Acute confusional state in elderly orthopaedic patients: factors of importance for detection in nursing care

Andersson, Edith; Gustafson, Lars; Hallberg, Ingalill Rahm

doi:10.1002/1099-1166(200101)16:1<7::aid-gps261>3.0.co;2-w

Cited by 54 publications

(63 citation statements)

References 35 publications

(46 reference statements)

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“…Since this publication, 21 prospective studies have investigated this topic [17,[56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75]. In addition, one systematic review studied postoperative risk factors for delirium [76].…”

Section: Risk Factorssupporting

confidence: 86%

Delirium: Guidelines for general hospitals

Michaud

Büla²,

Berney³

et al. 2007

Journal of Psychosomatic Research

128

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Section: Risk Factorssupporting

confidence: 86%

Delirium: Guidelines for general hospitals

Michaud

Büla²,

Berney³

et al. 2007

Journal of Psychosomatic Research

128

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“…This fact suggests that intensive postoperative management of pain, blood sugar levels, and patient discomfort should be conducted as soon as the patient leaves the operating room and should be sustained until at least postoperative day 3. The factors associated with the development of POD in our study were similar to those identified in previous reports [1][2][3][4]7,[13][14][15][16][17][18]27) . Surprisingly, we could not obtain any significant relationship between brain surgery and POD, regardless of disease category or surgery, such as performed on microscope or by naked-eye.…”

Section: Incidence and Risk Factors Of Podmentioning

confidence: 68%

“…Moreover, as the population becomes older as a whole, the incidence of POD is also likely to increase accordingly, as proven by previous literature 1,4) . In this study, we investigated the real incidence and risk factors of POD in elderly neurosurgical patients.…”

Section: Introductionmentioning

confidence: 99%

Incidence and Risk Factors of Acute Postoperative Delirium in Geriatric Neurosurgical Patients

Kim

et al. 2008

J Korean Neurosurg Soc

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Objective : Postoperative delirium (POD) is characterized by an acute change in cognitive function and can result in longer hospital stays, higher morbidity rates, and more frequent discharges to long-term care facilities. In this study, we investigated the incidence and risk factors of POD in 224 patients older than 70 years of age, who had undergone a neurosurgical operation in the last two years. Methods : Data related to preoperative factors (male gender, >70 years, previous dementia or delirium, alcohol abuse, serum levels of sodium, potassium and glucose, and co-morbidities), perioperative factors (type of surgery and anesthesia, and duration of surgery) and postoperative data (length of stay in recovery room, severity of pain and use of opioid analgesics) were retrospectively collected and statistically analyzed. Results : POD appeared in 48 patients (21.4%) by postoperative day 3. When we excluded 26 patients with previous dementia or delirium, 17 spontaneously recovered by postoperative day 14, while 5 patients recovered by postoperative 2 months with medication, among 22 patients with newly developed POD. The univariate risk factors for POD included previously dementic or delirious patients, abnormal preoperative serum glucose level, pre-existent diabetes, the use of local anesthesia for the operation, longer operation time (>3.2 hr) or recovery room stay (>90 min), and severe pain (VAS>6.8) requiring opioid treatment (p<0.05). Backward regression analysis revealed that previously dementic patients with diabetes, the operation being performed under local anesthesia, and severe postoperative pain treated with opioids were independent risk factors for POD. Conclusion : Our study shows that control of blood glucose levels and management of pain during local anesthesia and in the immediate postoperative period can reduce unexpected POD and help preventing unexpected medicolegal problems and economic burdens.

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“…Two research members (KSC, JKL) and the nursing staff were trained to focus on the symptoms of delirium and for assessing mental status using the observational guidelines based on the CAM and DSM IV. The symptoms included acute onset; fluctuating course; inattention; disorganized thinking; disturbance of consciousness; disorientation of patients to their own identity, time, and current situation; disturbances developing over a short period of time; and altered sleep/wake cycles (Andersson, Gustafson, & Hallberg, 2001;Rade, Yadeau, Ford, & Reid, 2011). Two research members checked the patient's mental status twice per day, in the morning and evening, and the nursing staff checked the patient's mental status during the day and night after the operation.…”

Section: Study Design and Participantsmentioning

confidence: 99%