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Sundar S, Biggs S, Abraham M, Cook J, Watts N, Price R, Brack M, Brown N, Dixon L, Crowther O, Trenaman R, Quinn D, Hall W, Younie S. 1232 Trust-Wide Assessment of Delirium in Post-Operative Elective Surgery. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
Delirium is an acute change in cognition and associated with adverse patient outcomes. The incidence of post-operative delirium after elective non-cardiac surgery is unknown. We aimed to assess the incidence of post-operative delirium in this group and the effect on patient outcomes.
Method
Patients aged 65 and over who underwent elective non-cardiac surgery were identified on post-operative day three. Delirium screening was performed in real time using the validated 4-AT assessment tool. A retrospective review of the patients’ preoperative and perioperative record was conducted to collect demographics and identify risk factors for delirium. Outcome data was collected at 30 days. Patients with a positive delirium score (>4) underwent a more in-depth assessment and managing teams given a delirium management pack.
Results
75 (39 male) consecutive patients were screened over a period of 4 months. Median age 77 years and 18% had frailty assessed as “vulnerable”. The majority of patients (37.3%) underwent thoracic surgery, followed by hepatobiliary (17.3%), gynaecological (17.3%), colorectal (12%), maxillofacial (9.3%) and ENT (4%). 5.3% (4) of patients had a positive 4-AT screen. No patients had a formal delirium screen or diagnosis in the initial 48 hours. The median length of stay for patients with a positive screen was 8.5 days (IQR 7.5-12) compared to 8 days (IQR 5-13) for patients with a negative screen.
Conclusions
Reassuringly, rate of post-operative delirium following elective operations in our Trust are low (5%). Larger numbers of patients are required to assess the impact this has on patient outcomes and identify correlation with risk factors.
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Affiliation(s)
- S Sundar
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - S Biggs
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - M Abraham
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - J Cook
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - N Watts
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - R Price
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - M Brack
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - N Brown
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - L Dixon
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - O Crowther
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - R Trenaman
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - D Quinn
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - W Hall
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - S Younie
- Bristol Royal Infirmary, Bristol, United Kingdom
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