Risk factors for postoperative delirium and subsyndromal delirium in older patients in the surgical ward: A prospective observational study

Kanno, Maya; Doi, Mana; Kubota, Kazumi; Kanoya, Yuka

doi:10.1371/journal.pone.0255607

Cited by 15 publications

(24 citation statements)

References 35 publications

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“…The precipitating factors of delirium in surgical patients may continue for a long period of time, such as postoperative pain, withdrawal from anesthetics, inflammation, anemia due to blood loss, or hypoactivity that may not resolve in a short duration. 28 The peak concentration of ramelteon is approximately 45 min, and the elimination half-life is approximately 2.6 h. 29 Postoperative delirium commonly occurs between postoperative Days 2−5. 30 Thus, administration of ramelteon once or twice before or after the surgery date may not adequately cover the high-risk period of postoperative delirium.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, participants in the three RCTs 14,15,19 in the non‐multiple‐dose group were all surgical patients. The precipitating factors of delirium in surgical patients may continue for a long period of time, such as postoperative pain, withdrawal from anesthetics, inflammation, anemia due to blood loss, or hypoactivity that may not resolve in a short duration 28 . The peak concentration of ramelteon is approximately 45 min, and the elimination half‐life is approximately 2.6 h 29 .…”

Section: Discussionmentioning

confidence: 99%

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Ramelteon for delirium prevention in hospitalized patients: An updated meta‐analysis and trial sequential analysis of randomized controlled trials

Carvalho

Thompson

et al. 2023

Journal of Pineal Research

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Although ramelteon has been examined as a relatively new therapeutic option for delirium prevention, current evidence to evaluate its efficacy is limited. We conducted an updated meta‐analysis and examine the reliability of existing evidence regarding the effect of ramelteon on delirium prevention in hospitalized patients. Seven major electronic databases were systematically searched to identify randomized controlled trials examining the efficacy of ramelteon in delirium prevention. Data were pooled using a frequentist‐restricted maximum‐likelihood random‐effects model. A trial sequential analysis was performed using relative risk reduction thresholds of 50%. The primary outcome was the incidence of delirium (reported as odds ratio with 95% confidence intervals). The secondary outcomes were the days of delirium, all‐cause mortality, and all‐cause discontinuation. Of 187 potentially eligible studies identified, 8 placebo‐controlled randomized controlled trials (n = 587) were included. This updated meta‐analysis showed that ramelteon was associated with lower odds of delirium occurrence than placebo (0.50; 0.29−0.86; I2 = 17.48%). In trial sequential analysis, the effect of ramelteon across the superiority boundary when using a relative risk reduction threshold ranging from 40% to 60%. In subgroup analyses, ramelteon compared with placebo was associated with lower odds of delirium occurrence in the elderly group (k = 5; 0.28; 0.09−0.85; I2 = 27.93%) and multiple dosage group (k = 5; 0.34; 0.14−0.82; I2 = 44.24%) but not in the non‐elderly and non‐multiple dosage groups. When considering surgical patients and medical patients separately, ramelteon showed a trend in the treatment of delirium prevention in both groups, while these findings were not statistically significant. No significant between‐group differences were found in the secondary outcomes. The current meta‐analysis provides updated and reliable evidence that ramelteon, in comparison with placebo, reduces the risk of delirium among hospitalized patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ramelteon for delirium prevention in hospitalized patients: An updated meta‐analysis and trial sequential analysis of randomized controlled trials

Carvalho

Thompson

et al. 2023

Journal of Pineal Research

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“…The CGA7 was administered to each patient at baseline. The CGA7 is a screening tool that extracts seven key items from a total of 40 items on four validated scales: the Barthel Index, the revised version of Hasegawa's Dementia Scale, the Vitality Index, and the Geriatric Depression Scale 13,15,16 . The CGA7 is used to assess aspects of the geriatric physical, psychological, and social domains.…”

Section: Methodsmentioning

confidence: 99%

“…The CGA7 is a screening tool that extracts seven key items from a total of 40 items on four validated scales: the Barthel Index, the revised version of Hasegawa's Dementia Scale, the Vitality Index, and the Geriatric Depression Scale. 13,15,16 The CGA7 is used to assess aspects of the geriatric physical, psychological, and social domains. It comprises the following questions: CGA1 (motivation): "Can the subject greet the examiner by himself/herself?…”

Section: Assessment Using the Cga7mentioning

confidence: 99%

“…To complete the CGA can take hours, and it needs to be assessed by specialists 10,14 . By contrast, the CGA7 is a simplified geriatric assessment tool comprising seven items, including activities of daily living (ADLs) and cognitive impairment 13,15,16 . However, it remains unclear whether the CGA7 is applicable for assessing postoperative walking ability.…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with maintaining walking ability postoperation for hip fractures and the predictive value of the CGA7 score for postoperative walking ability

Morisaki,

Yoshii,

Tsuchida

et al. 2023

Geriatrics Gerontology Int

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AimPatients with hip fractures have a high rate of mortality or decreased mobility, despite early operative treatment and rehabilitation. The first aim of this study was to investigate the factors of decreased walking ability after hip fracture based on whether walking ability was or was not maintained postoperatively. The second aim was to examine the usefulness of the Comprehensive Geriatric Assessment 7 (CGA7), modified from the conventional Comprehensive Geriatric Assessment, for predicting postoperative walking ability.MethodsThis study included patients who were treated surgically for hip fractures. We divided patients by whether they did or did not maintain their walking ability postoperatively. We registered the following demographic data: walking ability preadmission and at discharge, CGA7 score, cognitive impairment, the patient's prefracture status, fracture type, surgical waiting time, hospital stay duration, limitation of weight‐bearing, postoperative complications, transfer to rehabilitation hospital, final living place, and follow‐up period. The characteristics of the two groups were compared using Wilcoxon's rank‐sum test, the chi‐squared test, or Fisher's exact test.ResultsAmong 855 patients, 616 (73.0%) patients maintained walking ability and 239 (27.0%) patients did not. Multivariate logistic regression revealed that the factors of age, sex, preoperative walking ability, and postoperative complications were significantly associated with maintaining postoperative walking ability. Furthermore, the higher the CGA7 score, the more likely were patients to maintain their walking ability (odds ratio, 0.72; 95% confidence interval, 0.61–0.85; P < 0.001).ConclusionsPatients who had a low CGA7 score had the potential risk of decreased walking ability. Geriatr Gerontol Int 2023; ••: ••–••.

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Electroencephalography-Guided Anesthesia and Delirium in Older Adults After Cardiac Surgery

Deschamps,

Ben Abdallah,

Jacobsohn

et al. 2024

JAMA

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ImportanceIntraoperative electroencephalogram (EEG) waveform suppression, suggesting excessive general anesthesia, has been associated with postoperative delirium.ObjectiveTo assess whether EEG-guided anesthesia decreases the incidence of delirium after cardiac surgery.Design, Setting, and ParticipantsRandomized, parallel-group clinical trial of 1140 adults 60 years or older undergoing cardiac surgery at 4 Canadian hospitals. Recruitment was from December 2016 to February 2022, with follow-up until February 2023.InterventionsPatients were randomized in a 1:1 ratio (stratified by hospital) to receive EEG-guided anesthesia (n = 567) or usual care (n = 573). Patients and those assessing outcomes were blinded to group assignment.Main Outcomes and MeasuresThe primary outcome was delirium during postoperative days 1 through 5. Intraoperative measures included anesthetic concentration and EEG suppression time. Secondary outcomes included intensive care and hospital length of stay. Serious adverse events included intraoperative awareness, medical complications, and 30-day mortality.ResultsOf 1140 randomized patients (median [IQR] age, 70 [65-75] years; 282 [24.7%] women), 1131 (99.2%) were assessed for the primary outcome. Delirium during postoperative days 1 to 5 occurred in 102 of 562 patients (18.15%) in the EEG-guided group and 103 of 569 patients (18.10%) in the usual care group (difference, 0.05% [95% CI, −4.57% to 4.67%]). In the EEG-guided group compared with the usual care group, the median volatile anesthetic minimum alveolar concentration was 0.14 (95% CI, 0.15 to 0.13) lower (0.66 vs 0.80) and there was a 7.7-minute (95% CI, 10.6 to 4.7) decrease in the median total time spent with EEG suppression (4.0 vs 11.7 min). There were no significant differences between groups in median length of intensive care unit (difference, 0 days [95% CI, −0.31 to 0.31]) or hospital stay (difference, 0 days [95% CI, −0.94 to 0.94]). No patients reported intraoperative awareness. Medical complications occurred in 64 of 567 patients (11.3%) in the EEG-guided group and 73 of 573 (12.7%) in the usual care group. Thirty-day mortality occurred in 8 of 567 patients (1.4%) in the EEG-guided group and 13 of 573 (2.3%) in the usual care group.Conclusions and RelevanceAmong older adults undergoing cardiac surgery, EEG-guided anesthetic administration to minimize EEG suppression, compared with usual care, did not decrease the incidence of postoperative delirium. This finding does not support EEG-guided anesthesia for this indication.Trial RegistrationClinicalTrials.gov Identifier: NCT02692300

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Risk factors for postoperative delirium and subsyndromal delirium in older patients in the surgical ward: A prospective observational study

Cited by 15 publications

References 35 publications

Ramelteon for delirium prevention in hospitalized patients: An updated meta‐analysis and trial sequential analysis of randomized controlled trials

Ramelteon for delirium prevention in hospitalized patients: An updated meta‐analysis and trial sequential analysis of randomized controlled trials

Factors associated with maintaining walking ability postoperation for hip fractures and the predictive value of the CGA7 score for postoperative walking ability

Electroencephalography-Guided Anesthesia and Delirium in Older Adults After Cardiac Surgery

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