A personality trait contributes to the occurrence of postoperative delirium: a prospective study

Abstract

BackgroundAlthough various physical risk factors for delirium have been identified, the effect of psychological aspects is currently unknown. This study aimed to examine psychological risk factors for postoperative delirium and to identify hidden subgroups of delirium in clinical and psychological feature space.MethodsAmong 200 patients with hip fracture, 78 elderly patients were prospectively evaluated for clinical and psychological assessments before surgery. As delirium was assessed from the next day to the 7th day after surgery, postoperative delirium was found in 40 patients, but not in 38 patients. Univariate and multivariate logistic regression analyses were used to explore risk factors for postoperative delirium. Phenotypic subgroups of delirium were assessed using Topological Data Analysis, in which the significant risk factors were used for evaluating filter and distance metrics.ResultsMini-Mental State Examination, neuroticism, conscientiousness, and regional anesthesia were identified as a predictive risk factor for postoperative delirium. The filter metric showed significant negative correlations with nutrition-related factors such as total protein and albumin. When filter metric and Euclidean distances were entered, delirious patients were bifurcated as a function of personality traits and anesthesia method in the patient-patient network.ConclusionsA personality trait of neuroticism and conscientiousness may predispose elderly patients to postoperative delirium and this influence may be amplified by regional anesthesia. This study verifies the contribution of psychological risk factors to delirium and provides new insight for complex etiologies of delirium by mapping various clinical variables in the topological space.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-1079-z) contains supplementary material, which is available to authorized users.

Decreased Cerebral Glucose Metabolism in Elderly Patients with Postoperative Delirium: A Case-Control Study

“…A higher incidence was reported in the elderly, most medically complex patients after vascular, cardiac, or hip fracture operations (1)(2)(3)(4)(5)(6)(7)(8). In our study, the incidence of POD was 1.9% (42/2195) of 2195 patients who underwent major abdominal surgery, lower than the reported incidence of POD.…”

“…POD usually begins during the first 24 h after surgery and mostly disappears within the first 4 days after surgery (2)(3)(4)(5)(6)(7). Although the duration of POD is short, it is closely associated with longer hospital stay, greater cognitive impairment, increased postoperative morbidity, mortality, and higher health care costs (1)(2)(3)(4)(5)(6)(7)(8). Thus, the prevention and treatment of POD become one of aims to improve the quality of medical care for elderly patients (1).…”

Impact of Delirium on Short-term Prognosis in Geriatric Patients with Hip Fracture

“…Compared with some research hotspots such as deep vein thrombosis, pulmonary embolism, and cardiovascular and cerebrovascular diseases of the lower extremities, POD is a common phenomenon, but it is easily ignored by orthopedic surgeons in elderly patients with hip fractures. Probably because POD is often an acute transient abnormality, resulting in missed diagnosis and misdiagnosis, which may lead to patients not receiving timely, reasonable, and effective intervention 6,[11][12][13] . In this study, we found that POD may be associated with a series of early adverse prognoses.…”

“…Therefore, POD needs to be treated as soon as possible to be corrected in time. Previous studies reported that delirium results from the combined effects of environmental, pathological, and physiological factors 6,11,12 . Thus, early treatment should not just be symptomatic use of antipsychotic drugs such as haloperidol, olanzapine, and aripiprazole, but should also involve etiological treatments to reduce pain and suffering, correct hypoproteinemia and anemia, restore water and electrolyte balance, provide adequate oxygen inhalation and nutritional support, ensure good sleep, and allow patients to carry out early functional exercises.…”

Cognitive Dysfunction after Surgery: An Emergent Problem

“…Although several pathologies have been identified as risk factors, for postoperative delirium, the physiological factors have an important role. Patients undergoing hip surgery regional anaesthesia have unexpected major risk factors, for postoperative delirium, while the recent administration of low doses of Dexmedetomidine has significantly reduced these complications, although there is no convincing evidence showing the effectiveness of a pharmacological treatment or prevention [13][14][15]. Delirium remains grossly unrecognized, during routine clinical practice, and should be handled as a true emergency.…”