An update on delirium in the postoperative setting: Prevention, diagnosis and management

Shim, J. Jewel; Leung, Jacqueline M.

doi:10.1016/j.bpa.2012.08.003

Cited by 41 publications

(27 citation statements)

References 95 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Levkoff et al (1996) and others assert that delirium symptoms represent a spectrum of neurobehavioral impairments rather than a condition with distinct clinical profiles and outcomes (Levkoff et al, 1996; Ouimet et al, 2007; Shim & Leung, 2012). However, others question the notion that subsyndromal delirium is a graded step in the spectrum of brain dysfunction severity due to differences in risk factors (Skrobik, 2009).…”

Section: Introductionmentioning

confidence: 99%

Preoperative Risk Factors for Subsyndromal Delirium in Older Adults Who Undergo Joint Replacement Surgery

Denny

Lindseth

2017

Orthopaedic Nursing

View full text Add to dashboard Cite

Background Older adults with subsyndromal delirium have similar risks for adverse outcomes following joint replacement surgery as those who suffer from delirium. Purpose This study examined relationships among subsyndromal delirium and select preoperative risk factors in older adults following major orthopaedic surgery. Methods Delirium assessments of a sample of 62 adults age 65 or older were completed on postoperative day 1, 2, and 3 following joint replacement surgery. Data were analyzed for relationships among delirium symptoms and the following preoperative risk factors: increased comorbidity burden, cognitive impairment, fall history, and preoperative fasting time. Results Postoperative subsyndromal delirium occurred in 68% of study participants. A recent fall history and a longer preoperative fasting time were associated with delirium symptoms (p ≤ .05). Conclusions Older adults with a recent history of falls within the past 6 months or a longer duration of preoperative fasting time may be at higher risk for delirium symptoms following joint replacement surgery.

show abstract

Section: Introductionmentioning

confidence: 99%

Preoperative Risk Factors for Subsyndromal Delirium in Older Adults Who Undergo Joint Replacement Surgery

Denny

Lindseth

2017

Orthopaedic Nursing

View full text Add to dashboard Cite

show abstract

“…Postoperative delirium is associated with longer hospital stays, worse functional outcomes, higher healthcare costs, and increased mortality. 1 Delirium develops through a complex interaction between the patient's baseline vulnerability (predisposing risk factors before hospitalization) and precipitating factors or insults (events that occur during hospitalization). Some of the vulnerability factors identifi ed include advanced age, cognitive impairment or dementia, and preexisting comorbidities.…”

mentioning

confidence: 99%

Preoperative Sleep Disruption and Postoperative Delirium

Leung

Sands

Newman

et al. 2015

Journal of Clinical Sleep Medicine

Self Cite

View full text Add to dashboard Cite

Study Objectives: To describe preoperative and postoperative sleep disruption and its relationship to postoperative delirium. Design: Prospective cohort study with 6 time points (3 nights pre-hospitalization and 3 nights post-surgery). Setting: University medical center. Patients: The sample consisted of 50 English-speaking patients ≥ 40 years of age scheduled for major non-cardiac surgery, with an anticipated hospital stay ≥ 3 days. Interventions: None. Measurements and results: Sleep was measured before and after surgery for a total of 6 days using a wrist actigraph to quantify movement in a continuous fashion. Postoperative delirium was measured by a structured interview using the Confusion Assessment Method. Sleep variables for patients with (n = 7) and without (n = 43) postoperative delirium were compared using the unpaired Student t-tests or χ 2 tests. Repeated measures analysis of variance for the 6 days was used to examine within-subject changes over time and between group differences. The mean age of the patients was 66 ± 11 years (range 43-91 years), and it was not associated with sleep variables or postoperative delirium. The incidence of postoperative delirium observed during any of the 3 postoperative days was 14%. For the 7 patients who subsequently developed postoperative delirium, wake after sleep onset (WASO) as a percentage of total sleep time was signifi cantly higher (44% ± 22%) during the night before surgery compared to the patients who did not subsequently developed delirium (21% ± 20%, p = 0.012). This sleep disruption continued postoperatively, and to a greater extent, for the fi rst 2 nights after surgery. Patients with WASO < 10% did not experience postoperative delirium. Self-reported sleep disturbance did not differ between patients with vs. without postoperative delirium. D elirium is a major challenge facing geriatric practice due to its prevalence, complex etiology, and potential severe impact on patients. Postoperative delirium is associated with longer hospital stays, worse functional outcomes, higher healthcare costs, and increased mortality.1 Delirium develops through a complex interaction between the patient's baseline vulnerability (predisposing risk factors before hospitalization) and precipitating factors or insults (events that occur during hospitalization). Some of the vulnerability factors identifi ed include advanced age, cognitive impairment or dementia, and preexisting comorbidities.2,3 Over the last two decades, a large body of literature has focused on the clinical manifestations, risk factors and outcomes of postoperative delirium. Sleep disruption, in particular, has frequently been cited as an important etiological factor associated with the development of delirium. 4 Sleep disturbance, especially sleep fragmentation, and poor sleep quality are commonly observed in older adults. In the hospital, environmental factors and health care practices further contribute to sleep disruption. BRIEF SUMMARYCurrent Knowledge/Study Rationale: Sleep disruption has frequently ...

show abstract

“…The financial burden of delirium is staggering, totalling more than $16,303 to $64,421 per patient, with direct 1-year health costs estimated to exceed $143 to $152 billion [8,9]. Unsurprisingly, the United States has seen rapid growth of multicomponent interventional and educational programs aimed to prevent, screen, and reduce delirium occurrence and its complications [6,10].…”

Section: Introductionmentioning

confidence: 99%

“…Often underrecognized, if left untreated delirium is associated with serious health and quality-of-life consequences, including increased risk of morbidity and mortality, as well as greater functional dependence after discharge. Overall delirium incidence ranges widely, from 14-56% of hospitalized older patients, with a reported 9-65% incidence in those patients undergoing orthopedic fracture repair [2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

We can Do it: Nursing Educational Intervention to Increase Delirium Documentation

Chow

Mujahid²,

Butterfield³

et al. 2015

J Gerontol Geriatr Res

View full text Add to dashboard Cite

show abstract

An update on delirium in the postoperative setting: Prevention, diagnosis and management

Cited by 41 publications

References 95 publications

Preoperative Risk Factors for Subsyndromal Delirium in Older Adults Who Undergo Joint Replacement Surgery

Preoperative Risk Factors for Subsyndromal Delirium in Older Adults Who Undergo Joint Replacement Surgery

Preoperative Sleep Disruption and Postoperative Delirium

We can Do it: Nursing Educational Intervention to Increase Delirium Documentation

Contact Info

Product

Resources

About