Post‐Operative Delirium: Predictors and Prognosis in Elderly Orthopedic Patients

Williams-Russo, Pamela; Urquhart, Barbara; Sharrock, Nigel E.; Charlson, Mary E.

doi:10.1111/j.1532-5415.1992.tb01846.x

Cited by 321 publications

(170 citation statements)

References 70 publications

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“…The negative results of Figiel et al, 42 Fisher and Flowerdew, 26 and WilliamsRusso et al 21 could be explained by the healthier and less-demented population they studied. Other probable risk factors include advanced age, abnormal blood urea nitrogen/creatinine ratio, abnormal sodium or potassium level, alcohol abuse, sensory impairment, and medications.…”

Section: Discussionmentioning

confidence: 60%

Delirium risk factors in elderly hospitalized patients

et al. 1998

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OBJECTIVE: Delirium is frequent in elderly hospitalized patients. Many studies have examined its risk factors, but results have been quite variable. Thus, the goal of this study is to identify through systematic literature review the risk factors associated with the development of delirium in hospitalized geriatric patients. MEASUREMENTS AND MAIN RESULTS:First, MEDLINE / CURRENT CONTENTS databases were screened for relevant articles published from 1966 to December 1995, and from bibliographies of identified articles additional reports were selected. Second, the reports were screened by two different investigators and retained only if meeting the five following criteria: (1) original research in French or English; (2) prospective study; (3) patients over age 50; (4) minimum of one risk factor examined; (5) acceptable definition of delirium. Third, the methodology of each study was graded according to specific criteria for risk factor studies. Fourth, risk factors were identified and tabulated, unadjusted odds ratios (ORs) were computed, and where appropriate a combined OR with the Mantel-Haenszel estimator was calculated. Twenty-seven articles were retained meeting all of the above criteria. Among these studies, 11 were done on medical patients, 9 on surgical patients, 2 on medical and surgical patients, and 5 on psychiatric patients. In total 1,365 subjects with delirium were studied. Sixty-one different risk factors were examined, the five most common being dementia, medication, medical illness, age, and male gender. Mantel-Haenszel estimator was calculated for 10 risk factors, the most strongly associated being dementia (OR 5.2; 95% confidence interval [CI] 4.2, 6.3), medical illness (OR 3.8; 95% CI 2.2, 6.4), alcohol abuse (OR 3.3; 95% CI 1.9, 5.5), and depression (OR 1.9; 95% CI 1.3, 2.6). Methodologic weaknesses were present in many studies.

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Section: Discussionmentioning

confidence: 60%

Delirium risk factors in elderly hospitalized patients

et al. 1998

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“…The reported incidence of postoperative cognitive dysfunction ranges between 28-41% for elderly patients in the orthopedic surgery group. 4,5 The wide range for reported incidence might be attributed to differences in diagnostic criteria, populations under study, and differences in surveillance methods. 6 The low incidence of reported postoperative cognitive dysfunction in our study may be related to the small sample size.…”

Section: Table IV Intraoperative Bis Indexmentioning

confidence: 99%

“…2 The incidence of postoperative cognitive deficits in general surgical patients has been reported to be 5-10% for all age groups, and increases to 10-15% in elderly patients. [3][4][5] Postoperative cognitive dysfunction may contribute to increased perioperative morbidity. 6 Therefore, it is important to minimize the risk of postoperative cognitive dysfunction.…”

Section: Conclusion : Le Niveau De Déficit Cognitif Postopératoire N'mentioning

confidence: 99%

Titration of isoflurane using BIS index improves early recovery of elderly patients undergoing orthopedic surgeries

Wong

Song

Blanshard

et al. 2002

Can J Anesth/J Can Anesth

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Purpose: This study was designed to investigate the effect of bispectral index (BIS) monitoring on the recovery profiles, level of postoperative cognitive dysfunction, and anesthetic drug requirements of elderly patients undergoing elective orthopedic surgery with general anesthesia.Methods: Sixty-eight patients over the age of 60 were randomized into one of two groups. In the standard practice (SP) group, the anesthesiologists were blinded to the BIS value, and isoflurane was titrated according to standard clinical practice. In the BIS group, isoflurane was titrated to maintain a BIS value between 50-60.Results: The total isoflurane usage was 30% lower in the BIS group compared to the SP group (5.6 ± 3 vs 7.7 ± 3 mL, P <0.05). The time to orientation was faster in the BIS group compared to the SP group (9.5 ± 3 vs 13.1 ± 4 min, P <0.001). There were no differences in the postoperative psychometric tests between the two groups.Conclusions: There was no difference in the level of postoperative cognitive dysfunction between the two groups. However, titration of isoflurane using the BIS index decreased utilization of isoflurane and contributed to faster emergence of elderly patients undergoing elective knee or hip replacement surgery. H E percentage of the population over the age of 65 will increase to approximately 12.5% by the beginning of the 21 st century. 1 This population has a high likelihood of requiring some type of surgical intervention, thus a greater number of elderly patients will present for anesthesia and surgery. 2 The incidence of postoperative cognitive deficits in general surgical patients has been reported to be 5-10% for all age groups, and increases to 10-15% in elderly patients. Résultats : L'utilisation totale d'isoflurane a été plus basse de 30 % dans le groupe BIS, comparé au groupe PC (5,6 ± 3 vs 7,7 ± 3 mL, P < 0,05). Le retour à la conscience a été plus rapide dans le groupe BIS, comparé au groupe PC (9,5 ± 3 vs 13,1 ± 4 min, P < 0,001). Les tests psychométriques postopératoires n'ont présenté aucune différence intergroupe. Conclusion

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“…Overall, surgical patients who consumed more alcohol were at significantly greater risk of post-operative delirium. Despite variation in sample characteristics and alcohol assessment instruments, alcohol use or misuse was significantly associated with a 2 to 6 fold increase in the odds of post-operative delirium in three of four studies [26,28,36]. The other showed a trend toward an association [32].…”

Section: Associations Between Alcohol Use or Misuse And Surgical Outcmentioning

confidence: 93%

“…Among patients undergoing bilateral knee replacement, 27.5% reported drinking > 3 drinks per week [36]. Among patients with injuries resulting in surgical repair of the mandible, 52% of the injuries were judged to be alcohol related based on medical record reviews [34].…”

Section: Specific Surgical Proceduresmentioning

confidence: 99%

Alcohol Misuse Prevalence and Associations with Post-Operative Complications in US Surgical Patients: A Review

Harris¹,

Frey²,

DeBenedetti³

et al. 2009

TOSJ

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Abstract:We conducted a standardized review of research on the prevalence of alcohol use or misuse (including alcohol use disorders), and the association of alcohol use or misuse with post-operative surgical complications among US patients. Twenty seven studies that included a preoperative measure of alcohol use or misuse and included at least 50 US surgical patients were identified using a standardized search strategy (1950( -April 2007. Twenty-two of the studies reported prevalence of alcohol use or misuse, which was highest in major otolaryngology surgeries (mostly for cancer and injuries: 22-88.5%) and thoracic surgery (lung transplant and cancer resections: 29-33%) and ranged from 8-28% in the remaining studies. Nineteen studies examined the association between pre-operative alcohol consumption and post-operative complications suggesting positive associations between alcohol use or misuse and risk for post-operative delirium, pneumonia, cognitive decline, overall complications, and death. Most identified studies had methodological limitations, especially the widespread use of drinking assessment methods that cannot distinguish alcohol use from misuse.

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Post‐Operative Delirium: Predictors and Prognosis in Elderly Orthopedic Patients

Abstract: There is a high incidence of post-operative delirium in elderly non-demented patients following bilateral knee replacement, regardless of whether post-operative analgesia is administered by the epidural or intravenous route.

Cited by 321 publications

References 70 publications

Delirium risk factors in elderly hospitalized patients

Delirium risk factors in elderly hospitalized patients

Titration of isoflurane using BIS index improves early recovery of elderly patients undergoing orthopedic surgeries

Alcohol Misuse Prevalence and Associations with Post-Operative Complications in US Surgical Patients: A Review

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