan King
- Department of Anesthesiology, School of Medicine, Washington University in St Louis, MO, United States
| | - Bing Xue
- Department of Electrical & Systems Engineering, McKelvey School of Engineering, Washington University in St Louis, MO, United States
| | - Chenyang Lu
- Department of Computer Science & Engineering, McKelvey School of Engineering, Washington University in St Louis, MO, United States
| | - Michael S Avidan
- Department of Anesthesiology, School of Medicine, Washington University in St Louis, MO, United States
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20
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Tachibana M, Inada T. Poor prognostic impact of delirium: especially on mortality and institutionalisation. Psychogeriatrics 2023; 23:187-195. [PMID: 36416212 DOI: 10.1111/psyg.12914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/19/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022]
Abstract
The course of delirium is associated with increased hospital costs, healthcare complications, increased mortality, and long-term poor outcomes. Despite delirium being long recognised as one of the most important prognostic components of patients with illnesses, delirium remains poorly understood, effective management options are limited, and no effective treatment has yet been established. This review evaluated the effects of delirium on mortality, institutionalisation, and dementia in various situations to clarify its prognostic seriousness to elucidate important areas for clinical practice and future research. The effect of delirium on mortality in COVID-19 patients was similar to that in other diseases. The effect of delirium on mortality in patients with delirium between the ages of 18 and 65 may be higher than in those with delirium aged over 65, but studies are scarce. Promoting recognition of delirium at all ages is needed. With careful attention to the specific factors in younger patients that contribute to delirium, healthcare providers may be able to decrease the poor impact of delirium on clinical outcomes. Evaluation of the association between interventions for delirium such as sedation in present clinical practice and the prognosis of delirium is lacking, and further clinical studies are essential.
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Affiliation(s)
- Masako Tachibana
- Department of Psychiatry, Nagoya University Hospital, Nagoya-shi, Japan.,Department of Psychiatry, Nagoya Ekisaikai Hospital, Nagoya-shi, Japan
| | - Toshiya Inada
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya-shi, Japan
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21
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Heymann A, Susewind M, Schneider NM, Liederwald L, Spies CD, Pohrt A, Mueller A. Routine Perioperative Assessment of Risk Factors Regarding Development of Postoperative Delirium During Elective Bariatric Surgery. Bariatr Surg Pract Patient Care 2022. [DOI: 10.1089/bari.2022.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Anja Heymann
- Department of Anaesthesiology and Intensive Care Medicine, Evangelisches Krankenhaus Hubertus, Lehrkrankenhaus der Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Susewind
- Department of Bariatric Surgery, Klinik für Minimal Invasive Chirurgie (MIC) Berlin, Germany
| | - Nathalie M. Schneider
- Department of Anaesthesiology and Intensive Care Medicine, Evangelisches Krankenhaus Hubertus, Lehrkrankenhaus der Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Leonie Liederwald
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité– Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Claudia D. Spies
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité– Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anne Pohrt
- Institute of Biometry and Clinical Epidemiology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anika Mueller
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité– Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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22
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Zhao J, Liang G, Hong K, Pan J, Luo M, Liu J, Huang B. Risk factors for postoperative delirium following total hip or knee arthroplasty: A meta-analysis. Front Psychol 2022; 13:993136. [PMID: 36248575 PMCID: PMC9565976 DOI: 10.3389/fpsyg.2022.993136] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesThe purpose of this study was to identify risk factors for delirium after total joint arthroplasty (TJA) and provide theoretical guidance for reducing the incidence of delirium after TJA.MethodsThe protocol for this meta-analysis is registered with PROSPERO (CRD42020170031). We searched PubMed, the Cochrane Library and Embase for observational studies on risk factors for delirium after TJA. Review Manager 5.3 was used to calculate the relative risk (RR) or standard mean difference (SMD) of potential risk factors related to TJA. STATA 14.0 was used for quantitative publication bias evaluation.ResultsIn total, 25 studies including 3,767,761 patients from 9 countries were included. Old age has been widely recognized as a risk factor for delirium. Our results showed that the main risk factors for delirium after TJA were patient factors (alcohol abuse: RR = 1.63; length of education: SMD = −0.93; and MMSE score: SMD = −0.39), comorbidities (hypertension: RR = 1.26; diabetes mellitus: RR = 1.67; myocardial infarction: RR = 17.75; congestive heart failure: RR = 2.54; dementia: RR = 17.75; renal disease: RR = 2.98; history of stroke: RR = 4.83; and history of mental illness: RR = 2.36), surgical factors (transfusion: RR = 1.53; general anesthesia: RR = 1.10; pre-operative albumin: SMD = −0.38; pre-operative hemoglobin: SMD = −0.29; post-operative hemoglobin: SMD = −0.24; total blood loss: SMD = 0.15; duration of surgery: SMD = 0.29; and duration of hospitalization: SMD = 2.00) and drug factors (benzodiazepine use: RR = 2.14; ACEI use: RR = 1.52; and beta-blocker use: RR = 1.62).ConclusionsMultiple risk factors were associated with delirium after TJA. These results may help doctors predict the occurrence of delirium after surgery and determine the correct treatment.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42020170031.
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Affiliation(s)
- Jinlong Zhao
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Guihong Liang
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Kunhao Hong
- Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China
| | - Jianke Pan
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Minghui Luo
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun Liu
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Jun Liu
| | - Bin Huang
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Bin Huang
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23
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Bowman EML, Cardwell C, McAuley DF, McGuinness B, Passmore AP, Beverland D, Zetterberg H, Schott JM, Cunningham EL. Factors influencing resilience to postoperative delirium in adults undergoing elective orthopaedic surgery. Br J Surg 2022; 109:908-911. [PMID: 35707934 PMCID: PMC10364747 DOI: 10.1093/bjs/znac197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/15/2022] [Accepted: 05/13/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Emily M L Bowman
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Belfast, UK
| | - Christopher Cardwell
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Belfast, UK
| | - Daniel F McAuley
- Centre for Experimental Medicine, Queen's University Belfast, Wellcome-Wolfson Institute for Experimental Medicine, Belfast, UK
| | - Bernadette McGuinness
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Belfast, UK
| | - Anthony P Passmore
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Belfast, UK
| | - David Beverland
- Outcomes Assessment Unit, Musgrave Park Hospital, Belfast Trust, Belfast, UK
| | - Henrik Zetterberg
- UK Dementia Research Institute at UCL, London, UK.,Department of Neurodegenerative Disease, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Jonathan M Schott
- Dementia Research Centre, Department of Neurodegenerative Disease, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
| | - Emma L Cunningham
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Belfast, UK
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24
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Rajeev A, Railton C, Devalia K. The crucial factors influencing the development and outcomes of postoperative delirium in proximal femur fractures. Aging Med (Milton) 2022; 5:94-100. [PMID: 35783117 PMCID: PMC9245175 DOI: 10.1002/agm2.12206] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 01/09/2023] Open
Abstract
Objective The aim of this study is to find the incidence, risks, and reasons for prolonged length of hospital stay, short, long-term mortality, and the factors contributing to mortality of postoperative delirium in proximal femoral fractures. Methods The data for the study was obtained from National Hip Fracture Database (NHFD) and internal hospital computer systems (Medway, ICE, Clinic letters) between January 2018 and December 2019. One hundred seventy-five patients were found have developed postoperative delirium. The outcomes measured were postoperative anemia, lower respiratory tract infection, urinary tract infection, acute kidney injury, urinary retention, cardiac event and stroke, alcohol or drug withdrawal, length of hospital stay, and 30 day and 1 year mortality. Results The patients who developed delirium were 68 (38.9%) with American Society of Anesthesiologists (ASA) grade 4 and 94 (22.3%) without delirium (p < 0.05). The average length of stay after developing postoperative delirium was 19.69 days compared to 17.4 days for patients without delirium. The mortality at 30 days and 1 year was 10.9% and 37% in patients who had postoperative delirium compared to 2.1% and 2.8% to those without delirium, respectively. Conclusion Postoperative delirium is three times more common in hip fractures. Early detection and timely management are crucial in the improvement of functional outcomes and mortality.
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Affiliation(s)
- Aysha Rajeev
- Department of Trauma and OrthopaedicsGateshead Health Foundation NHS TrustTyne and WearUK
| | - Catherine Railton
- Department of Trauma and OrthopaedicsGateshead Health Foundation NHS TrustTyne and WearUK
| | - Kailash Devalia
- Department of Trauma and OrthopaedicsGateshead Health Foundation NHS TrustTyne and WearUK
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25
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Kong H, Xu LM, Wang DX. Perioperative neurocognitive disorders: A narrative review focusing on diagnosis, prevention, and treatment. CNS Neurosci Ther 2022; 28:1147-1167. [PMID: 35652170 PMCID: PMC9253756 DOI: 10.1111/cns.13873] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 12/13/2022] Open
Abstract
Perioperative neurocognitive disorders (NCDs) refer to neurocognitive abnormalities detected during the perioperative periods, including preexisting cognitive impairment, preoperative delirium, delirium occurring up to 7 days after surgery, delayed neurocognitive recovery, and postoperative NCD. The Diagnostic and Statistical Manual of Mental Disorders‐5th edition (DSM‐5) is the golden standard for diagnosing perioperative NCDs. Given the impracticality of using the DSM‐5 by non‐psychiatric practitioners, many diagnostic tools have been developed and validated for different clinical scenarios. The etiology of perioperative NCDs is multifactorial and includes predisposing and precipitating factors. Identifying these risk factors is conducive to preoperative risk stratification and perioperative risk reduction. Prevention for perioperative NCDs should include avoiding possible contributors and implementing nonpharmacologic and pharmacological interventions. The former generally includes avoiding benzodiazepines, anticholinergics, prolonged liquid fasting, deep anesthesia, cerebral oxygen desaturation, and intraoperative hypothermia. Nonpharmacologic measures include preoperative cognitive prehabilitation, comprehensive geriatric assessment, implementing fast‐track surgery, combined use of regional block, and sleep promotion. Pharmacological measures including dexmedetomidine, nonsteroidal anti‐inflammatory drugs, and acetaminophen are found to have beneficial effects. Nonpharmacological treatments are the first‐line measures for established perioperative NCDs. Pharmacological treatments are still limited to severely agitated or distressed patients.
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Affiliation(s)
- Hao Kong
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Long-Ming Xu
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Dong-Xin Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China.,Outcomes Research Consortium, Cleveland, Ohio, USA
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26
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Kinchin I, Edwards L, Hosie A, Agar M, Mitchell E, Trepel D. Cost-effectiveness of clinical interventions for delirium: A systematic literature review of economic evaluations. Acta Psychiatr Scand 2022; 147:430-459. [PMID: 35596552 DOI: 10.1111/acps.13457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Little is known about the economic value of clinical interventions for delirium. This review aims to synthesise and appraise available economic evidence, including resource use, costs, and cost-effectiveness of interventions for reducing, preventing, and treating delirium. METHODS Systematic review of published and grey literature on full and partial economic evaluations. Study quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). RESULTS Fourteen economic evaluations (43% full, 57% partial) across nine multicomponent and nonpharmacological intervention types met inclusion criteria. The intervention costs ranged between US$386 and $553 per person in inpatient settings. Multicomponent delirium prevention intervention and the Hospital Elder Life Program (HELP) reported statistically significant cost savings or cost offsets somewhere else in the health system. Cost savings related to inpatient, outpatient, and out-of-pocket costs ranged between $194 and $6022 per person. The average CHEERS score was 74% (±SD 10%). CONCLUSION Evidence on a joint distribution of costs and outcomes of delirium interventions was limited, varied and of generally low quality. Directed expansion of health economics towards the evaluation of delirium care is necessary to ensure effective implementation that meets patients' needs and is cost-effective in achieving similar or better outcomes for the same or lower cost.
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Affiliation(s)
- Irina Kinchin
- Centre for Health Policy and Management, Trinity College Dublin, the University of Dublin, Dublin, Ireland.,Global Brain Health Institute, Trinity College Dublin, the University of Dublin, Dublin, Ireland.,Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT) Centre, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Layla Edwards
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT) Centre, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Annmarie Hosie
- School of Nursing Sydney, The University of Notre Dame Australia, Darlinghurst, NSW, Australia.,St Vincent's Health Network Sydney, Darlinghurst, NSW, Australia
| | - Meera Agar
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT) Centre, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Eileen Mitchell
- Global Brain Health Institute, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Dominic Trepel
- Global Brain Health Institute, Trinity College Dublin, the University of Dublin, Dublin, Ireland
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27
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Villa G, Foti L, Piazzini T, Russo G, Verrengia M, Sangermano C, Bilotta F, Romagnoli S. Clinical literature on postoperative delirium and neurocognitive disorders: a historical systematic review. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2022; 2:11. [PMID: 37386546 DOI: 10.1186/s44158-022-00039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/15/2022] [Indexed: 07/01/2023]
Abstract
BACKGROUND Since the appearance of the first report on postoperative cognitive impairment in 1955, the number of papers focusing on perioperative neurocognitive disorders (PND) has constantly increased, both in the field of basic science and clinical research. A critical comprehensive review may explore the perception of how noteworthy PND is for physicians and clinical researchers. The aim of this systematic review is to describe how the clinical papers published to date with PND as primary or secondary outcome have changed over time in terms of editorial characteristics. RESULTS A literature search was performed on PubMed, Embase, CINAHL, Cochrane, Scopus, and Web of Science databases, up to March 2021. Human prospective or retrospective clinical studies in which incidence, risk factors, treatments, or outcomes associated with PND are described among primary or secondary outcomes were included. A total of 2109 articles were considered. CONCLUSIONS The bibliometric analysis suggests a stable increase in attention towards PND, particularly in general surgery adult-elderly patients, and underlines the importance for the clinicians not to underestimate this specific field.
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Affiliation(s)
- Gianluca Villa
- Department of Health Science Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy.
| | - Lorenzo Foti
- Department of Health Science Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy
- Department of Anesthesiology and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Tessa Piazzini
- Department of Health Science Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy
- Department of Anesthesiology and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Gaetano Russo
- Department of Anesthesiology and Intensive Care Medicine, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Marin Verrengia
- Department of Anesthesiology and Intensive Care Medicine, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Corinne Sangermano
- Department of Anesthesiology and Intensive Care Medicine, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Federico Bilotta
- Department of Anesthesiology and Intensive Care Medicine, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Stefano Romagnoli
- Department of Health Science Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy
- Department of Anesthesiology and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Yoshida K, Murakawa M, Hosono A. Effects of anesthetics on expression of dopamine and acetylcholine receptors in the rat brain in vivo. J Anesth 2022; 36:436-440. [PMID: 35137267 DOI: 10.1007/s00540-022-03046-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 01/30/2022] [Indexed: 11/26/2022]
Abstract
Dopamine D2 and acetylcholine M1 receptors might be related to post-operative cognitive dysfunction. The aim of the present study is to investigate whether several anesthetics which are used for general anesthesia and/or sedation, affect expression of dopamine D2 and acetylcholine M1 receptors in the rat brain. Thirty-six male rats aged 5-9 weeks old were divided into six groups (n = 6 in each group); five groups for anesthetics and one for control. The five groups were anesthetized with either dexmedetomidine 0.4 µg/kg/min, propofol 50 mg/kg/h, midazolam 25 mg/kg/h, sevoflurane 3.3%, or nitrous oxide 75% for 4 h. Then, the rats were decapitated, and the cerebral cortex, hippocampus, corpus striatum, brain stem, and cerebellum were collected from all rats. Then, real-time polymerase chain reaction was performed to examine the expression of Drd2 (cord dopamine D2 receptor) and Chrm1 (cord acetylcholine M1 receptor). There were no significant differences among the groups regarding Drd2 and Chrm1 mRNA expression of each region of the brain. Postsynaptic changes of dopamine D2 and acetylcholine M1 receptors due to administration of dexmedetomidine, propofol, midazolam, sevoflurane, and nitrous oxide are unlikely to occur at the doses of each anesthetic used in the present study.
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Affiliation(s)
- Keisuke Yoshida
- Department of Anesthesiology, Fukushima Medical University School of Medicine, 1, Hikariga-oka, Fukushima, 960-1297, Japan.
| | - Masahiro Murakawa
- Department of Anesthesiology, Fukushima Medical University School of Medicine, 1, Hikariga-oka, Fukushima, 960-1297, Japan
| | - Atsuyuki Hosono
- Department of Anesthesiology, Fukushima Medical University School of Medicine, 1, Hikariga-oka, Fukushima, 960-1297, Japan
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Delirium and geriatric syndromes in hospitalized older patients: Results from World Delirium Awareness Day. MARMARA MEDICAL JOURNAL 2022. [DOI: 10.5472/marumj.1059577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hulde N, Zittermann A, Tigges-Limmer K, Koster A, Weinrautner N, Gummert J, von Dossow V. Preoperative Risk Factors and Early Outcomes of Delirium in Valvular Open-Heart Surgery. Thorac Cardiovasc Surg 2022; 70:558-565. [PMID: 35042244 DOI: 10.1055/s-0041-1740984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Compared with coronary artery bypass grafting surgery, data regarding postoperative delirium are scant in valvular open-heart surgery. Therefore, the goal of this retrospective study was to investigate the incidence, preoperative risk factors, and early outcomes of delirium in a large group of patients undergoing valvular open-heart surgery. METHODS In 13,229 patients with isolated valvular or combined valvular and bypass surgery, the incidence of postoperative delirium was assessed until discharge. Independent risk factors of delirium were evaluated by multivariable logistic regression analysis. Moreover, we assessed the multivariable-adjusted risk of prolonged intensive care unit (ICU) stay (>48 hours) and in-hospital mortality in patients with delirium. RESULTS Overall, the incidence of postoperative delirium was 8.4%. The incidence in patients experiencing a postoperative stroke or seizure was 23.1 and 29.7%, respectively. Twelve preoperative risk factors, mostly nonmodifiable, were independently associated with the risk of delirium, including advanced age, renal impairment, stroke, the need for emergency surgery, and severe preoperative anemia (hemoglobin < 9 g/dL). Postoperative delirium was associated with an adjusted odds ratio (OR) of prolonged ICU stay of 9.48 (95% confidence interval [CI]: 7.96-11.30). Adjusted in-hospital mortality was, however, significantly lower in patients with delirium versus patients without delirium (OR, 0.56; 95% CI: 0.38-0.83). CONCLUSION In valvular open-heart surgery, postoperative delirium is a frequent neurological complication that is associated with other postoperative neurological complications and several, mostly nonmodifiable, preoperative risk factors. Although postoperative delirium was associated with a significantly increased risk of prolonged ICU stay, this did not translate into an increased short-term mortality.
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Affiliation(s)
- Nikolai Hulde
- Institute of Anesthesiology and Pain Therapy, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Katharina Tigges-Limmer
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Andreas Koster
- Institute of Anesthesiology and Pain Therapy, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Nicole Weinrautner
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Jan Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Vera von Dossow
- Institute of Anesthesiology and Pain Therapy, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
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31
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Yamanashi T, Nagao T, Wahba NE, Marra PS, Crutchley KJ, Meyer AA, Andreasen AJ, Hellman MM, Jellison SS, Hughes CG, Pandharipande PP, Howard, III MA, Kawasaki H, Iwata M, Hefti MM, Shinozaki G. DNA methylation in the inflammatory genes after neurosurgery and diagnostic ability of post-operative delirium. Transl Psychiatry 2021; 11:627. [PMID: 34887385 PMCID: PMC8660911 DOI: 10.1038/s41398-021-01752-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/18/2021] [Accepted: 11/29/2021] [Indexed: 11/09/2022] Open
Abstract
The pathophysiological mechanisms of postoperative delirium (POD) are still not clear, and no reliable biomarker is available to differentiate those with and without POD. Pre- and post-surgery blood from epilepsy subjects undergoing neurosurgery were collected. DNA methylation (DNAm) levels of the TNF gene, IL1B gene, and IL6 gene by the Illumina EPIC array method, and DNAm levels of the TNF gene by pyrosequencing, were analyzed. Blood from 37 subjects were analyzed by the EPIC array method, and blood from 27 subjects were analyzed by pyrosequencing. Several CpGs in the TNF gene in preoperative blood showed a negative correlation between their DNAm and age both in the POD group and in the non-POD group. However, these negative correlations were observed only in the POD group after neurosurgery. Neurosurgery significantly altered DNAm levels at 17 out of 24 CpG sites on the TNF gene, 8 out of 14 CpG sites on the IL1B gene, and 4 out of 14 CpG sites on the IL6 gene. Furthermore, it was found that the Inflammatory Methylation Index (IMI), which was based on the post-surgery DNAm levels at the selected five CpG sites, can be a potential detection tool for delirium with moderate accuracy; area under the curve (AUC) value was 0.84. The moderate accuracy of this IMI was replicated using another cohort from our previous study, in which the AUC was 0.79. Our findings provide further evidence of the potential role of epigenetics and inflammation in the pathophysiology of delirium.
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Affiliation(s)
- Takehiko Yamanashi
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, USA. .,University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, USA. .,Tottori University Faculty of Medicine, Department of Neuropsychiatry, Yonago-shi, Tottori, Japan.
| | - Takaaki Nagao
- grid.214572.70000 0004 1936 8294University of Iowa Carver College of Medicine, Department of Neurosurgery, Iowa City, IA USA ,grid.265050.40000 0000 9290 9879Toho University School of Medicine Faculty of Medicine, Department of Neurosurgery (Sakura), Sakura-shi, Chiba Japan
| | - Nadia E. Wahba
- grid.214572.70000 0004 1936 8294University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA USA
| | - Pedro S. Marra
- grid.214572.70000 0004 1936 8294University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA USA
| | - Kaitlyn J. Crutchley
- grid.214572.70000 0004 1936 8294University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA USA
| | - Alissa A. Meyer
- grid.214572.70000 0004 1936 8294University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA USA
| | - Ally J. Andreasen
- grid.214572.70000 0004 1936 8294University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA USA
| | - Mandy M. Hellman
- grid.214572.70000 0004 1936 8294University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA USA
| | - Sydney S. Jellison
- grid.214572.70000 0004 1936 8294University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA USA
| | - Christopher G. Hughes
- grid.412807.80000 0004 1936 9916Vanderbilt University Medical Center, Department of anesthesiology, Nashville, TN USA
| | - Pratik P. Pandharipande
- grid.412807.80000 0004 1936 9916Vanderbilt University Medical Center, Department of anesthesiology, Nashville, TN USA
| | - Matthew A. Howard, III
- grid.214572.70000 0004 1936 8294University of Iowa Carver College of Medicine, Department of Neurosurgery, Iowa City, IA USA
| | - Hiroto Kawasaki
- grid.214572.70000 0004 1936 8294University of Iowa Carver College of Medicine, Department of Neurosurgery, Iowa City, IA USA
| | - Masaaki Iwata
- grid.265107.70000 0001 0663 5064Tottori University Faculty of Medicine, Department of Neuropsychiatry, Yonago-shi, Tottori Japan
| | - Marco M. Hefti
- grid.214572.70000 0004 1936 8294University of Iowa Carver College of Medicine, Department of Pathology, Iowa City, IA USA
| | - Gen Shinozaki
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, USA. .,University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, USA.
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Lee H, Kim J, Lee KY, Gan TJ, Lekprasert V, Laosuwan P, Chew STH, Seet E, Lim V, Ti LK. Awareness and Perspectives among Asian Anesthesiologists on Postoperative Delirium: A Multinational Survey. J Clin Med 2021; 10:jcm10245769. [PMID: 34945064 PMCID: PMC8703815 DOI: 10.3390/jcm10245769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/04/2021] [Accepted: 12/08/2021] [Indexed: 11/16/2022] Open
Abstract
Postoperative delirium (POD) is a common perioperative complication. Although POD is preventable in up to 40% of patients, it is frequently overlooked. The objective of the survey is to determine the level of knowledge and clinical practices related to POD among anesthesiologists in different Asian countries. A questionnaire of 22 questions was designed by members of the Asian focus group for the study of POD, and it was sent to anesthesiologists in Singapore, Thailand, and South Korea from 1 April 2019 through 17 September 2019. In total, 531 anesthesiologists (Singapore: 224, Thailand: 124, Korea: 183) responded to the survey. Half the respondents estimated the incidence of POD to be 11–30% and believed that it typically occurs in the first 48 h after surgery. Among eight important postoperative complications, POD was ranked fifth. While 51.4% did not perform any test for POD, only 13.7% monitored the depth of anesthesia in all their patients. However, 83.8% preferred depth of anesthesia monitoring if they underwent surgery themselves. The results suggest that Asian anesthesiologists underestimate the incidence and relevance of POD. Because it increases perioperative mortality and morbidity, there is an urgent need to educate anesthesiologists regarding the recognition, prevention, detection, and management of POD.
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Affiliation(s)
- Hyungmook Lee
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Jeongmin Kim
- Department of Anaesthesiology and Pain Medicine, Anaesthesia and Pain Research Institute, College of Medicine, Yonsei University, Seoul 03722, Korea;
| | - Ki-Young Lee
- Department of Anaesthesiology and Pain Medicine, Anaesthesia and Pain Research Institute, College of Medicine, Yonsei University, Seoul 03722, Korea;
- Correspondence:
| | - Tong J. Gan
- Department of Anesthesiology, School of Medicine, Stony Brook University Renaissance, Stony Brook, NY 11794, USA;
| | - Varinee Lekprasert
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Prok Laosuwan
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand;
| | - Sophia Tsong Huey Chew
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore 169608, Singapore;
| | - Edwin Seet
- Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore 768828, Singapore;
| | - Vera Lim
- Department of Anaesthesia, Tan Tock Seng Hospital, Singapore 308433, Singapore;
| | - Lian Kah Ti
- Department of Anaesthesia, National University Health System, Singapore 119228, Singapore;
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Ma K, Bebawy JF. Electroencephalographic Burst-Suppression, Perioperative Neuroprotection, Postoperative Cognitive Function, and Mortality: A Focused Narrative Review of the Literature. Anesth Analg 2021; 135:79-90. [PMID: 34871183 DOI: 10.1213/ane.0000000000005806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Burst-suppression is an electroencephalographic pattern that results from a diverse array of pathophysiological causes and/or metabolic neuronal suppression secondary to the administration of anesthetic medications. The purpose of this review is to provide an overview of the physiological mechanisms that underlie the burst-suppression pattern and to present in a comprehensive way the available evidence both supporting and in opposition to the clinical use of this electroencephalographic pattern as a therapeutic measure in various perioperative settings.
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Affiliation(s)
- Kan Ma
- From the *Department of Anesthesiology and Pain Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John F Bebawy
- Department of Anesthesiology & Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Paixao L, Sun H, Hogan J, Hartnack K, Westmeijer M, Neelagiri A, Zhou DW, McClain LM, Kimchi EY, Purdon PL, Akeju O, Westover MB. ICU delirium burden predicts functional neurologic outcomes. PLoS One 2021; 16:e0259840. [PMID: 34855749 PMCID: PMC8638853 DOI: 10.1371/journal.pone.0259840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 10/28/2021] [Indexed: 12/13/2022] Open
Abstract
Background We investigated the effect of delirium burden in mechanically ventilated patients, beginning in the ICU and continuing throughout hospitalization, on functional neurologic outcomes up to 2.5 years following critical illness. Methods Prospective cohort study of enrolling 178 consecutive mechanically ventilated adult medical and surgical ICU patients between October 2013 and May 2016. Altogether, patients were assessed daily for delirium 2941days using the Confusion Assessment Method for the ICU (CAM-ICU). Hospitalization delirium burden (DB) was quantified as number of hospital days with delirium divided by total days at risk. Survival status up to 2.5 years and neurologic outcomes using the Glasgow Outcome Scale were recorded at discharge 3, 6, and 12 months post-discharge. Results Of 178 patients, 19 (10.7%) were excluded from outcome analyses due to persistent coma. Among the remaining 159, 123 (77.4%) experienced delirium. DB was independently associated with >4-fold increased mortality at 2.5 years following ICU admission (adjusted hazard ratio [aHR], 4.77; 95% CI, 2.10–10.83; P < .001), and worse neurologic outcome at discharge (adjusted odds ratio [aOR], 0.02; 0.01–0.09; P < .001), 3 (aOR, 0.11; 0.04–0.31; P < .001), 6 (aOR, 0.10; 0.04–0.29; P < .001), and 12 months (aOR, 0.19; 0.07–0.52; P = .001). DB in the ICU alone was not associated with mortality (HR, 1.79; 0.93–3.44; P = .082) and predicted neurologic outcome less strongly than entire hospital stay DB. Similarly, the number of delirium days in the ICU and for whole hospitalization were not associated with mortality (HR, 1.00; 0.93–1.08; P = .917 and HR, 0.98; 0.94–1.03, P = .535) nor with neurological outcomes, except for the association between ICU delirium days and neurological outcome at discharge (OR, 0.90; 0.81–0.99, P = .038). Conclusions Delirium burden throughout hospitalization independently predicts long term neurologic outcomes and death up to 2.5 years after critical illness, and is more predictive than delirium burden in the ICU alone and number of delirium days.
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Affiliation(s)
- Luis Paixao
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Haoqi Sun
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Jacob Hogan
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Katie Hartnack
- Antioch University New England, Keene, NH, United States of America
| | - Mike Westmeijer
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Anudeepthi Neelagiri
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
| | - David W. Zhou
- Harvard Medical School, Boston, MA, United States of America
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Lauren M. McClain
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Eyal Y. Kimchi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Patrick L. Purdon
- Harvard Medical School, Boston, MA, United States of America
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Oluwaseun Akeju
- Harvard Medical School, Boston, MA, United States of America
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - M. Brandon Westover
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- * E-mail:
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Cartei A, Mossello E, Ceccofiglio A, Rubbieri G, Polidori G, Ranalli C, Cammilli A, Curcio M, Cavallini MC, Mannarino GM, Ungar A, Toccafondi G, Peris A, Marchionni N, Rostagno C. Independent, Differential Effects of Delirium on Disability and Mortality Risk After Hip Fracture. J Am Med Dir Assoc 2021; 23:654-659.e1. [PMID: 34861226 DOI: 10.1016/j.jamda.2021.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To assess the independent effect of delirium on mortality and disability after 1 year of follow-up, in consecutive older patients with hip fracture hospitalized for surgical repair. DESIGN This is a prospective observational study. SETTING AND PARTICIPANTS Patients aged older than 65 years consecutively admitted for hip fracture to the Trauma and Orthopedics Centre of a third-level hospital, between March and October 2014. METHODS Patients were evaluated by a multidisciplinary team. A comprehensive geriatric assessment was performed on admission. Delirium was assessed before and after surgical repair according to the Confusion Assessment Method. Mortality and disability status were collected at 3 months and 1 year after hospital discharge. RESULTS Of 411 patients with hip fracture, 387 (mean age 82 years, female 72%) were enrolled. Delirium was assessed in 50% of the enrolled population. Patients with delirium were older, frequently affected by dementia, severe prefracture disability, history of falls, and polypharmacy. One-year mortality was 19% in all populations, and higher in patients with delirium, although delirium did not show an independent association with mortality, in multivariable analysis. Conversely, delirium was identified as an independent prognostic factor of long-term disability (B-1.605, SE 0.211, P < .001). CONCLUSION AND IMPLICATIONS This study identifies delirium as an independent long-term disability generator, regardless of associated clinical conditions and premorbid cognitive and functional status. This emphasises the importance of delirium prevention through a multidisciplinary approach and the potential role of systematic treatment of risk factors in reducing functional decline, even in subjects with preexistent disability and dementia. Moreover, these data call for research on rehabilitation interventions specifically targeted to these complex patients, with the aim of identifying approaches effective in reducing long-term disability. Conversely, a high level of clinical alertness is required in patients with delirium, as an appropriate treatment of acute diseases should reduce their high mortality risk.
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Affiliation(s)
- Alessandro Cartei
- Division of Internal and Post-Surgical Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy.
| | - Enrico Mossello
- Division of Geriatric Medicine and Cardiology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Alice Ceccofiglio
- Division of Internal and Post-Surgical Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Gaia Rubbieri
- Division of Internal and Post-Surgical Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Gianluca Polidori
- Division of Internal and Post-Surgical Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Claudia Ranalli
- Division of Internal and Post-Surgical Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Alessandra Cammilli
- Division of Internal and Post-Surgical Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Massimo Curcio
- Division of Internal and Post-Surgical Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Maria Chiara Cavallini
- Agency for Postdischarge Continuity of Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulio Maria Mannarino
- Division of Internal and Post-Surgical Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Andrea Ungar
- Division of Geriatric Medicine and Cardiology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Giulio Toccafondi
- Clinical Risk Management and Patient Safety Centre, Tuscany Region, Italy
| | - Adriano Peris
- Intensive Care Unit and Regional ECMO Referral Centre Emergency Department Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Niccolò Marchionni
- Division of Geriatric Medicine and Cardiology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Carlo Rostagno
- Division of Internal and Post-Surgical Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
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Kim H, Lee SM. Effect on Quality of Care of a Delirium Prevention Campaign for Surgical Intensive Care Nurses. J Nurs Care Qual 2021; 36:361-368. [PMID: 33394874 DOI: 10.1097/ncq.0000000000000535] [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: 11/26/2022]
Abstract
BACKGROUND Delirium is an important issue related to mortality in patients treated in intensive care units. LOCAL PROBLEM Although there are guidelines for preventing delirium, its importance may be overlooked compared with the treatment of physical illness. METHODS A 2-step delirium prevention campaign (DPC) was implemented and its effects compared (before and after the DPC). INTERVENTIONS The DPC comprised the Confusion Assessment Method for the Intensive Care Unit and a checklist for delirium prevention. RESULTS Hospital mortality declined after the DPC, but there were no significant changes in the incidence and duration of delirium. CONCLUSIONS Nurses led the delirium preventive care intervention. Delirium prevention care may be more effective with policy approaches to progress the DPC.
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Affiliation(s)
- Heejeong Kim
- Seoul St. Mary's Hospital (Ms Kim), and Department of Nursing, College of Nursing (Dr Lee), The Catholic University of Korea, Seoul, Republic of Korea
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De Vincentis A, Behr AU, Bellelli G, Bravi M, Castaldo A, Galluzzo L, Iolascon G, Maggi S, Martini E, Momoli A, Onder G, Paoletta M, Pietrogrande L, Roselli M, Ruggeri M, Ruggiero C, Santacaterina F, Tritapepe L, Zurlo A, Antonelli Incalzi R. Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus. Aging Clin Exp Res 2021; 33:2405-2443. [PMID: 34287785 DOI: 10.1007/s40520-021-01898-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/28/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Health outcomes of older subjects with hip fracture (HF) may be negatively influenced by multiple comorbidities and frailty. An integrated multidisciplinary approach (i.e. the orthogeriatric model) is, therefore, highly recommended, but its implementation in clinical practice suffers from the lack of shared management protocols and poor awareness of the problem. The present consensus document has been implemented to address these issues. AIM To develop evidence-based recommendations for the orthogeriatric co-management of older subjects with HF. METHODS A 20-member Expert Task Force of geriatricians, orthopaedics, anaesthesiologists, physiatrists, physiotherapists and general practitioners was established to develop evidence-based recommendations for the pre-, peri-, intra- and postoperative care of older in-patients (≥ 65 years) with HF. A modified Delphi approach was used to achieve consensus, and the U.S. Preventive Services Task Force system was used to rate the strength of recommendations and the quality of evidence. RESULTS A total of 120 recommendations were proposed, covering 32 clinical topics and concerning preoperative evaluation (11 topics), perioperative (8 topics) and intraoperative (3 topics) management, and postoperative care (10 topics). CONCLUSION These recommendations should ease and promote the multidisciplinary management of older subjects with HF by integrating the expertise of different specialists. By providing a convenient list of topics of interest, they might assist in identifying unmet needs and research priorities.
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Preoperative Delirium Nursing Model Initiatives to Determine the Incidence of Postoperative Delirium Among Elderly Orthopaedic Patients. Orthop Nurs 2021; 40:81-88. [PMID: 33756535 DOI: 10.1097/nor.0000000000000741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Delirium is a common neurocognitive disorder prevalent in hospitalized older adults. The development of delirium is associated with adverse health outcomes, including functional decline and mortality. This study aimed to investigate the incidence and risk factors of postoperative delirium in older adults (≥60 years) who underwent orthopaedic surgery. Elderly orthopaedic patients were recruited from a large urban hospital over 12 months. Patients were preoperatively screened for delirium and followed up at least once daily postoperatively until discharge. Of the 124 patients in the sample, 21 (16.9%) had postoperative delirium. There were no significant differences in any of the baseline characteristics between the delirious and nondelirious patients. Patients using antidepressants were more likely to develop postoperative delirium compared with those not using antidepressants (odds ratio: 2.72, p = .05). Postoperative delirium was common in this sample of older adults who underwent orthopaedic surgery. Aiming prevention strategies toward patients using antidepressants may help reduce the incidence of delirium in this population.
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Risk factors and predictive value of perioperative neurocognitive disorders in elderly patients with gastrointestinal tumors. BMC Anesthesiol 2021; 21:193. [PMID: 34281529 PMCID: PMC8287702 DOI: 10.1186/s12871-021-01405-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/17/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study aims to investigate the risk factors of perioperative neurocognitive disorders (PNDs) mainly including postoperative cognitive dysfunction (POCD) in elderly patients with gastrointestinal tumors, and evaluate its predictive value. METHODS A total of 222 eligible elderly patients (≥65 years) scheduled for elective gastroenterectomy under general anesthesia were enrolled. The cognitive function assessment was carried out 1 day before surgery and 7 days after surgery. Receiver operating characteristic curve analysis was performed to evaluate the predictive value of risk factors for early POCD. The risk factors for POCD were analyzed using univariate and multivariate logistic regression model. RESULTS Of all the 222 enrolled patients, 91 (41.0%) developed early POCD and 40 (18.0%) were identified as major POCD within 7 days after the surgery. Visual analogue score (VAS, 1st day, resting) ≥4 (OR = 7.618[3.231-17.962], P < 0.001) and alcohol exposure (OR = 2.398[1.174-4.900], P = 0.016) were independent risk factors for early POCD. VAS score (1st, resting) ≥4 (OR = 13.823[4.779-39.981], P < 0.001), preoperative white blood cell (WBC) levels ≥10 × 10*9/L (OR = 5.548[1.128-26.221], P = 0.035), blood loss ≥500 ml (OR = 3.317[1.094-10.059], P = 0.034), history of hypertension (OR = 3.046[1.267-7.322], P = 0.013), and neutrophil-lymphocyte ratio (NLR) ≥2 (OR = 3.261[1.020-10.419], P = 0.046) were independent risk factors for major POCD. Receiver operating characteristic curve analysis indicated that VAS score (1st day, resting) was a significant predictor for major POCD with a cut-off value of 2.68 and an area under the curve of 0.860 (95% confidence interval: 0.801-0.920, P < 0.001). CONCLUSIONS The risk factors for early POCD after gastroenterectomy included high VAS score (1st day, resting) and alcohol exposure. High VAS score, preoperative WBC levels ≥10 × 10*9/L, blood loss ≥500 ml, NLR ≥2, and history of hypertension were independent risk factors for major POCD. Among them, VAS score was one of the important predictors.
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Pedemonte JC, Sun H, Franco-Garcia E, Zhou C, Heng M, Quraishi SA, Westover B, Akeju O. Postoperative delirium mediates 180-day mortality in orthopaedic trauma patients. Br J Anaesth 2021; 127:102-109. [PMID: 34074525 PMCID: PMC8258970 DOI: 10.1016/j.bja.2021.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 03/06/2021] [Accepted: 03/18/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Frailty has been associated with increased incidence of postoperative delirium and mortality. We hypothesised that postoperative delirium mediates a clinically significant (≥1%) percentage of the effect of frailty on mortality in older orthopaedic trauma patients. METHODS This was a single-centre, retrospective observational study including 558 adults 65 yr and older, who presented with an extremity fracture requiring hospitalisation without initial ICU admission. We used causal statistical inference methods to estimate the relationships between frailty, postoperative delirium, and mortality. RESULTS In the cohort, 180-day mortality rate was 6.5% (36/558). Frail and prefrail patients comprised 23% and 39%, respectively, of the study cohort. Frailty was associated with increased 180 day mortality from 1.4% to 12.2% (11% difference; 95% confidence interval [CI], 8.4-13.6), which translated statistically into an 88.7% (79.9-94.3%) direct effect and an 11.3% (5.7-20.1%) postoperative delirium mediated effect. Prefrailty was also associated with increased 180 day mortality from 1.4% to 4.4% (2.9% difference; 2.4-3.4), which was translated into a 92.5% (83.8-99.9%) direct effect and a 7.5% (0.1-16.2%) postoperative delirium mediated effect. CONCLUSIONS Frailty is associated with increased postoperative mortality, and delirium might mediate a clinically significant, but small percentage of this effect. Studies should assess whether, in patients with frailty, attempts to mitigate delirium might decrease postoperative mortality.
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Affiliation(s)
- Juan C Pedemonte
- Department of Anesthesia, Critical Care and Pain Medicine, Boston, MA, USA; División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Haoqi Sun
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Carmen Zhou
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Marilyn Heng
- Department of Orthopaedic Surgery, Boston, MA, USA
| | - Sadeq A Quraishi
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, USA
| | - Brandon Westover
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Henry and Allison McCance Center for Brain Health, Boston, MA, USA; Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, USA
| | - Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Boston, MA, USA; Henry and Allison McCance Center for Brain Health, Boston, MA, USA
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Alkadri J, Hage D, Nickerson LH, Scott LR, Shaw JF, Aucoin SD, McIsaac DI. A Systematic Review and Meta-Analysis of Preoperative Frailty Instruments Derived From Electronic Health Data. Anesth Analg 2021; 133:1094-1106. [PMID: 33999880 DOI: 10.1213/ane.0000000000005595] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Frailty is a strong predictor of adverse outcomes in the perioperative period. Given the increasing availability of electronic medical data, we performed a systematic review and meta-analysis with primary objectives of describing available frailty instruments applied to electronic data and synthesizing their prognostic value. Our secondary objectives were to assess the construct validity of frailty instruments that have been applied to perioperative electronic data and the feasibility of electronic frailty assessment. METHODS Following protocol registration, a peer-reviewed search strategy was applied to Medline, Excerpta Medica dataBASE (EMBASE), Cochrane databases, and the Comprehensive Index to Nursing and Allied Health literature from inception to December 31, 2019. All stages of the review were completed in duplicate. The primary outcome was mortality; secondary outcomes included nonhome discharge, health care costs, and length of stay. Effect estimates adjusted for baseline illness, sex, age, procedure, and urgency were of primary interest; unadjusted and adjusted estimates were pooled using random-effects models where appropriate or narratively synthesized. Risk of bias was assessed. RESULTS Ninety studies were included; 83 contributed to the meta-analysis. Frailty was defined using 22 different instruments. In adjusted data, frailty identified from electronic data using any instrument was associated with a 3.57-fold increase in the odds of mortality (95% confidence interval [CI], 2.68-4.75), increased odds of institutional discharge (odds ratio [OR], 2.40; 95% CI, 1.99-2.89), and increased costs (ratio of means, 1.54; 95% CI, 1.46-1.63). Most instruments were not multidimensional, head-to-head comparisons were lacking, and no feasibility data were reported. CONCLUSIONS Frailty status derived from electronic data provides prognostic value as it is associated with adverse outcomes, even after adjustment for typical risk factors. However, future research is required to evaluate multidimensional instruments and their head-to-head performance and to assess their feasibility and clinical impact.
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Affiliation(s)
- Jamal Alkadri
- From the Department of Anesthesiology & Pain Medicine
| | - Dima Hage
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Lia R Scott
- Department of General Surgery, Queen's University, Ottawa, Ontario, Canada
| | - Julia F Shaw
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Daniel I McIsaac
- From the Department of Anesthesiology & Pain Medicine.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Wang Y, Liu W, Chen K, Shen X. Postoperative Delirium is Not Associated with Long-Term Decline in Activities of Daily Living or Mortality After Laryngectomy. Clin Interv Aging 2021; 16:823-831. [PMID: 34040359 PMCID: PMC8139736 DOI: 10.2147/cia.s303800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/23/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the relationships between postoperative delirium (POD) and postoperative activities of daily living (ADL) and mortality in patients undergoing laryngectomy. We hypothesized that POD would reduce postoperative ADL and increase postoperative mortality. Patients and Methods The prospective study included older participants (age ≥65 y) undergoing total laryngectomy, partial laryngectomy, total laryngectomy plus neck dissection, or partial laryngectomy plus neck dissection under general anesthesia. The diagnosis of delirium was based on the Confusion Assessment Method algorithm, which was administered on postoperative days 1 through 6. ADL were evaluated using the Chinese version of the Index of ADL scale. Follow-up assessments of ADL and mortality were conducted 24 months after surgery. Results Of 127 participants (aged 70.3 ± 4.1 y), 19 (15.0%) developed POD. POD was not associated with a decrease in ADL after laryngectomy (p=0.599) nor with an increase in postoperative mortality [3/19 (15.8%) vs 12/108 (11.1%), p=0.560, Log rank test]. However, longer surgery duration was significantly associated with worse overall survival (OR, 3.262; 95% CI, 1.261–9.169, p=0.025). Conclusion POD was not associated with long-term ADL or mortality after laryngectomy. Prolonged surgery was the only factor associated with a higher postoperative mortality rate.
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Affiliation(s)
- Yiru Wang
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
| | - Weiwei Liu
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
| | - Kaizheng Chen
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
| | - Xia Shen
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China
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Rickard F, Ibitoye S, Deakin H, Walton B, Thompson J, Shipway D, Braude P. The Clinical Frailty Scale predicts adverse outcome in older people admitted to a UK major trauma centre. Age Ageing 2021; 50:891-897. [PMID: 32980868 DOI: 10.1093/ageing/afaa180] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Frailty assessment using the Clinical Frailty Scale (CFS) has been mandated for older people admitted to English major trauma centres (MTC) since April 2019. Little evidence is available as to CFS-associated outcomes in the trauma population. OBJECTIVE To investigate post-injury outcomes stratified by the CFS. METHODS A single centre prospective observational cohort study was undertaken. CFS was prospectively assigned to patients ≥ 65 years old admitted to the MTC over a 5-month period. Primary outcome was 30-day post-injury mortality. Secondary outcomes were length of hospital stay, complications and discharge level of care. RESULTS In 300 patients median age was 82; 146 (47%) were frail (CFS 5-9) and 28 (9.3%) severely frail (CFS 7-9). Frail patients had lower injury severity scores (median 9 vs 16) but greater 30-day mortality (CFS 5-6 odds ratio (OR) 5.68; P < 0.01; CFS 7-9 OR 10.38; P < 0.01). Frailty was associated with delirium (29.5% vs 17.5%; P = 0.02), but not complication rate (50.7% vs 41.6%; P = 0.20) or length of hospital stay (13 vs 11 days; P = 0.35). Mild to moderate frailty was associated with increased care level at discharge (OR 2.31; P < 0.01). CONCLUSIONS Frailty is an independent predictor of 30-day mortality, inpatient delirium and increased care level at discharge in older people experiencing trauma. CFS can therefore be used to identify those at risk of poor outcome who may benefit from comprehensive geriatric review, validating its inclusion in the 2019 best practice tariff for major trauma.
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Affiliation(s)
- Frances Rickard
- Clinical Fellow in Geriatric Trauma, North Bristol NHS Trust, Bristol, UK
| | - Sarah Ibitoye
- Clinical Fellow in Geriatric Trauma, North Bristol NHS Trust, Bristol, UK
| | - Helen Deakin
- Clinical Fellow in Geriatric Trauma, North Bristol NHS Trust, Bristol, UK
| | - Benjamin Walton
- Consultant in Critical Care Medicine & Anaesthetics, North Bristol NHS Trust, Bristol, UK
| | - Julian Thompson
- Consultant in Critical Care Medicine & Anaesthetics, North Bristol NHS Trust, Bristol, UK
| | - David Shipway
- Consultant Physician and Perioperative Geriatrician, North Bristol NHS Trust, Bristol, UK
- Honorary Senior Clinical Lecturer, University of Bristol, Bristol, UK
| | - Philip Braude
- Consultant Physician and Perioperative Geriatrician, North Bristol NHS Trust, Bristol, UK
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Abate SM, Checkole YA, Mantedafro B, Basu B, Aynalem AE. Global prevalence and predictors of postoperative delirium among non-cardiac surgical patients: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Winterer JM, Ofosu K, Borchers F, Hadzidiakos D, Lammers-Lietz F, Spies C, Winterer G, Zacharias N. Neurocognitive disorders in the elderly: altered functional resting-state hyperconnectivities in postoperative delirium patients. Transl Psychiatry 2021; 11:213. [PMID: 33846284 PMCID: PMC8041755 DOI: 10.1038/s41398-021-01304-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 02/03/2021] [Accepted: 03/02/2021] [Indexed: 01/11/2023] Open
Abstract
Postoperative delirium (POD) represents a confusional state during days/weeks after surgery and is particularly frequent in elderly patients. Hardly any fMRI studies were conducted to understand the underlying pathophysiology of POD patients. This prospective observational cohort study aims to examine changes of specific resting-state functional connectivity networks across different time points (pre- and 3-5 months postoperatively) in delirious patients compared to no-POD patients. Two-hundred eighty-three elderly surgical patients underwent preoperative resting-state fMRI (46 POD). One-hundred seventy-eight patients completed postoperative scans (19 POD). For functional connectivity analyses, three functional connectivity networks with seeds located in the orbitofrontal cortex (OFC), nucleus accumbens (NAcc), and hippocampus were investigated. The relationship of POD and connectivity changes between both time points (course connectivity) were examined (ANOVA). Preoperatively, delirious patients displayed hyperconnectivities across the examined functional connectivity networks. In POD patients, connectivities within NAcc and OFC networks demonstrated a decrease in course connectivity [max. F = 9.03, p = 0.003; F = 4.47, p = 0.036, resp.]. The preoperative hyperconnectivity in the three networks in the patients at risk for developing POD could possibly indicate existing compensation mechanisms for subtle brain dysfunction. The observed pathophysiology of network function in POD patients at least partially involves dopaminergic pathways.
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Affiliation(s)
- Jeanne M. Winterer
- grid.6363.00000 0001 2218 4662Department of Psychiatry and Psychotherapy (CCM), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany ,grid.484013.aDepartment of Anesthesiology, Charité (CVK, CCM)–Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany ,Pharmaimage Biomarker Solutions GmbH, Berlin, Germany
| | - Kwaku Ofosu
- grid.484013.aDepartment of Anesthesiology, Charité (CVK, CCM)–Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Friedrich Borchers
- grid.484013.aDepartment of Anesthesiology, Charité (CVK, CCM)–Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Daniel Hadzidiakos
- grid.484013.aDepartment of Anesthesiology, Charité (CVK, CCM)–Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Florian Lammers-Lietz
- grid.484013.aDepartment of Anesthesiology, Charité (CVK, CCM)–Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Claudia Spies
- grid.484013.aDepartment of Anesthesiology, Charité (CVK, CCM)–Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Georg Winterer
- Department of Anesthesiology, Charité (CVK, CCM)-Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany. .,Pharmaimage Biomarker Solutions GmbH, Berlin, Germany.
| | - Norman Zacharias
- grid.484013.aDepartment of Anesthesiology, Charité (CVK, CCM)–Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany ,Pharmaimage Biomarker Solutions GmbH, Berlin, Germany
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Tarazona-Santabalbina FJ, Ojeda-Thies C, Figueroa Rodríguez J, Cassinello-Ogea C, Caeiro JR. Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3049. [PMID: 33809573 PMCID: PMC7999190 DOI: 10.3390/ijerph18063049] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/05/2021] [Accepted: 03/12/2021] [Indexed: 12/13/2022]
Abstract
Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Quality of care in orthogeriatric co-management units has increased, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms "hip fracture", "geriatric assessment", "second hip fracture", "surgery", "perioperative management" and "orthogeriatric care", in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.
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Affiliation(s)
- Francisco José Tarazona-Santabalbina
- Department of Geriatric Medicine, Hospital Universitario de la Ribera, Alzira, 46600 Valencia, Spain
- CIBERFES, Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable, Instituto Carlos III, 28029 Madrid, Spain
| | - Cristina Ojeda-Thies
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | - Jesús Figueroa Rodríguez
- Department of Physical Medicine and Rehabilitation, Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain;
| | | | - José Ramón Caeiro
- Department of Orthopaedics and Traumatology, Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain;
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Shayan S, DE Wolf AM. Delirious after liver transplantation: are we oblivious? Minerva Anestesiol 2021; 87:630-633. [PMID: 33688702 DOI: 10.23736/s0375-9393.21.15623-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Shahriar Shayan
- Feinberg School of Medicine, Department of Anesthesiology, Northwestern University, Chicago, IL, USA
| | - Andre M DE Wolf
- Feinberg School of Medicine, Department of Anesthesiology, Northwestern University, Chicago, IL, USA -
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Costa-Martins I, Carreteiro J, Santos A, Costa-Martins M, Artilheiro V, Duque S, Campos L, Chedas M. Post-operative delirium in older hip fracture patients: a new onset or was it already there? Eur Geriatr Med 2021; 12:777-785. [PMID: 33569717 DOI: 10.1007/s41999-021-00456-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 01/20/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Hip fractures are a worldwide health issue primarily for older patients, conditioning major morbidity and mortality. An experienced multidisciplinary team is essential to manage surgery and peri-operative implications, to enable rapid functional and cognitive recovery. Delirium is a recognizable problem associated with negative outcomes. Our study aims to determine the influence of pre-operative delirium in the incidence of post-operative delirium, and to evaluate the association between other known peri-operative risk factors with both conditions. METHODS A single-center, retrospective cohort study, conducted at a Level II trauma center over a 14-month period, included 241 patients with 65 years of age or older submitted to hip fracture surgery. Peri-operative data were gathered regarding baseline characteristics (sociodemographic, functional and cognitive status), intra-operative events (anesthesia technique, surgery duration, blood loss) and post-operative outcomes (delirium occurrence). RESULTS Statistical analysis evidenced a female (75.5%) and elderly population (83.9 ± 7.8 years old) with significant comorbidities (cognitive impairment in 51.9%, ASA ≥ III in 79.7%, mean CIRS-G 8.83 ± 4.69) that underwent surgical fracture repair, mostly under 4 h (96.3%) and under regional anesthesia (63.1%). Pre- and post-operative delirium incidence was 18.3% and 12.9%, respectively, displaying increased presence according to cognitive impairment severity. CONCLUSION Post-operative delirium was almost inexistent when it was absent pre-operatively. Moreover, pre-operative cognitive status was associated with the development of pre- and post-operative delirium. Careful cognitive assessment, implementation of preventive strategies and avoidance of peri-operative pro-delirium factors are crucial for comprehensive geriatric care.
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Affiliation(s)
- Isabel Costa-Martins
- Anaesthesiology Department, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal.
| | - Joana Carreteiro
- Anaesthesiology Department, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal
| | - Ana Santos
- Internal Medicine Department, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal
| | - Mariana Costa-Martins
- Clinical Psychologist, Rua Major Neutel de Abreu, nr 13, 10° A, 1500-409, Lisbon, Portugal
| | - Vanessa Artilheiro
- Anaesthesiology Department, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal
| | - Sofia Duque
- Orthogeriatric Unit, Internal Medicine Department, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal
| | - Luís Campos
- Internal Medicine Department, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal
| | - Manuel Chedas
- Anaesthesiology Department, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal
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Delirium in trauma patients: a 1-year prospective cohort study of 2026 patients. Eur J Trauma Emerg Surg 2021; 48:1017-1024. [PMID: 33538844 PMCID: PMC9001539 DOI: 10.1007/s00068-021-01603-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/02/2021] [Indexed: 12/11/2022]
Abstract
Background Delirium in trauma surgery is common, especially post-operatively, but medical characteristics, risk factors and residence post-discharge have not comprehensively been investigated in all trauma patients. Methods Over 1 year, 2026 trauma patients were prospectively screened for delirium with the following tools: Delirium Observation screening scale (DOS), Intensive Care Delirium Screening Checklist (ICDSC) and a DSM (Diagnostic and Statistical Manual)-5, nursing tool (ePA-AC) construct. Risk factors—predisposing und precipitating—for delirium were assessed via multiple regression analysis. Results Of 2026 trauma patients, 440 (21.7%) developed delirium, which was associated with an increased risk of assisted living (OR 6.42, CI 3.92–10.49), transfer to nursing home (OR 4.66, CI 3.29–6.6), rehabilitation (OR 3.96, CI 3.1–5.1), or death (OR 70.72, CI 22–227.64). Intensive care management (OR 18.62, CI 14.04–24.68), requirement of ventilation (OR 32.21, CI 21.27–48.78), or its duration (OR 67.22, CI 33.8–133.71) all increased the risk for developing delirium. Relevant predisposing risk factors were dementia (OR 50.92, CI 15.12–171.45), cardiac insufficiency (OR 11.76, CI 3.6–38.36), and polypharmacy (OR 5.9, CI 4.01–8.68).Relevant precipitating risk factors were brain edema (OR 40.53, CI 4.81–341.31), pneumonia (OR 39.66, CI 8.89–176.93) and cerebral inflammation (OR 21.74, CI 2.34–202.07). Conclusion Delirium in trauma patients is associated with poor outcome as well as with intensive care management and various predisposing and/or precipitating factors. Three quarters of patients who had undergone delirium were not able to live independently at home any more. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-021-01603-5.
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