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Postoperative delirium. A review of 80 primary data-collection studies

Postoperative delirium. A review of 80 primary data-collection studies,10.1001/archinte.155.5.461,Archives of Internal Medicine,C. B. Dyer

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Postoperative delirium. A review of 80 primary data-collection studies   (Citations: 121)
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Journal: Archives of Internal Medicine - ARCH INTERN MED , vol. 155, no. 5, pp. 461-465, 1995
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    • ...Postoperative delirium is common after certain surgical procedures with a reported incidence as high as 20-60%[34]...

    Basem Abdelmalak, et al. Design and Organization of the Dexamethasone, Light Anesthesia and Tig...

    • ...Age was also a risk factor in the studies reviewed by Dyer et al. [11], which included studies of patients of different age groups but few studies of general surgery...

    Mitsuyoshi TeiMasataka, et al. Risk factors for postoperative delirium in elderly patients with color...

    • ...However, in a review of 17 studies performed with different types of surgical patients who had delirium risk factors, sleep deprivation was not a risk factor for delirium [96]...

    Milagros I. Figueroa-Ramos, et al. Sleep and delirium in ICU patients: a review of mechanisms and manifes...

    • ...According to this method, the confusional state is assessed when it occurs after the first 24 postoperative hours. The 1st postoperative day is excluded because of the difficulty of distinguishing true delirium from the residual effects of anesthesia.The groups of patients with and without postoperative delirium were compared using the Student t test. A stepwise logistic regression was used to determine which parameter was the most predictive for postoperative delirium. All the variables from univariate analysis with p < 0.2 were included in the stepwise logistic regression analysis.ResultsOne hundred and one patients and their informants were enrolled and completed the questionnaire. The female:male ratio was 1.3:1 (58 F, 43 M) with a mean age of 73.6 ± 6.6 years. Fifteen patients had past neurologic or psychiatric problems. There were no cases of dementia. On admission, one third of the patients were treated with either neuroleptics or antidepressants or anxiolytic drugs. The informants were the spouse (70%) or the children. The mean MMSE score was 26 ± 3, and the mean short IQCODE score was 50.7 ± 6.2. Hip surgery was performed in 58 patients, and 43 patients underwent knee prosthesis implantation. The mean length of surgery was 1.6 ± 0.4 h. The mean blood loss during the surgical procedure was 351 ± 283 ml, and 56.5% of patients had a decline of their systolic blood pressure to 80 mm Hg or less intraoperatively.Postoperative delirium was noted in 15 patients (14.8%) and always occurred on the 2nd or 3rd day after surgery. The comparisons between the two groups (with/without delirium) are shown in table 1. The patients with confusion were significantly older and more often had undergone knee surgery. The MMSE scores of the patients and the short IQCODE scores according to the answers of the informants were significantly different between the two groups of patients. The mean MMSE score was significantly lower (p = 0.02) and the mean short IQCODE score significantly higher in patients with postoperative delirium (p = 0.0001). Twelve patients with delirium (80%) had a short IQCODE score >50, while only 34% of the other patients had such a score (p < 0.001). The stepwise logistic regression analysis showed that age (OR 1.2, 95% CI 1–1.5; p = 0.004), a short IQCODE score >50 (OR 12.7, 95% CI 1.4–115.5; p = 0.02), and current medications with psychotropic drugs (OR 7.5, 95% CI 1.7–37.4; p = 0.01) were the main predictors of postoperative delirium (table 2). The sensitivity to predict postoperative delirium for a mean short IQCODE score >50 is 80%, and the specificity is 66%.The length of hospitalization was the same in the two groups, with a mean hospital stay of 9.1 ± 2.6 days.DiscussionDelirium is a common complication after surgery in the elderly, occurring in >30% of the cases [...

    Mathieu Priner, et al. Usefulness of the Short IQCODE for Predicting Postoperative Delirium i...

    • ...Cognitive decline usually begins immediately after surgery (Silbert et al, 2001), peaks within 3 days (Dyer, Ashton, & Teasdale, 1995), and recovers in most patients by 1 week after the surgery, although in a small number of cases it might still be evident even 1–2 years after surgery (Abildstrom et al, 2000)...

    Benzion Beilin, et al. Comparison of two patient-controlled analgesia techniques on neuropsyc...

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