Adverse Outcomes of Geriatric Patients Undergoing Abdominal Surgery Who Are at High Risk for Delirium

Abstract

Hypothesis: Among geriatric patients undergoing abdominal surgery who are at high risk for in-hospital delirium, clinical factors associated with delirium correlate with adverse outcomes. Design: Retrospective case series study. Setting: University-affiliated referral hospital. Patients: Among 228 consecutive patients 70 years or older who underwent major abdominal surgery from September 1, 2002, through December 31, 2003, 89 patients with risk factors for delirium were included in the study. Main Outcome Measures: Preoperative, intraoperative, and postoperative clinical factors known to affect the incidence of in-hospital delirium were tested for correlation with adverse outcomes. Incidence of delirium, mortality, and prolonged length of stay (LOS) of 14 days or longer were evaluated as adverse outcomes. Results: Postoperative delirium occurred in 60%, death in 20%, and prolonged LOS in 32% of patients. Multivariate analysis identified independent predictors of adverse outcomes. Poor preoperative functional and nutritional status correlated with postoperative delirium and mortality. Inadequate postoperative glycemic control also correlated with mortality. Complications in 2 or more organ systems and postoperative hypoalbuminemia (albumin level Ͻ3.0 mg/dL[Ͻ.003 g/dL; to convert to grams per liter, multiply by 10]) correlated with prolonged LOS. Suboptimal care was identified in the following clinical areas: use of precipitative medications, prolonged bedrest, uncontrolled pain, hypoxia, and glycemic control. Conclusions: In a subset of geriatric patients undergoing abdominal surgery who are at high risk for inhospital delirium, adverse outcomes correlated only with key clinical variables, such as hyperglycemia and poor nutritional and functional states. A high incidence of suboptimal care was observed in several clinical areas, suggesting opportunities for intervention.

Postoperative Course After Emergency Colorectal Surgery for Secondary Peritonitis in the Elderly Is Often Complicated by Delirium

“…This is close to our mortality rate of 14.4%. As mortality is considerable in these patients and delirium further seems to complicate the postoperative course, 4,17,18 surgeons in clinical practice strive to dispose of reliable and objective instruments to classify a patient's risk for the development of postoperative delirium. In emergency situations, detailed medical and social histories of the patients are often hard to investigate and therefore functional assessment, like the Charlson index, is difficult to obtain.…”

“…As the management of surgical and systemic postoperative complications in these patients is a challenge, the postoperative course may further be complicated by delirium. [4][5][6][7] Specific research has been performed to describe and understand the risk factors that favor the development of a postoperative delirium. Known risk factors include poor preoperative functional status, cognitive impairment, depression, alcoholism, vascular disease, comorbidity, and older age.…”

“…Known risk factors include poor preoperative functional status, cognitive impairment, depression, alcoholism, vascular disease, comorbidity, and older age. 4,[8][9][10][11][12][13][14][15][16] Delirium is associated with a poorer postoperative outcome and it prolongs the hospital stay. Furthermore long-term cognitive function of the patients who suffered from postoperative delirium can be impaired with a poor functional status.…”

“…Furthermore long-term cognitive function of the patients who suffered from postoperative delirium can be impaired with a poor functional status. 4,17,18 Often surgeons lack reliable instruments to evaluate risk factors for the development of postoperative delirium in an emergency setting. It is not known whether preoperative evaluable physiologic scores correlate with the development of postoperative delirium.…”

Delirium after Abdominal Surgery at a Surgical Ward with a High Standard of Delirium Care: Incidence, Risk Factors and Outcomes

“…Only a few small studies evaluated the incidence and risk factors for delirium after abdominal surgery [1, 2, 23, 24]. …”