A Simple Model for Predicting Postoperative Delirium in Older Patients Undergoing Elective Orthopedic Surgery

Fisher, Bruce; Flowerdew, Gordon

doi:10.1111/j.1532-5415.1995.tb06385.x

Cited by 117 publications

(98 citation statements)

References 20 publications

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“…The negative results of Figiel et al, 42 Fisher and Flowerdew, 26 and WilliamsRusso et al 21 could be explained by the healthier and less-demented population they studied. Other probable risk factors include advanced age, abnormal blood urea nitrogen/creatinine ratio, abnormal sodium or potassium level, alcohol abuse, sensory impairment, and medications.…”

Section: Discussionmentioning

confidence: 66%

“…Schor et al 38 and Bergmann and Eastham, 31 respectively, found living in an institution and having little contract with relatives to be risk factors. Race, 34 marital status, 34 education, 26 and first language other than English 26 had no association.…”

Section: Risk Factor Analysismentioning

confidence: 89%

“…Clock-drawing abnormality, to a certain extent a reflection of cognitive impairment, also was shown in one study to predict development of delirium. 26 History of nocturnal confusion, 26 history of delirium, 13,26 and a preoperative measure of anxiety 22 showed no association. Depression was found to have an association in only two of six studies, but the combined OR of 1.9 was statistically significant (95% CI 1.3, 2.6).…”

Section: Risk Factor Analysismentioning

confidence: 98%

“…Most studies found no association between urinary or fecal incontinence and delirium. 26 Laboratory Findings. Of the 12 biochemical parameters studied, blood urea nitrogen/creatinine ratio and sodium or potassium abnormalities were significant risk factors most often.…”

Section: Risk Factor Analysismentioning

confidence: 99%

“…26 Other surgical risks were unplanned surgery 22 and low mobility after surgery. 25 Not shown to have an influence on the development of delirium were surgical technique, 19 number of previous surgeries, 26 time between surgeries, 19 type of anesthesia, 19 and surgery duration. 19 Furthermore, Schor et al did not find surgery in itself a risk factor for their mixed medicalsurgical population.…”

Section: Surgery and Anaesthesia Marcantonio Et Al Demonstratedmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 66%

Section: Risk Factor Analysismentioning

confidence: 89%

Section: Risk Factor Analysismentioning

confidence: 98%

Section: Risk Factor Analysismentioning

confidence: 99%

Section: Surgery and Anaesthesia Marcantonio Et Al Demonstratedmentioning

confidence: 99%

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Delirium risk factors in elderly hospitalized patients

et al. 1998

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Preventable Medical Injuries in Older Patients

Rothschild¹,

Bates²,

Leape³

2000

Arch Intern Med

257

151

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Injuries associated with hospitalization are more common in older (>/=65 years) than in younger patients (<65 years), and they may be more severe and more often preventable. The increasing age of the population magnifies the importance of this problem. In this review, we first consider medical injuries in general and then review the literature for 6 categories: adverse drug events, falls, nosocomial infections, pressure sores, delirium, and surgical and perioperative complications. For each of these categories, older patients appear to be at higher risk, ranging from a 2.2-fold increase for perioperative complications to a 10-fold increase for falling, based on Harvard Medical Practice Study rates. The main cause of these increased risks appears to be the diminished physiological reserve of elderly patients; however, age alone is a less important predictor of adverse events than comorbidities and functional status. Furthermore, many of these complications appear to be preventable, although the proportion preventable varies by type of complication. While some prevention strategies are specifically beneficial in older patients, many apply to all age groups. Geriatric care units and consultation systems have improved outcomes in some instances, although the data are mixed. The success of intervention varies by type of complications. For medications, various interventions have been successful, and fall prevention programs have been demonstrated to be effective in the nursing home and home.

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Predisposing and Precipitating Factors Associated With Delirium

et al. 2023

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ImportanceDespite discrete etiologies leading to delirium, it is treated as a common end point in hospital and in clinical trials, and delirium research may be hampered by the attempt to treat all instances of delirium similarly, leaving delirium management as an unmet need. An individualized approach based on unique patterns of delirium pathophysiology, as reflected in predisposing factors and precipitants, may be necessary, but there exists no accepted method of grouping delirium into distinct etiologic subgroups.ObjectiveTo conduct a systematic review to identify potential predisposing and precipitating factors associated with delirium in adult patients agnostic to setting.Evidence ReviewA literature search was performed of PubMed, Embase, Web of Science, and PsycINFO from database inception to December 2021 using search Medical Subject Headings (MeSH) terms consciousness disorders, confusion, causality, and disease susceptibility, with constraints of cohort or case-control studies. Two reviewers selected studies that met the following criteria for inclusion: published in English, prospective cohort or case-control study, at least 50 participants, delirium assessment in person by a physician or trained research personnel using a reference standard, and results including a multivariable model to identify independent factors associated with delirium.FindingsA total of 315 studies were included with a mean (SD) Newcastle-Ottawa Scale score of 8.3 (0.8) out of 9. Across 101 144 patients (50 006 [50.0%] male and 49 766 [49.1%] female patients) represented (24 015 with delirium), studies reported 33 predisposing and 112 precipitating factors associated with delirium. There was a diversity of factors associated with delirium, with substantial physiological heterogeneity.Conclusions and RelevanceIn this systematic review, a comprehensive list of potential predisposing and precipitating factors associated with delirium was found across all clinical settings. These findings may be used to inform more precise study of delirium’s heterogeneous pathophysiology and treatment.

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A Simple Model for Predicting Postoperative Delirium in Older Patients Undergoing Elective Orthopedic Surgery

Abstract: A simple model using clock-drawing scores and male gender for preoperative identification of elective patients at greatest risk for POD appears sensitive, predictive, and practical for the preadmission clinic setting, but it should be validated in a prospective trial.

Cited by 117 publications

References 20 publications

Delirium risk factors in elderly hospitalized patients

Delirium risk factors in elderly hospitalized patients

Preventable Medical Injuries in Older Patients

Predisposing and Precipitating Factors Associated With Delirium

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