Prevention and Management of Postoperative Delirium in Elderly Patients Following Elective Spinal Surgery

Nazemi, Alireza K; Gowd, Anirudh K.; Carmouche, Jonathan J.; Kates, Stephen L.; Albert, Todd J.; Behrend, Caleb

doi:10.1097/bsd.0000000000000467

Cited by 88 publications

(80 citation statements)

References 65 publications

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“…In the study of Nazemi et al, hypercarbia was effective in the development of POD (21). In our study,…”

Section: Discussionsupporting

confidence: 62%

Early Diagnosis Of Postoperative Delirium In Patients Who Underwent General Surgery

oluş¹,

Gündüz²,

Arıcı³

2020

Preprint

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Objective: Postoperative delirium (POD) is a common postoperative complication. This study aimed to diagnose POD early primarily in patients who underwent General Surgery. This study also aimed to shorten the duration of hospital stays, prevent re-hospitalization after discharge and decrease the rates of morbidity/mortality through investigating the relationship with the characteristics of the patients/surgery/anesthesia in patients diagnosed with postoperative delirium in an early period. Material and Methods: Data of 303 patients at the age of 18 and above who were operated by General Surgery Clinic between March 2018 and May 2018, who were followed up by the Department of Anesthesiology and Reanimation for preoperative, intraoperative and postoperative periods and who received general anesthesia were included in the study.Patients’ demographic data, occupation, educational status, income level, additional diseases, ASA (American Society of Anesthesia) score, previous surgeries, history of a psychiatric or neurological disease, history of alcohol, cigarette, or drug use, and memory problems were recorded. Mini Mental State Examination (MMSE) was used to identify preoperative mental levels of the patients. Diagnosis of the patient, name, duration and features of the surgery to be performed, whether the surgery was urgent or elective, drugs used, type of catheterization (artery, central, foley or nasogastric), Hb value, intraoperative vital findings, and duration of postoperative discharge were recorded. The diagnosis of POD in patients was evaluated with Confusion Assessment Method (CAM). Results: POD developed in 2-6% (8 patients) of the patients. A significant relationship was recorded between the diagnosis of POD and age and additional diseases (ASA score). Results showed that the risk of delirium decreased as the education levels of the patients increased. A significant relationship was recorded between delirium and only midazolam among anesthetic agents used. A significant relationship was recorded among hypercarbia that developed during the surgery, invasive procedures, prolonged duration of surgery and hospitalizations in Intensive Care Units and Post-Anesthesia Care Units.Conclusion: The rate of POD (2.6%) and risk factors determined for POD within the first three days in our study were in compliance with literature. Diagnosing POD with CAM in an early postoperative period was advantageous. The treatment planning of the patients for POD could be done in the early period. By doing this, increase in mortality, morbidity and cost as a result of missing the diagnosis of POD was prevented.

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“…In the study of Nazemi et al, hypercarbia was effective in the development of POD (21). In our study,…”

Section: Discussionsupporting

confidence: 62%

Early Diagnosis Of Postoperative Delirium In Patients Who Underwent General Surgery

oluş¹,

Gündüz²,

Arıcı³

2020

Preprint

View full text Add to dashboard Cite

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“…psychiatrist, neurologist, intensivist) is considered the method of choice, this approach is impractical in clinical routine and even challenging in study environments given the high prevalence of delirium and its fluctuating character that requires multiple assessments per day (3,79,80). The use of screening tools, which are time-efficient and can be applied by trained nurses or physicians, is hence an important step towards a timely diagnosis and effective treatment of delirious patients (30,43). In order to achieve a balanced tradeoff between feasibility and accuracy of diagnostic tools, we chose a combination of methods for the detection of POD regarding our primary endpoint.…”

Section: Diagnostic Challenges To Identify Deliriummentioning

confidence: 99%

“…The reported incidence of delirium yet varied substantially between 8% and 41%, which is not resolved by clear methodological differences since all studies included patients of similar age (mean age between 70 and 75 years) and used validated instruments for the diagnosis of delirium. A notable difference between studies is a proportional increase of durations of surgery and POD incidences, which was more distinctly elaborated in a subgroup analysis by Brown et al (30,37).…”

Section: Introductionmentioning

confidence: 99%

“…Even though surgery may sometimes be unnecessary and stricter application of guidelines pose a viable means to decrease postoperative cognitive complications in some cases, surgery is often inevitable to preserve or restore patients' abilities to participate in activities of daily living (27,29). Knowledge of, particularly modifiable, risk factors for POD and POCD is therefore imperative to enhance informed patient consent, adjust anesthetic and surgical strategies to individual risk profiles and facilitate appropriate postoperative monitoring (30). Numerous risk prediction models have been developed, yet recent studies highlight that a general application of these models in clinical routine is limited, not least because trajectories of cognitive decline are not independent of the type of surgery (20,24,31,32).…”

Section: Introductionmentioning

confidence: 99%

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Evaluating mechanisms of postoperative delirium and cognitive dysfunction following elective spine surgery in elderly patients (CONFESS): study protocol for a prospective observational trial

Müller

Nowak

Dewey

et al. 2018

Preprint

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Background Elderly people are a rapidly growing proportion of the world's population that increasingly undergo major elective spine surgery. They are yet at particular high risk for postoperative delirium (POD), which is associated with longer hospital stays, higher costs, risk for delayed complications, long-term care dependency and cognitive dysfunction (POCD). It is insufficiently understood, which mechanisms and, particularly modifiable, risk factors contribute to the development of POD and POCD following these major but plannable surgeries. A better understanding thereof would help to adapt medical management and surgical strategies to individual risk profiles. Methods This is a single-center observational study that is jointly conducted by the departments of Neurosurgery, Neurology and Anesthesiology at a tertiary care hospital in Germany. All patients presenting to the neurosurgery outpatient clinic or ward for elective spine surgery are screened for eligibility. Inclusion criteria are age ≥ 60 years, indication for elective spine surgery, ability to give informed consent without assistance and speaking German natively. Exclusion criteria include presence of neurodegenerative disease, diagnosis of any psychiatric disease, medication with central nervous system activity (e.g. antidepressants, antipsychotics, sedatives), impossibility to participate in follow-up, participation in an interventional trial, presence of electronic or displaceable metallic implants and active neoplasm. All patients are evaluated for their preoperative cognitive abilities and physical, mental and social health and wellbeing. They additionally receive preoperative cerebrovascular ultrasound and structural and functional brain imaging. The immediate postoperative period includes screening for POD and the investigation of markers of (neuro‑)inflammation. Preoperative examinations are repeated three months postoperatively to investigate the presence of POCD and its mechanisms. Discussion This is the first study to prospectively evaluate risk factors for POD and POCD in spine surgery including comprehensive pre- and postoperative assessments of cognitive abilities, markers of (neuro‑)inflammation, cerebral vasculature and structural and functional neuroimaging. The identification of, possibly common, mechanisms underlying POD and POCD would be a major step towards the definition of effective interventional strategies early in or even before the postoperative period, including the adaptation of surgical strategies to individual risk profiles.

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“…Serum albumin and high sensitivity C-reactive protein (hs-CRP) are one of the most prevalently monitored biomarkers in clinical practice. Pre-or postoperative hypoalbuminemia and higher levels of CRP has been recognized as a strong predictor of a worse prognosis but the data about the impact of preoperative hs-CRP on outcome, is much more limited in patients undergoing SS (9)(10)(11)(12) .…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Preoperative High-Sensitivity C-Reactive Protein/Albumin Ratio in Spinal Surgery

Acarbaş¹

2019

TERH

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Objective: The relation high-sensitivity C-reactive protein/albumin ratio (CAR) with perioperative adverse events have not been studied in patients undergoing spinal surgery (SS). This study aimed to evaluate the prognostic value of preoperative CAR on outcome of patients undergoing elective SS. Method: A retrospective analysis of 811 consecutive patients, older than 18 years old and undergoing elective SS between October 2014 and January 2019 was performed. Demographic and clinical data were obtained from medical records. Routine preoperative laboratory tests including high-sensitivity C-reactive protein and albumin levels were recorded. The outcomes of interest were perioperative medical and surgical complications during hospitalization. Results: The perioperative adverse event rate was 9.0% (73 patients). The CAR was higher in in the individuals that experienced complicated in-hospital course than in those who did not (30.2±27.5 vs. 15.8±24.5, p<0.001). Multivariate analysis showed that only age, higher CAR, and history of malignancy were significant and independent predictors of perioperative adverse events. The best cutoff value of the CAR was 5.25, with 84.3% sensitivity and 85.2% specificity. Conclusion: This is the first study to show an association between preoperative CAR and perioperative adverse events in patients undergoing SS.

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Prevention and Management of Postoperative Delirium in Elderly Patients Following Elective Spinal Surgery

Abstract: Level II.

Cited by 88 publications

References 65 publications

Early Diagnosis Of Postoperative Delirium In Patients Who Underwent General Surgery

Early Diagnosis Of Postoperative Delirium In Patients Who Underwent General Surgery

Evaluating mechanisms of postoperative delirium and cognitive dysfunction following elective spine surgery in elderly patients (CONFESS): study protocol for a prospective observational trial

Prognostic Value of Preoperative High-Sensitivity C-Reactive Protein/Albumin Ratio in Spinal Surgery

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