Risk Factors Associated With Postoperative Delirium in Patients Undergoing Head and Neck Free Flap Reconstruction

Densky, Jaron; Eskander, Antoine; Kang, Stephen Y.; Chan, Justin; Tweel, Ben; Sitapara, Jigar; Özer, Enver; Agrawal, Amit; Carrau, Ricardo L.; Rocco, James W.; Teknos, Ted; Old, Matthew

doi:10.1001/jamaoto.2018.3820

Cited by 49 publications

(53 citation statements)

References 27 publications

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“…Although some evidence points to male gender as a risk factor for postoperative delirium (Densky et al, 2019), we did not find any differences based on gender among participants with subsyndromal delirium, delirium, or no delirium. Demographic variables including gender, living arrangement, and marital status, although there was a statistical difference between participants who developed subsyndromal delirium, delirium, and no delirium on the basis of smoking status, χ 2 = 7.7 ( p ≤ .05).…”

Section: Discussioncontrasting

confidence: 96%

Pain, Opioid Intake, and Delirium Symptoms in Adults Following Joint Replacement Surgery

Denny

Lindseth

2019

West J Nurs Res

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This study examined the effects of pain and opioid intakes on subsyndromal delirium in older adults who had joint replacement surgery. Delirium assessments of 53 older adults were completed on the first, second, and third days following joint replacement surgery using the Confusion Assessment Method (CAM). Statistical relationships were analyzed using correlations and multiple regressions. Subsyndromal delirium developed in 68% ( n = 36) of participants. Pain was significantly related ( p < .05) to increased delirium symptoms after accounting for preoperative risk factors of comorbidity, cognitive status, fall history, and preoperative fasting times, whereas opioid intake was not significantly associated with increased delirium symptoms. Findings suggest older adults with increased pain levels are at higher risk for subsyndromal delirium as well as delirium after joint replacement surgery.

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Section: Discussioncontrasting

confidence: 96%

Pain, Opioid Intake, and Delirium Symptoms in Adults Following Joint Replacement Surgery

Denny

Lindseth

2019

West J Nurs Res

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“…Two previously published meta‐analyses had similar results 39,40 . Therefore, the nursing and medical staff members participating in a surgery should make an effort to reduce operating time 41 …”

Section: Discussionmentioning

confidence: 67%

Risk Factors of Postoperative Delirium in Older Adult Spine Surgery Patients: A Meta‐Analysis

Baek¹,

Kim²,

Lee³

2020

AORN Journal

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This literature review identifies factors that may place older adult patients at risk for developing delirium after spine surgery. We conducted a meta-analysis according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Using a variety of electronic databases, we identified five studies for inclusion that represent 645 patients who were 65 years or older. The pooled incidence rate of postoperative delirium was 13.0%. Factors associated with developing postoperative delirium included preoperative opioid use, cervical spine surgery versus lumbar or thoracic spine surgery, spine fusion versus simple spine surgery, hypertension, cerebrovascular disease, pulmonary disease, duration of surgery, and infused IV fluid volume. Nurses who provide perioperative care for older adult patients undergoing spine surgery should be aware of the potential risk factors of delirium to ensure patient safety. Additional research is required to clearly delineate the risk factors for postoperative delirium in older adults.

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“…The lack of quality prospective data to draw from is a challenging issue. Currently, free flap success rates remain very high across the world, exceeding 95% at high volume centers ( Densky et al, 2019 ). As such, many studies are under-powered and identifying statistically significant variables is not possible without extremely large patient volumes from multiple centers or across a time frame that introduces significant variations in clinical protocol.…”

Section: Discussionmentioning

confidence: 99%

“…Microvascular free tissue transfer (MFTT) has become an essential component of head and neck reconstruction ( Monroe et al, 2010 ). While advancements have led to excellent surgical outcomes with MFTT success rates routinely exceeding 95% ( Densky et al, 2019 ), there remains controversy regarding the use of intraoperative intravenous vasopressor agents among both surgeons and anesthesiologists during these procedures ( Harris et al, 2012 ; Chan et al, 2013 ; Ibrahim et al, 2014 ; Swanson et al, 2016 ; Wax and Azzi, 2018 ). Due to intraoperative hypotension, it is commonplace for teams to have ongoing discussions during these cases to select intraoperative fluid administration or vasopressor therapy medication and dosing.…”

Section: Introductionmentioning

confidence: 99%

The Use of Vasopressor Agents in Free Tissue Transfer for Head and Neck Reconstruction: Current Trends and Review of the Literature

Naik

Freeman

et al. 2020

Front. Pharmacol.

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Background/Objectives Microvascular free tissue transfer has become essential to head and neck reconstruction and recent advancements in microvascular surgery have led to excellent surgical outcomes. However, there continues to be controversy and a stigma associated with the use of perioperative intravenous vasopressor agents among both surgeons and anesthesiologists. Due to concern for vasoconstriction of peripheral vasculature flowing to the denervated tissue flap, there remains concerns about potential thrombosis, decreased tissue perfusion and ultimately flap failure. This topic becomes even more important as vasopressors play an essential role in new Extended Recovery After Surgery (ERAS) protocols being put in place to optimize postoperative recovery for patients. The purpose of this study was to comprehensively review the role and safety as well as discuss current trends with intraoperative vasopressor agents in free tissue transfer for head and neck reconstruction. Methods A scoping literature review was conducted of all studies that examined the use of vasopressor agents during head and neck free flap tissue transfer. Primary and secondary outcomes included free flap survival, arterial thrombosis, venous congestion, need for revision surgery, and other postoperative complications. Results One prospective and nine retrospective studies were identified. Phenylephrine and ephedrine were the most common vasopressors reported; the rate of vasopressor use ranged from 53% to 85% and administration methods included both bolus and infusion. The included studies did not show any significant association between the use of vasopressors and free flap failure, pedicle thrombosis, or other flap complications. Conclusion The administration of vasopressors during microvascular free tissue transfer for head and neck reconstruction does not seem to be associated with increased flap failure rates or other postoperative morbidities. Moreover, vasopressors may provide overall improved hemodynamic stability and help to limit overall fluid administration and subsequent postoperative complications. Additional prospective investigation is warranted to further elucidate and establish evidence-based recommendations regarding the type, timing, and dose of vasopressors to further enhance free flap survival and patient outcomes.

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Risk Factors Associated With Postoperative Delirium in Patients Undergoing Head and Neck Free Flap Reconstruction

Cited by 49 publications

References 27 publications

Pain, Opioid Intake, and Delirium Symptoms in Adults Following Joint Replacement Surgery

Pain, Opioid Intake, and Delirium Symptoms in Adults Following Joint Replacement Surgery

Risk Factors of Postoperative Delirium in Older Adult Spine Surgery Patients: A Meta‐Analysis

The Use of Vasopressor Agents in Free Tissue Transfer for Head and Neck Reconstruction: Current Trends and Review of the Literature

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