A Clinical Prediction Rule for Delirium after Elective Noncardiac Surgery

Marcantonio, Edward R.; Goldman, Lee; Mangione, Carol M.; Ludwig, Lynn E.; Muraca, B.; Haslauer, Carla M.; Donaldson, Magruder C.; Whittemore, Anthony D.; Sugarbaker, David J.; Poss, Robert; Haas, Susan; Cook, E. Francis; Orav, John; Lee, T. H.

doi:10.1097/00132586-199410000-00031

Cited by 180 publications

(323 citation statements)

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“…[17][18][19] Le tableau 1 présente de façon détaillée un modèle représentatif de prédiction du risque conçu pour une population non sélectionnée de patients subissant une chirurgie non cardiaque. 18 Dans une synthèse systématique récente évaluant les modèles de prédiction du risque médical et chirurgical, plusieurs thèmes communs ont été identifiés parmi les différentes variables prédictives décrites; la rapidité et la gravité de la lésion physique, ainsi que les comorbidités du patient semblent être les caractéristiques essentielles pour prédire la survenue d'un delirium après l'intervention chirurgicale. 20 Une chirurgie réalisée en urgence (rapidité d'apparition) expose les patients un risque particulièrement élevé de delirium.…”

Section: é Léments Prédictifsunclassified

“…[17][18][19] A representative riskprediction model designed for an unselected population of non-cardiac surgical patients is detailed in Table 1. 18 In a recent systematic review assessing the available medical and surgical risk-prediction models, several common themes were identified among the variety of predictor variables reported; the rapidity and severity of the physical insult and the patient's comorbidities appear as the key features predicting delirium following surgery. 20 Surgery performed on an emergency basis (rapidity of onset) places patients at a uniquely high risk of delirium.…”

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Postoperative delirium: risk factors and management: Continuing Professional Development

Chaput

Bryson

2012

Can J Anesth/J Can Anesth

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Purpose Postoperative delirium often remains undiagnosed and therefore untreated. The purpose of this continuing professional development module is to identify patients at high risk of developing delirium following noncardiac surgery and to provide tools to aid in the diagnosis of delirium at the bedside. Optimal prevention and treatment strategies are recommended. Principal findings Delirium is characterized by an acute onset and a fluctuating course, inattention, disorganized thinking and an altered level of consciousness, and occurs in up to 40% of patients in the perioperative period. The pathophysiology of delirium is multifactorial, but it is believed to be related to inflammation, altered neurotransmission, and stress in the patient who has had surgery. Acetylcholine and dopamine appear to play a significant role. There is an increased risk of a poor outcome in patients who develop delirium, including a longer hospital stay and death. Surgical and patient factors play a significant role in predicting who will subsequently develop delirium. Prevention is much more effective than treatment in the management of delirium. The most effective prevention strategies include proactive geriatric assessment and care of the patient on a geriatrics surgical ward as well as prophylactic low-dose antipsychotic agents. From an anesthetic perspective, evidence in some surgical populations would support the use of regional techniques and minimal sedation. If delirium develops, treatment with lowdose oral antipsychotics appears to be most effective.Conclusions Delirium is a serious condition that must be recognized early and treated promptly to minimize deleterious outcomes. In order to institute prevention strategies and treat the condition effectively when it occurs, the anesthesiologist must be vigilant in identifying patients at risk and in screening for this condition. Objectives of this Continuing Professional Development (CPD) module:After reading this module, the reader should be able to:1. Define delirium in the context of other cognitive changes following non-cardiac surgery. 2. Understand the incidence and adverse outcomes associated with delirium. 3. List predisposing and precipitating factors of postoperative delirium and identify the patient at risk. 4. Explain the underlying pathophysiologic mechanisms believed to be implicated in causing delirium. 5. Formulate an anesthetic plan that minimizes the risk of developing postoperative delirium. 6. Devise a management plan to treat postoperative delirium most effectively while minimizing the adverse effects of treatment.Like other Western nations, Canada's population is aging rapidly. Over the past 50 years, the proportion of Canadians over the age of 65 has risen from 7.7% to 13.7%. A Statistics Canada estimates that the proportion of seniors will double 123Can J Anesth/J Can Anesth (2012) 59:304-320 DOI 10.1007 yet again by 2036 and will represent 23-25% of Canada's population. B This rapid demographic shift will impact anesthesiologists and hospitals ...

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Section: é Léments Prédictifsunclassified

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Postoperative delirium: risk factors and management: Continuing Professional Development

Chaput

Bryson

2012

Can J Anesth/J Can Anesth

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“…12,13 Inconsistent results in the above studies, however, make it difficult to draw conclusions. For example, the presence of dementia was found to be a risk factor in most studies, 2,11-13 but other risk factors such as anticholinergic medications, laboratory abnormalities, and psychiatric disorders, commonly believed to increase the risk of delirium, have shown conflicting results.…”

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“…For example, the presence of dementia was found to be a risk factor in most studies, 2,11-13 but other risk factors such as anticholinergic medications, laboratory abnormalities, and psychiatric disorders, commonly believed to increase the risk of delirium, have shown conflicting results. 1,11,12 This may be due to varying methods for detection of delirium and identification of risk factors. Also, different risk factors may be particular to the surgical, medical, or psychiatric geriatric population.…”

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Delirium risk factors in elderly hospitalized patients

et al. 1998

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OBJECTIVE: Delirium is frequent in elderly hospitalized patients. Many studies have examined its risk factors, but results have been quite variable. Thus, the goal of this study is to identify through systematic literature review the risk factors associated with the development of delirium in hospitalized geriatric patients. MEASUREMENTS AND MAIN RESULTS:First, MEDLINE / CURRENT CONTENTS databases were screened for relevant articles published from 1966 to December 1995, and from bibliographies of identified articles additional reports were selected. Second, the reports were screened by two different investigators and retained only if meeting the five following criteria: (1) original research in French or English; (2) prospective study; (3) patients over age 50; (4) minimum of one risk factor examined; (5) acceptable definition of delirium. Third, the methodology of each study was graded according to specific criteria for risk factor studies. Fourth, risk factors were identified and tabulated, unadjusted odds ratios (ORs) were computed, and where appropriate a combined OR with the Mantel-Haenszel estimator was calculated. Twenty-seven articles were retained meeting all of the above criteria. Among these studies, 11 were done on medical patients, 9 on surgical patients, 2 on medical and surgical patients, and 5 on psychiatric patients. In total 1,365 subjects with delirium were studied. Sixty-one different risk factors were examined, the five most common being dementia, medication, medical illness, age, and male gender. Mantel-Haenszel estimator was calculated for 10 risk factors, the most strongly associated being dementia (OR 5.2; 95% confidence interval [CI] 4.2, 6.3), medical illness (OR 3.8; 95% CI 2.2, 6.4), alcohol abuse (OR 3.3; 95% CI 1.9, 5.5), and depression (OR 1.9; 95% CI 1.3, 2.6). Methodologic weaknesses were present in many studies.

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“…A number of risk factors are reported for POD, including older age, preoperative cognitive or functional impairment, decreased postoperative hemoglobin, markedly abnormal sodium potassium and glucose, the presence of alcohol abuse, noncardiac thoracic surgery, aortic aneurysm surgery, history of delirium, preoperative use of narcotics, low postoperative oxygen saturation, history of cerebrovascular disease, and untreated pain [6,7].…”

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Is postoperative delirium a relevant outcome?

Egi

2015

J Anesth

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A Clinical Prediction Rule for Delirium after Elective Noncardiac Surgery

Cited by 180 publications

References 4 publications

Postoperative delirium: risk factors and management: Continuing Professional Development

Postoperative delirium: risk factors and management: Continuing Professional Development

Delirium risk factors in elderly hospitalized patients

Is postoperative delirium a relevant outcome?

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