Postoperative Delirium Is Associated with Long-term Decline in Activities of Daily Living

Abstract

Background: Postoperative delirium is one of the most common complications in the elderly surgical population. However, its long-term outcomes remain largely to be determined. Therefore a prospective cohort study was conducted to determine the association between postoperative delirium and long-term decline in activities of daily living and postoperative mortality. The hypothesis in the present study was that postoperative delirium was associated with a greater decline in activities of daily living and higher mortality within 24 to 36 months after anesthesia and surgery. Methods: The participants (at least 65 yr old) having the surgeries of (1) proximal femoral nail, (2) hip replacement, or (3) open reduction and internal fixation under general anesthesia were enrolled. The Confusion Assessment Method algorithm was administered to diagnose delirium before and on the first, second, and fourth days after the surgery. Activities of daily living were evaluated by using the Chinese version of the activities of daily living scale (range, 14 to 56 points), and preoperative cognitive function was assessed by using the Chinese Mini-Mental State Examination (range, 0 to 30 points). The follow-up assessments, including activities of daily living and mortality, were conducted between 24 and 36 months after anesthesia and surgery.

Elevated Level of Serum C-reactive Protein Predicts Postoperative Delirium among Patients Receiving Cervical or Lumbar Surgery

“…There are some limitations in this study. First, POD was assessed once daily within day 1 and day 2 after surgery in our study, so such a short observation time might imply that potential POD cases might not be identified if they occurred at different time points in days 1-2 or occurred in days 3-7 after surgery, although evidence has suggested that most POD occurs within the first two postoperative days and POD assessment once daily was acceptable [ 17 – 22 ]. This might lead to underestimation of POD incidence and consequently might reduce the potential statistical power for examining CRP-POD association in our study.…”

“…POD, as a common postoperative complication, usually occurs between postoperative days 1 and 3 and actually most often on day 1 or day 2 after surgery [17][18][19][20]. Moreover, such an approach has been used in previous studies for identifying POD cases in that POD was assessed once on each of day 1 and day 2 after surgery [20][21][22]. Therefore, we adopted this POD assessment method to identify POD cases in our study.…”

The Investigation of Hippocampus-Dependent Cognitive Decline Induced by Anesthesia/Surgery in Mice Through Integrated Behavioral Z-Scoring

“…The impaired postoperative cognition is ever known as postoperative delirium (POD) or postoperative cognitive dysfunction (POCD), and recently, is recommended to be classified as perioperative neurocognitive disorders (Evered et al, 2018). As an acute confusion state, POD is typically of short duration and potentially reversible but may be associated with long-term decline in activities of daily living (Shi et al, 2019), while POCD refers to longer-lasting cognitive decline and features disturbance of memory, attention, orientation, and information processing, leading to the increase of postoperative mortality and risk of leaving the labor market prematurely (Steinmetz et al, 2009).…”

Postoperative Delirium is Associated with Negative Outcomes and Long-Term Mortality in Elderly Koreans: A Retrospective Observational Study

“…The incidence of delirium is particularly high in elderly patients. For persons over 65 years of age, prevalence is above 30.0%, whilst for persons over 80 years of age, it ranges from 33.5% to 50.0% [3,4,5,6,7,8,9,10,11,12]. More than 80.0% of delirium cases occur one-three days post-surgery and are temporary [13,14].…”

“…However, delirium symptoms persist for more than four days in approximately 10.0% of cases [9,14,15]. Patients with delirium have temporary symptoms, such as cognitive and physical dysfunction [3,15,16], and also negative outcomes, such as increased hospital stay lengths and mortality rates [6,8,9,10]. Compared to those without delirium, elderly patients with post-operative delirium exhibit reduced cognitive functioning, poorer engagement in activities of daily living after their discharge [3,15], higher rates of readmission [8], up to three times higher in-hospital mortality, and 17.0% increases in six-month mortality rates [9,13,17].…”