Incidence and risk factors of postoperative delirium in elderly patients undergoing urological surgery: A multi‐institutional prospective study

Abstract

Objectives To investigate the incidence and risk factors of postoperative delirium among patients aged ≥65 years undergoing elective urological surgery. Methods From April 2015 through December 2016, 1023 consecutive patients aged ≥65 years who received transurethral, laparoscopic (with or without robot assistance) or open surgery in eight institutions were enrolled in this prospective observational study. Their preoperative cognitive status was assessed with the Hasegawa Dementia Scale‐Revised score. The treating physician or nurse assessed delirium using the Intensive Care Delirium Screening Checklist. Multivariate logistic regression analysis was used to determine predictive factors for postoperative delirium. Results We analyzed 946 patients whose median age was 74 years (range 65–95 years). Postoperative delirium was observed in 32 patients (3.4%). Multivariate analysis showed that a history of cerebrovascular disease (odds ratio 5.24, 95% confidence interval 2.05–13.40), low Hasegawa Dementia Scale‐Revised score <20 points (odds ratio 3.50, 95% confidence interval 1.36–9.02), low serum albumin level <3.5 g/dL (odds ratio 3.12, 95% confidence interval 1.25–7.83) and long surgery duration >4 h (odds ratio 4.94, 95% confidence interval 2.20–11.10) were independent risk factors for the development of postoperative delirium. Conclusions The preoperative medical history, cognitive status, low serum albumin level and operative duration were associated with the development of postoperative delirium, although the incidence was just 3.4% in elective urological surgery. The present results suggest that the Hasegawa Dementia Scale‐Revised is a useful tool for assessment of the risk for delirium.

Incidence and risk factors of post operative delirium in elderly patients who underwent spinal anesthesia in Orotta, Halibet and Sembel Hospitals: A Cross sectional analytic study in ERITREA

“…This findings supported by Ozbas et al, (2018), which shows a higher rate of incidence in elderly participants undergoing spinal anesthesia in hip surgery. Other study done in urological surgery, found a definite correlation with the incidence of POD (Matsuki, et al, 2017).…”

Risk factors for incident delirium among urological patients: a systematic review and meta-analysis with GRADE summary of findings

“…Although promising, these results do have limitations and therefore the CDT would need extensive further evaluation before use as a screening tool within clinical practice. A recently published prospective study of over 1000 patients identified a different cognitive screening tool for dementia was associated with development of POD [42]. The authors found that a Hasegawa Dementia Scale-Revised (HDS-R) score of less than 20 was an independent risk factors for POD in elderly urological patients [42].…”

Editorial Comment to Incidence and risk factors of postoperative delirium in elderly patients undergoing urological surgery: A multi‐institutional prospective study

“…investigated the incidence and risk factors of postoperative delirium among patients aged ≥65 years undergoing elective urological surgery. They concluded that the incidence was just 3.4%, and preoperative history of cerebrovascular disease, cognitive status, low serum albumin level and operative duration was associated with the development of postoperative delirium . The incidence rates of delirium were significantly higher for laparoscopic/open surgery (18/328, 5.5%) than that for transurethral surgery (14/618, 2.3%, P = 0.015).…”

“…Although the optimal assessment tool for delirium requires further investigation, their findings showed that the Intensive Care Delirium Screening Checklist is a useful tool for assessment of delirium. Also, they developed a screening flow model for risk stratification, and suggested the risk for postoperative delirium was <5%, 5–15% and >25% in the low‐, intermediate‐ and high‐risk patients, respectively . A validation study for this model is necessary.…”