Postoperative Delirium in the Geriatric Patient

Schenning, Katie J.; Deiner, Stacie

doi:10.1016/j.anclin.2015.05.007

Cited by 113 publications

(74 citation statements)

References 59 publications

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“…A higher incidence was reported in the elderly, most medically complex patients after vascular, cardiac, or hip fracture operations (1)(2)(3)(4)(5)(6)(7)(8). In our study, the incidence of POD was 1.9% (42/2195) of 2195 patients who underwent major abdominal surgery, lower than the reported incidence of POD.…”

Section: Discussioncontrasting

confidence: 51%

“…POD usually begins during the first 24 h after surgery and mostly disappears within the first 4 days after surgery (2)(3)(4)(5)(6)(7). Although the duration of POD is short, it is closely associated with longer hospital stay, greater cognitive impairment, increased postoperative morbidity, mortality, and higher health care costs (1)(2)(3)(4)(5)(6)(7)(8). Thus, the prevention and treatment of POD become one of aims to improve the quality of medical care for elderly patients (1).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Decreased Cerebral Glucose Metabolism in Elderly Patients with Postoperative Delirium: A Case-Control Study

Ma¹,

Liao²,

Mo³

et al. 2017

J Anesth Perioper Med

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Section: Discussioncontrasting

confidence: 51%

mentioning

confidence: 99%

Decreased Cerebral Glucose Metabolism in Elderly Patients with Postoperative Delirium: A Case-Control Study

Ma¹,

Liao²,

Mo³

et al. 2017

J Anesth Perioper Med

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“…2 Postoperative delirium has been reported to occur in 10% to 60% of elderly surgical patients, varying by surgical procedure. 3,4 Assessed with neuropsychological tests and in the absence of delirium, POCD is a decline in cognitive ability occurring between 1 week and 1 year after surgery. 5 The incidence of POCD is approximately 10% to 12% and varies with clinical, demographic, and surgical variables, as well as the interval between surgery and assessment.…”

mentioning

confidence: 99%

Intraoperative Infusion of Dexmedetomidine for Prevention of Postoperative Delirium and Cognitive Dysfunction in Elderly Patients Undergoing Major Elective Noncardiac Surgery

et al. 2017

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“…In fact, inadequate pain control, infection, pneumonia, acute kidney injury, prolonged hospitalization and sleep disorders in the early postoperative period are the known precipitating factors for POD in elderly patients. 4 We argue that not taking the aforementioned factors into the model would have distorted the inferences of multivariate analysis for risk factors of POD in this study. References 1 Matsuki M, Tanaka T, Takahashi A et al Incidence and risk factors of postoperative delirium in elderly patients undergoing urological surgery: a multiinstitutional prospective study.…”

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confidence: 83%

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

2020

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In a multi-institutional prospective study, Matsuki et al. assessed incidence and risk factors of postoperative delirium (POD) in elderly patients undergoing urological surgery, and showed that a history of cerebrovascular disease, low Hasegawa Dementia Scale-Revised score and serum albumin level, and long surgery duration were independent risk factors for POD. 1 As POD has been significantly associated with increased length of hospital stay, costs, morbidity and mortality in patients undergoing urological surgery, their findings have potential clinical implications. However, we noted several issues in this study that were not well addressed.First, in this study, the POD that occurred within 7 days after surgery was defined by a criterion of Intensive Care Delirium Screening Checklist ≥3 points in accordance with the Japanese version of the Intensive Care Delirium Screening Checklist. In the new recommendations for the nomenclature of cognitive change associated with anesthesia and surgery-2018, however, it is required that definitions of POD must meet the diagnostic criteria of delirium in the Diagnostic and Statistical Manual of Mental Disorders fifth edition. 2 Evidently, the use of Intensive Care Delirium Screening Checklist ≥3 points for definitions of POD in this study could not achieve the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders fifth edition for delirium. Actually, the intensive care unit delirium assessment tools are not adequately sensitive to identify POD in non-intensive care unit settings. We are concerned that the use of an improper criterion of definition in this study would have confounded diagnosis of POD.Second, by using a cut-off value of <3.5 g/dL (diagnostic criteria of hypoalbuminemia), a low serum albumin level was identified as an independent risk factor for POD. We noted that mean hemoglobin levels were 12.7 AE 1.8 and 13.2 AE 1.8 g/dL in patient with and without POD, with no significant difference. However, only comparing mean hemoglobin levels might have limited clinical values. The authors should report the incidence of preoperative anemia and assess the effect of preoperative anemia on the occurrence of POD. It must be emphasized that preoperative anemia is common among elderly surgical patients, and has been significantly associated with an increased risk of POD. In clinical practice, correction of both hypoalbuminemia and anemia before surgery has become one element of multicomponent prehabilitation programs reducing the occurrence of POD in elderly patients undergoing major surgery. 3 Third, only providing the type of anesthesia (general or spinal) was not enough when anesthetic interventions were taken as confounders for identifying potential risk factors of POD by multivariate analysis. Among drugs commonly used in anesthetic practice, opioids, sevoflurane, benzodiazepines and anticholinergics have been implicated in the development of POD. Other than great blood loss and transfusion provided in this study, furthermore, intraoperative hemo...

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Postoperative Delirium in the Geriatric Patient

Cited by 113 publications

References 59 publications

Decreased Cerebral Glucose Metabolism in Elderly Patients with Postoperative Delirium: A Case-Control Study

Decreased Cerebral Glucose Metabolism in Elderly Patients with Postoperative Delirium: A Case-Control Study

Intraoperative Infusion of Dexmedetomidine for Prevention of Postoperative Delirium and Cognitive Dysfunction in Elderly Patients Undergoing Major Elective Noncardiac Surgery

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

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