Perioperative Optimization of Senior Health in Spine Surgery: Impact on Postoperative Delirium

Abstract

BACKGROUND: Delirium is a common postoperative complication in geriatric patients, especially in those with underlying risk factors. Multicomponent nonpharmacologic interventions are effective in preventing delirium, however, implementation of these measures is variable in perioperative care. The aim of our study was to assess the impact of our Perioperative Optimization of Senior Health Program (UTSW POSH) on postoperative delirium in patients undergoing elective spine surgery. STUDY DESIGN: The UTSW POSH program is an interdisciplinary perioperative initiative involving geriatrics, surgery, and anesthesiology to improve care for high-risk geriatric patients undergoing elective spine surgery. Preoperatively, enrolled patients (n = 147) were referred for a geriatric assessment and optimization for surgery. Postoperatively, patients were co-managed by the primary surgical team and the geriatrics consult service. UTSW POSH patients were retrospectively compared to a matched historical control group (n = 177) treated with usual care. Main outcomes included postoperative delirium and provider recognition of delirium. RESULTS: UTSW POSH patients were significantly older (75.5 vs 71.5 years; P < .001), had more comorbidities (8.02 vs 6.58; P < .001), and were more likely to undergo pelvic fixation (36.1% vs 17.5%; P < .001). The incidence of postoperative delirium was lower in the UTSW POSH group compared to historical controls, although not statistically significant (11.6% vs 19.2%; P = .065). Delirium was significantly lower in patients who underwent complex spine surgery (≥4 levels of vertebral fusion; N = 106) in the UTSW POSH group (11.7% vs 28.9%, P = .03). There was a threefold increase in the recognition of postoperative delirium by providers after program implementation, (76.5% vs 23.5%; P = .001). CONCLUSIONS: This study suggests that interdisciplinary care for high-risk geriatric patients undergoing elective spine surgery may reduce the incidence of postoperative delirium and increase provider recognition of delirium. The benefit may be greater for those undergoing larger procedures.

Family Presence May Reduce Postoperative Delirium After Spinal Surgery

“…24,25 There are many studies on delirium in older populations, but there is lack of knowledge for spinal surgery patients. Our findings extend those of Pernik et al 26 who suggest that postop delirium in elderly patients will require multidisciplinary approach. Age > 70 years, benzodiazepine use, hearing loss, and history of psychiatric disorder were found to be predictors of delirium after spinal surgery.…”

Risk for post‐operative delirium related to comorbidities in older adult cardiac patients: An integrative review

“…Post‐operative delirium (POD) is a common medical complication seen among older adults aged 65 years and older proceeding a surgery (Pernik et al, 2020). Delirium is an acute‐onset of brain failure that can be correlated to an underlying medical condition or exposure to a toxin.…”

A Comparison of Short-Term Outcomes after Surgical Treatment of Multilevel Degenerative Cervical Myelopathy in the Geriatric Patient Population: An Analysis of the National Surgical Quality Improvement Program Database 2010–2020

“…Postoperative adverse events in geriatric patients are affected by not only the type of surgery but also by many other factors. Implementing a perioperative optimization program involving multidisciplinary teams, such as geriatricians, anesthesiologists, physical therapists, and nursing staff, has been shown to reduce the incidence of postoperative complications and shorten the length of hospitalization after spine surgery [ 30 , 31 ]. In addition, preoperative risk stratification should be performed on this patient population.…”