Probable risk factors for postoperative delirium in patients undergoing spinal surgery

Abstract

Postoperative delirium and its risk factors had been widely reported in several kinds of surgeries; however, there is only one known article relative to postoperative delirium in spinal surgery. We retrospectively examined the incidence of postoperative delirium and the probable risk factors in patients undergoing spinal surgery in our hospital, with the same aged non-delirium patients as controls, over a 6-month period. Studies about postoperative delirium were reviewed and referenced for variable factors collecting in our study. T tests, v 2 test and logistic regression analysis were performed to evaluate the various factors related to postoperative delirium. A total of 18 patients (3.3%), all of them were aged 54 years or older, had postoperative delirium after surgery. Patients without postoperative delirium aged 54 years or older served as the control group. The percentage of patients older than 65 years (P = 0.003), with comorbid diseases such as diabetes mellitus (P = 0.042) or central nervous system disorders (P = 0.013), with a surgical history (P = 0.028) in delirium group was larger than the control group. The absolute number of medications being taken before the operation in the delirium patients was also more than the control group (P = 0.000). The percentage of patients transfused with 800 mL or more blood was also larger (P = 0.024) in delirium group was larger than the control group. Logistic regression analysis showed that central nervous system disorder (OR 6.480), surgical history (OR 3.499), age older than 65 years (OR 3.390), diabetes mellitus (OR 2.981), transfused 800 mL or more blood (OR 2.537), and hemoglobin less than 100 g/L (OR 0.281) were significantly related to the occurrence postoperative delirium. Our findings suggest that postoperative delirium in spinal surgery can also occurred in younger patients and with an acceptable incidence in total. The risk for postoperative delirium is multifactorial. More prospective research is necessary in order to evaluate these and other risk factors in greater detail.

Risk Factors for Delirium After Spinal Surgery: A Meta-Analysis

“…Twenty-seven articles were subsequently excluded from the meta-analysis: twenty-four studies were excluded because they did not contain a risk factor for delirium, one paper's full text was not available [6], one study had fewer than 100 patients [34], and one did not obtain raw data [20]. Ultimately, six trials met the inclusion criteria [13,14,19,23,24,39].The process of identifying the relevant studies is shown in Figure 1.…”

“…To date, a number of studies have investigated the risk factors for the development of delirium after spinal surgery [13,14]. However, the results are controversial.…”

The association of perioperative autologous blood transfusion with the early postoperative cognitive dysfunction in aged patients following lumbar surgery

“…And the diagnostic criteria are in line with the recommendations from POCD group [7,9]. According to the studies, the Mini-Mental State Examination has been widely used for screening of dementia in Chinese [8,11].…”

Incidence and Risk Factors of Postoperative Delirium in Cervical Spine Surgery

“…Observations of subjects was conducted each shift and recorded using the delirium observation screening (DOS) that is developed on the basis of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria. 4,8 The DOS scale is with 13 items that can be rated as present or absent in less than 5 minutes. The highest total score is 13.…”

“…2,3 Although the incidence in hip and knee joint surgery has been widely reported, there are few studies regarding postoperative delirium in spine surgery. 4,5 Increasing age, blood urea levels, cardiothoracic index, hypertension, smoking habits, blood replacement during bypass, atrial fibrillation (AF), pneumonia, and blood fluid balance in the postoperative period were found to be significant risk factors for delirium by logistic regression analysis. 6 Previous reports also suggest that prior cognitive impairment and reduced hemoglobin and hematocrit levels are significant risk factors for postoperative delirium.…”