Posttransplantation delirium: a review

Abstract

Purpose of reviewDelirium in hospitalized patients can increase costs and worsen postoperative outcomes, yet it is underdiagnosed and undertreated. Among transplant recipients with numerous features to monitor, the potential for this complication may be overlooked. An understanding of current concepts of delirium is helpful for posttransplantation monitoring and treatment of this vulnerable patient population. Recent findingsThis review summarizes the latest literature on mechanisms, risk factors, sequelae, and treatments for delirium. Different types of transplantation may involve risk factors for delirium such as advanced age, pain medications, drug interactions, prior cognitive impairment or alcohol abuse, and neurotoxicity from immunosuppressants. Delirium can increase length of stay and worsen postdischarge outcomes. Symptoms of delirium can be treated with low doses of antipsychotic medications. SummaryThe assistance of consultation/liaison psychiatry can be helpful in the diagnosis and treatment of delirium symptoms and the search for the underlying etiology. When the underlying cause is addressed, delirium is reversible. Prompt diagnosis and treatment of delirium can prevent the increased costs and negative outcomes associated with this complication.

Delirium affects length of hospital stay after lung transplantation

“…In addition, we found that the presence and duration of delirium were predictive of longer hospital stays following transplantation. The finding that poorer pre-transplant cognitive function was associated with greater incidence of delirium is consistent with previous studies among individuals undergoing elective[12] and cardiac surgeries,[14] demonstrating that delirium is associated with longer hospital stays among older adults,[26] significant public health expenditures,[1] and a 3- to 11-fold increased 6-month mortality risk after controlling for disease severity. [2, 27] In addition, we have previously shown that poorer executive function is associated with greater incidence of delirium among individuals undergoing elective surgery independent of medical risk factors.…”

“…Delirium is relatively common among hospitalized older adults and is associated with significant public health expenditures,[1] as well as 3- to 11-fold increased 6-month mortality risk after controlling for disease severity. [2] Delirium occurs in at least 20% of hospitalized older adults and may be even higher among post-transplant patients.…”

Neurocognitive Changes after Lung Transplantation

“…Delirium is common among hospitalized older adults and is associated with significant public health expenditures (38) and with a 3-to 11-fold increased 6-month mortality risk after controlling for disease severity (36). Delirium is also independently predictive of long-term neurocognitive impairment (25,39), and randomized trials are currently examining strategies to mitigate the negative impact of delirium (40).…”

Depressive Symptoms and Risk of Postoperative Delirium

“…Delirium is relatively common among hospitalized older adults and is associated with significant public health expenditures(3), as well as a substantially increased risk of 6-month mortality risk after controlling for disease severity(4). Available evidence suggests that the presence of delirium may also be associated with adverse cerebrovascular outcomes, similar to other surgeries(5, 6).…”