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Hu L, Kang S, Peng Q, An E, Lu J, Yang H, Zhou H, Zhang B. Knowledge, attitudes, and practice toward postoperative cognitive dysfunction among anesthesiologists in China: a cross-sectional study. BMC MEDICAL EDUCATION 2024; 24:359. [PMID: 38561709 PMCID: PMC10986038 DOI: 10.1186/s12909-024-05358-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 03/27/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND To investigate the knowledge, attitudes, and practice (KAP) toward postoperative cognitive dysfunction (POCD) among anesthesiologists in China. METHODS This cross-sectional study was conducted nationwide among Chinese anesthesiologists between December 2022 and January 2023. The demographic information and KAP scores of the respondents were collected using a web-based questionnaire. The mean KAP dimension scores ≥ 60% were considered good. RESULTS This study enrolled 1032 anesthesiologists (51.2% male). The mean total scores of knowledge, positive attitude, and positive practice were 9.3 ± 1.2 (max 12), 34.8 ± 3.3 (max 40), and 30.6 ± 6.7 (max 40), respectively. The knowledge items with correctness scores < 60% were "the anesthetic drugs that tend to cause POCD" (23.3%) and "Treatment of POCD" (40.3%). Multivariable analysis showed that ≥ 40 years old, master's degree or above, intermediate professional title (i.e., attending physician), senior professional title (i.e., chief physician), and working in tertiary hospitals were independently associated with adequate knowledge. Multivariable analysis showed that the attitude scores, middle professional title, and ≥ 16 years of experience were independently associated with good practice. CONCLUSIONS These results suggest that Chinese anesthesiologists have good knowledge, favorable attitudes, and good practice toward POCD. Still, some points remain to be improved (e.g., the drugs causing POCD and managing POCD) and should be emphasized in training and continuing education. TRIAL REGISTRATION ChiCTR2200066749.
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Affiliation(s)
- Li Hu
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Shuai Kang
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Qiaoyi Peng
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Erdan An
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jian Lu
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Hao Yang
- Department of Anesthesiology, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Hongmei Zhou
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China.
| | - Bin Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China.
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Rustenbach CJ, Reichert S, Radwan M, Doll I, Mustafi M, Nemeth A, Marinos SL, Berger R, Baumbach H, Zdanyte M, Haeberle H, Caldonazo T, Saqer I, Saha S, Schnackenburg P, Djordjevic I, Krasivskyi I, Wendt S, Kuhn E, Higuita LMS, Doenst T, Hagl C, Wahlers T, Boburg RS, Schlensak C. On- vs. Off-Pump CABG in Heart Failure Patients with Reduced Ejection Fraction (HFrEF): A Multicenter Analysis. Biomedicines 2023; 11:3043. [PMID: 38002044 PMCID: PMC10669606 DOI: 10.3390/biomedicines11113043] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE This study aimed to compare postoperative outcomes and 30-day mortality in patients with reduced ejection fraction (<40%) who underwent isolated coronary artery bypass grafting (CABG) with (ONCAB) and without (OPCAB) the use of cardiopulmonary bypass. METHODS data from four university hospitals in Germany, spanning from January 2017 to December 2021, were retrospectively analyzed. A total of 551 patients were included in the study, and various demographic, intraoperative, and postoperative data were compared. RESULTS demographic parameters did not exhibit any differences. However, the OPCAB group displayed notably higher rates of preoperative renal insufficiency, urgent surgeries, and elevated EuroScore II and STS score. During surgery, the ONCAB group showed a significantly higher rate of complete revascularization, whereas the OPCAB group required fewer intraoperative transfusions. No disparities were observed in 30-day/in-hospital mortality for the entire cohort and the matched population between the two groups. Subsequent to surgery, the OPCAB group demonstrated significantly shorter mechanical ventilation times, reduced stays in the intensive care unit, and lower occurrences of ECLS therapy, acute kidney injury, delirium, and sepsis. CONCLUSIONS the study's findings indicate that OPCAB surgery presents a safe and viable alternative, yielding improved postoperative outcomes in this specific patient population compared to ONCAB surgery. Despite comparable 30-day/in-hospital mortality rates, OPCAB patients enjoyed advantages such as decreased mechanical ventilation durations, shorter ICU stays, and reduced incidences of ECLS therapy, acute kidney injury, delirium, and sepsis. These results underscore the potential benefits of employing OPCAB as a treatment approach for patients with coronary heart disease and reduced ejection fraction.
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Affiliation(s)
- Christian Jörg Rustenbach
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany; (C.J.R.); (M.R.); (I.D.); (M.M.); (A.N.); (S.L.M.); (R.B.); (R.S.B.); (C.S.)
| | - Stefan Reichert
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany; (C.J.R.); (M.R.); (I.D.); (M.M.); (A.N.); (S.L.M.); (R.B.); (R.S.B.); (C.S.)
| | - Medhat Radwan
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany; (C.J.R.); (M.R.); (I.D.); (M.M.); (A.N.); (S.L.M.); (R.B.); (R.S.B.); (C.S.)
| | - Isabelle Doll
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany; (C.J.R.); (M.R.); (I.D.); (M.M.); (A.N.); (S.L.M.); (R.B.); (R.S.B.); (C.S.)
| | - Migdat Mustafi
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany; (C.J.R.); (M.R.); (I.D.); (M.M.); (A.N.); (S.L.M.); (R.B.); (R.S.B.); (C.S.)
| | - Attila Nemeth
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany; (C.J.R.); (M.R.); (I.D.); (M.M.); (A.N.); (S.L.M.); (R.B.); (R.S.B.); (C.S.)
| | - Spiros Lukas Marinos
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany; (C.J.R.); (M.R.); (I.D.); (M.M.); (A.N.); (S.L.M.); (R.B.); (R.S.B.); (C.S.)
| | - Rafal Berger
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany; (C.J.R.); (M.R.); (I.D.); (M.M.); (A.N.); (S.L.M.); (R.B.); (R.S.B.); (C.S.)
| | - Hardy Baumbach
- Independent Researcher, Roter-Stich 127, 70376 Stuttgart, Germany;
| | - Monika Zdanyte
- Department of Cardiology, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany;
| | - Helene Haeberle
- Department of Anesthesiology and Intensive Care Medicine, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany;
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Jena University Hospital, 07743 Jena, Germany; (T.C.); (I.S.); (T.D.)
| | - Ibrahim Saqer
- Department of Cardiothoracic Surgery, Jena University Hospital, 07743 Jena, Germany; (T.C.); (I.S.); (T.D.)
| | - Shekhar Saha
- Department of Cardiac Surgery, LMU University Hospital, 80539 Munich, Germany; (S.S.); (P.S.); (C.H.)
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Philipp Schnackenburg
- Department of Cardiac Surgery, LMU University Hospital, 80539 Munich, Germany; (S.S.); (P.S.); (C.H.)
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50923 Cologne, Germany; (I.D.); (I.K.); (S.W.); (E.K.); (T.W.)
| | - Ihor Krasivskyi
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50923 Cologne, Germany; (I.D.); (I.K.); (S.W.); (E.K.); (T.W.)
| | - Stefanie Wendt
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50923 Cologne, Germany; (I.D.); (I.K.); (S.W.); (E.K.); (T.W.)
| | - Elmar Kuhn
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50923 Cologne, Germany; (I.D.); (I.K.); (S.W.); (E.K.); (T.W.)
| | - Lina Maria Serna Higuita
- Institute for Clinical Epidemiology and Applied Biostatistics, Eberhard-Karls-University of Tuebingen, 72074 Tübingen, Germany;
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, 07743 Jena, Germany; (T.C.); (I.S.); (T.D.)
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, 80539 Munich, Germany; (S.S.); (P.S.); (C.H.)
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50923 Cologne, Germany; (I.D.); (I.K.); (S.W.); (E.K.); (T.W.)
| | - Rodrigo Sandoval Boburg
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany; (C.J.R.); (M.R.); (I.D.); (M.M.); (A.N.); (S.L.M.); (R.B.); (R.S.B.); (C.S.)
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany; (C.J.R.); (M.R.); (I.D.); (M.M.); (A.N.); (S.L.M.); (R.B.); (R.S.B.); (C.S.)
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Khaled M, Youssef N, Choi S, Uppal V, Chui J, Marcucci M, Madden K, Shanthanna H. Preoperative assessment of postoperative delirium: a cross-sectional study of patients and anesthesiologists in Canada. Can J Anaesth 2023; 70:1600-1610. [PMID: 37606836 DOI: 10.1007/s12630-023-02537-9] [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: 01/11/2023] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 08/23/2023] Open
Abstract
PURPOSE We sought to evaluate 1) patient- and anesthesiologist-reported rates of postoperative delirium (POD) risk discussion during preoperative meetings, 2) patients' and anesthesiologists' ratings of the importance of POD, and 3) predictors of patient-reported discussion of POD risk during preoperative meetings. METHODS In this multicentre two-part cross-sectional survey study, patients ≥ 65 yr scheduled to undergo elective noncardiac surgery completed a five-minute survey after preoperative anesthesia consultation. Patients were asked about their perception of POD importance, and whether they discussed or were assessed for POD risk. Anesthesiologists were surveyed using self-administered surveys circulated via institutional email lists. Anesthesiologists were asked about the frequency of POD risk assessment and discussion in older adults, tools used, and perception of POD-screening barriers. RESULTS Four hundred and twelve (of 510 approached) patients (50% male; mean age, 73 yr) and 267 anesthesiologists (of 1,205 invited via e-mail) participated in this study conducted in five Canadian hospitals. Postoperative delirium screening and discussion was reported by 88/412 (22%) patients and 229/267 (86%) anesthesiologists. Postoperative delirium was rated as "somewhat-extremely" important by 64% of patients. A previous history of delirium, higher education, the number of daily medications, and longer surgical duration were associated with POD discussion. On average, anesthesiologists rated the importance of POD at 8/10, and 42% ranked "patient risk factors" as the top reason prompting discussion. CONCLUSION The combined evaluation of patients' and anesthesiologists' perspectives provides valuable information on preoperative POD screening and risk assessment, and highlights areas for improvement in the current practice. Most factors we identified to be associated with higher odds of POD discussion are recognized risk factors of POD.
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Affiliation(s)
- Maram Khaled
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Perioperative and Surgery Research Program, Population Health Research Institute, Hamilton, ON, Canada
| | - Nayer Youssef
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Stephen Choi
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Vishal Uppal
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Jason Chui
- Department of Anesthesia & Perioperative Medicine, Western University, London, ON, Canada
| | - Maura Marcucci
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Perioperative and Surgery Research Program, Population Health Research Institute, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Kim Madden
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Harsha Shanthanna
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
- Department of Surgery, McMaster University, Hamilton, ON, Canada.
- St Joseph's Healthcare Hamilton, McMaster University, 50 Charlton Ave. E, Hamilton, ON, L8N 4A8, Canada.
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Sadlonova M, von Arnim CAF. [Update on the diagnosis and treatment of delirium]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023; 64:855-863. [PMID: 37540259 DOI: 10.1007/s00108-023-01561-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 08/05/2023]
Abstract
Delirium is an acute confusional state with typically fluctuating disturbances of attention, cognition, and qualitative awareness. Its incidence depends on the patient group. In the development of delirium, predisposing factors such as age, frailty, multimorbidity, surgical interventions, and pre-existing dementia are of high clinical relevance. The diagnosis of delirium should be based on symptoms and validated screening methods (e.g., Confusion Assessment Method). As delirium is a direct physiological consequence of a medical condition, the potential underlying cause(s) should be diagnosed. Prevention and therapy are primarily multimodal, non-pharmacological treatments such as reorientation, early mobilization, and sleep improvement. If symptomatic pharmacological treatment is necessary (e.g., due to delirium-related agitation), careful drug selection should be made depending on the patient population and symptoms.
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Affiliation(s)
- Monika Sadlonova
- Klinik für Psychosomatische Medizin und Psychotherapie, Herzzentrum, Universitätsmedizin Göttingen, Göttingen, Deutschland
- Klinik für Herz‑, Thorax und Gefäßchirurgie, Herzzentrum, Universitätsmedizin Göttingen, Göttingen, Deutschland
- Klinik für Geriatrie, Herzzentrum, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37077, Göttingen, Deutschland
- Deutsches Zentrum für Herz-Kreislauf-Forschung, Standort Göttingen, Herzzentrum, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Christine A F von Arnim
- Klinik für Geriatrie, Herzzentrum, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37077, Göttingen, Deutschland.
- Deutsches Zentrum für Herz-Kreislauf-Forschung, Standort Göttingen, Herzzentrum, Universitätsmedizin Göttingen, Göttingen, Deutschland.
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Akhlagh S, Jouybar R, Zohoori K, Khademi S, Mani A, reza Akhlagh S, Asadpour E. The effect of melatonin on cognitive functions following coronary artery bypass grafting: A triple-blind randomized-controlled trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2023; 28:14. [PMID: 37064795 PMCID: PMC10098135 DOI: 10.4103/jrms.jrms_118_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 08/23/2022] [Accepted: 09/26/2022] [Indexed: 03/18/2023]
Abstract
Background Cognitive dysfunction presents one of the chief causes of postoperative morbidity. Melatonin as a neurohormone can improve neurocognitive functioning and sleep disorders. We evaluated the effect of melatonin on the postoperative cognitive function of patients undergoing coronary artery bypass grafting (CABG). Materials and Methods A triple-blind randomized-controlled trial was conducted on 66 CABG candidates in Namazee Hospital (Shiraz, Iran). Patients were assigned equally into two groups receiving melatonin 10 mg or a placebo daily for 4 weeks before surgery and 2 days after surgery in the intensive care unit. The Mini-Mental State Examination (MMSE), Tower of London (ToL), and Wechsler Adults Intelligence Scale-Revised (WAIS-R) cognitive function tests were performed in both groups 4 weeks before surgery (time point 1), 2 days after surgery (time point 2), and 6 weeks after initial administration of melatonin (time point 3). Results The mean change score (time point 3-time point 1) differed significantly between the two groups in the MMSE (P ≤ 0.001), ToL total score (P = 0.001), and WAIS-R general IQ (P ≤ 0.001), picture completion (P ≤ 0.001), vocabulary (P = 0.024), and digit span (P = 0.01). On the other hand, no significant differences were detected in the WAIS-R block design, ToL total time delay, ToL total lab, and ToL total result scores. Conclusion The MMSE and WAIS-R tests revealed that melatonin might have prophylactic effects against postoperative cognitive disturbance in patients undergoing elective CABG.
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Liu Y, Song F, Yang Y, Yang S, Jiang M, Zhang W, Ma Z, Gu X. Mitochondrial DNA methylation drift and postoperative delirium in mice. Eur J Anaesthesiol 2022; 39:133-144. [PMID: 34726198 DOI: 10.1097/eja.0000000000001620] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mitochondrial dysfunction is linked to the etiopathogenesis of postoperative delirium (POD), which severely affects the prognosis of elderly patients undergoing surgery. The methylation of mitochondrial DNA (mtDNA), a new and incompletely described phenomenon that regulates the structure and function of mitochondria, is associated with ageing. However, the relationship between mtDNA methylation and POD has not been established. OBJECTIVE To explore the potential roles of mitochondrial epigenetic regulation in POD. DESIGN A randomised animal study. PARTICIPANTS Eighty-eight 6-month-old and one hundred seventy-six 18-month-old male C57BL/6N mice. INTERVENTIONS POD was induced by abdominal surgery under 1.4% isoflurane for 2 h. Behavioural tests were performed at 24 h before surgery and at 6, 9 and 24 h after surgery. MAIN OUTCOME MEASURES 5-methylcytosine (5-mC) at five CpG sites of the displacement loop (D-loop) and at 60 CpG sites of coding gene loci in the mitochondrial genome after surgery of the hippocampus, prefrontal cortex, amygdala and anterior cingulate cortex in 6 and 18-month-old mice were detected using bisulfite pyrosequencing. Mitochondrial structure, mitochondrial gene expression and mtDNA copy number were also examined using Electron microscopy and real time PCR to find the association with mtDNA methylation. RESULTS The mtDNA methylation drift manifested as a decrease in the methylation levels at the D-loop and an increase or decrease in the methylation levels at several coding gene loci, ultimately resulting in reduced mtDNA copy numbers, altered mitochondrial gene expression and damaged mitochondrial structures in the hippocampus and prefrontal cortex after surgery. The activation of Silent information regulator-1 (SIRT1) ameliorated anaesthesia-induced and surgery-induced mitochondrial dysfunction and delirium-like behaviours by regulating mtDNA methyltransferase-mediated mtDNA methylation. CONCLUSION These data support the existence of epigenetic mtDNA regulation in POD; however, further studies are required to explore the specific mechanisms. TRIAL REGISTRATION No 20181204 Drum tower hospital.
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Affiliation(s)
- Yue Liu
- From the Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical School of Nanjing University, Nanjing, Jiangsu Province, China
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Thomas C, Spank J, Weller S, Eschweiler GW. [Nonpharmaceutical concepts for prevention and treatment of delirium]. Z Gerontol Geriatr 2021; 54:759-767. [PMID: 34817684 DOI: 10.1007/s00391-021-01988-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/13/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cognitive impairment is common among older patients in German hospitals (40%). Dementia, other brain diseases and frailty significantly increase the risk of delirium and pose great challenges to interdisciplinary and interprofessional teams. Delirium prevention is achievable but requires complex interdepartmental strategies with specific components for timely recognition of the individual delirium risk, to carry out structured and sustained implementation of appropriate measures for delirium prevention as well as prompt etiological diagnostics and immediate treatment when delirium occurs. OBJECTIVE The present work aims to shed light on the role of interprofessional and interdisciplinary collaboration in evidence-based, nonpharmacological delirium prevention programs. MATERIAL AND METHODS Narrative review of international best practice programs. RESULTS Nonpharmacological prevention of delirium is effective but requires differentiated risk identification, regular delirium screening and daily targeted cognitive activation and sleep promotion. This can only be achieved in close interprofessional collaboration and is mostly carried out interdepartmentally by specialized teams. DISCUSSION Interprofessional multicomponent programs for delirium prevention hold the potential to reduce delirium and complication rates in older high-risk patients in regular care, thereby improving treatment and long-term quality of life. Additional interprofessional delirium prevention teams are deployed in different settings simultaneously and provide regular training on optimal delirium management. Demonstration of the effectiveness of cross-setting programs requires large multicenter studies and is therefore particularly laborious.
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Affiliation(s)
- Christine Thomas
- Klinik für Psychiatrie und Psychotherapie für Ältere, Zentrum für Seelische Gesundheit, Klinikum Stuttgart - Krankenhaus Bad Cannstatt, Prießnitzweg 24, 70374, Stuttgart, Deutschland.
- Universitätsklinik für Psychiatrie und Psychotherapie, Tübingen, Deutschland.
| | - Juliane Spank
- Klinik für Psychiatrie und Psychotherapie für Ältere, Zentrum für Seelische Gesundheit, Klinikum Stuttgart - Krankenhaus Bad Cannstatt, Prießnitzweg 24, 70374, Stuttgart, Deutschland
| | - Sarah Weller
- Klinik für Psychiatrie und Psychotherapie für Ältere, Zentrum für Seelische Gesundheit, Klinikum Stuttgart - Krankenhaus Bad Cannstatt, Prießnitzweg 24, 70374, Stuttgart, Deutschland
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Baek W, Kim YM, Lee H. Risk Factors of Postoperative Delirium in Older Adult Spine Surgery Patients: A Meta-Analysis. AORN J 2021; 112:650-661. [PMID: 33252809 DOI: 10.1002/aorn.13252] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/21/2020] [Accepted: 05/05/2020] [Indexed: 12/19/2022]
Abstract
This literature review identifies factors that may place older adult patients at risk for developing delirium after spine surgery. We conducted a meta-analysis according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Using a variety of electronic databases, we identified five studies for inclusion that represent 645 patients who were 65 years or older. The pooled incidence rate of postoperative delirium was 13.0%. Factors associated with developing postoperative delirium included preoperative opioid use, cervical spine surgery versus lumbar or thoracic spine surgery, spine fusion versus simple spine surgery, hypertension, cerebrovascular disease, pulmonary disease, duration of surgery, and infused IV fluid volume. Nurses who provide perioperative care for older adult patients undergoing spine surgery should be aware of the potential risk factors of delirium to ensure patient safety. Further research is required to clearly delineate the risk factors for postoperative delirium in older adults.
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