Operative and anaesthetic factors influencing on delirium in the intensive care unit: An Analysis of electronic health records

Abstract

The occurrence rate of postoperative delirium, which affects the patient outcomes negatively, is expected to increase as the number of operations associated with delirium increases yearly in Korea.However, a cognitive disorder following anaesthesia often hinders the early detection of symptom of delirium. Therefore, the identification of the risk factors that influence the postoperative delirium is important to provide early preventive intervention for the patients with those risk factors. | BACKG ROU N DThe reported occurrence rate of postoperative delirium is 36.8% Abstract Aims and objectives: To analyse the operation, anaesthesia and recovery-related factors affecting the occurrence of delirium in the intensive care unit. Background:The occurrence rate of postoperative delirium is high in surgical patients. Postoperative delirium most frequently occurs usually within 3 days after an operation.Design: This study used a secondary data analysis based on a case-control study. Methods:This study analysed data extracted from the electronic health records at a university hospital from October 2009-July 2015. One hundred and eighty patients with delirium admitted to the intensive care unit through the recovery room after surgery, and 720 nondelirium controls were included. A total of 17 variables were selected, and hierarchical logistic regression was performed to identify operative and anaesthetic factors influencing on delirium. STROBE statement was applied for reporting this study. Results:The operation, anaesthesia and recovery-related factors increasing the risk of delirium included Class II or higher in the classification system of American Society of Anesthesiologists physical status, continuous remifentanil infusion and lower than sevenpoint postanaesthesia recovery score at the time of admission to the recovery room. Conclusion:The operative and anaesthetic factors influencing the occurrence of delirium should be assessed when a patient is admitted to the ICU following an operation even if a patient is conscious.Relevance to clinical practice: Identifying operative and anaesthetic risk factors for delirium can improve the prevention intervention and the patient outcome in the intensive care unit. K E Y W O R D Sdelirium, electronic health records, intensive care unit, risk factor Journal of Critical Care, 30(3), 606-612. https://doi.

Immune, Blood Cell, and Blood Gas Biomarkers of Delirium in Elderly Individuals with Hip Fracture Surgery

“…Phrased differently, aseptic inflammation due to hip fracture or the consequent surgery may aggravate the existing neurocognitive deficits in neurodegenerative and neuro-inflammatory disease, thereby triggering delirium symptoms and the onset of full-blown delirium. In contrast, other known predisposing factors of delirium such as the operative time [49], preadmission deliriogenic drugs and polypharmacy [50, 51], and postoperative pain [52, 53] were not correlated with the diagnosis of delirium or the severity of delirium symptoms. Nevertheless, the current study showed that increased blood loss during surgery may further increase the severity of delirium.…”

Biomarkers and Clinical Features of Delirium in Elderly Individuals With Hip Fracture Surgery.

“…Phrased differently, aseptic inflammation due to hip fracture or the consequent surgery may aggravate the existing neurocognitive deficits in neurodegenerative and neuro-inflammatory disease thereby triggering delirium symptoms and the onset of full-blown delirium. In contrast, other known predisposing factors of delirium such as the operative time (59) , pre-admission deliriogenic drugs and polypharmacy (60,61) , and postoperative pain (62, 63) were not correlated with the diagnosis of delirium. On the other hand, the current study showed that increased blood loss during surgery may further increase the severity of delirium.…”

Postoperative Delirium: A Literature Review of Management in Intensive Care Unit

“…CAM-ICU was developed as a short, accurate and reliable instrument for doctors and nurses to identify delirium in ICU patients. [6][7][8]…”