Screening for postoperative delirium in patients with acute hip fracture: Assessment of predictive factors

Köşkderelioğlu, Aslı; Önder, Özlem; Gucuyener, Melike; Altay, Taşkın; Kayalı, Cemil; Gedizlioğlu, Muhteşem

doi:10.1111/ggi.12806

Cited by 29 publications

(35 citation statements)

References 30 publications

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“…Available data suggest that preexisting cognitive impairment predicts incident POD, which, in turn, can impair long‐term cognitive functioning . Preoperative cognitive impairment has also been linked to the incidence of other adverse outcomes, including postoperative complications, longer hospital stay, and functional decline .…”

Section: Discussionmentioning

confidence: 99%

Preoperative Cognitive Impairment As a Predictor of Postoperative Outcomes in a Collaborative Care Model

Zietlow

McDonald

Sloane

et al. 2018

J American Geriatrics Society

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OBJECTIVES:To compare postoperative outcomes of individuals with and without cognitive impairment enrolled in the Perioperative Optimization of Senior Health (POSH) program at Duke University, a comanagement model involving surgery, anesthesia, and geriatrics. DESIGN: Retrospective analysis of individuals enrolled in a quality improvement program. SETTING: Tertiary academic center. PARTICIPANTS: Older adults undergoing surgery and referred to POSH (N = 157). MEASUREMENTS: Cognitive impairment was defined as a score less than 25 out of 30 (adjusted for education) on the St. Louis University Mental Status (SLUMS) Examination. Median length of stay (LOS), mean number of postoperative complications, rates of postoperative delirium (POD, %), 30-day readmissions (%), and discharge to home (%) were compared using bivariate analysis. RESULTS: Seventy percent of participants met criteria for cognitive impairment (mean SLUMS score 20.3 for those with cognitive impairment and 27.7 for those without). Participants with and without cognitive impairment did not significantly differ in demographic characteristics, number of medications (including anticholinergics and benzodiazepines), or burden of comorbidities. Participants with and without cognitive impairment had similar LOS (P = .99), cumulative number of complications (P = .70), and 30-day readmission (P = .20). POD was more common in those with cognitive impairment (31% vs 24%), but the difference was not significant (P = .34). Participants without cognitive impairment had higher rates of discharge to home (80.4% vs 65.1%, P = .05). CONCLUSION: Older adults with and without cognitive impairment referred to the POSH program fared similarly on most postoperative outcomes. Individuals with cognitive impairment may benefit from perioperative geriatric comanagement. Questions remain regarding the validity of available measures of cognition in the preoperative period. J Am Geriatr Soc 2018.

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Section: Discussionmentioning

confidence: 99%

Preoperative Cognitive Impairment As a Predictor of Postoperative Outcomes in a Collaborative Care Model

Zietlow

McDonald

Sloane

et al. 2018

J American Geriatrics Society

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“…Those studies showed a contrasting sensitivity from 25-80% and a high specificity (97-99%). 18,19 The data from previous research at the current study site showed that approximately 50% of patients aged ≥60 years were admitted postoperatively to the ICU. 20 From a hospital perspective, the uniform utilization of a single delirium screening tool for all postoperative older patients, regardless of ICU admission, would be ideal for training in delirium detection and ensuring continuity of patient care during the postoperative period.…”

Section: Introductionmentioning

confidence: 93%

“…Inconsistent results have also been shown by recent reports of the diagnostic performance of the CAM‐ICU when used with postoperative older patients in non‐critical settings. Those studies showed a contrasting sensitivity from 25–80% and a high specificity (97–99%) . The data from previous research at the current study site showed that approximately 50% of patients aged ≥60 years were admitted postoperatively to the ICU .…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of postoperative delirium in older adults using the Confusion Assessment Method for the intensive care unit in non‐intensive care unit settings: A test modification might improve its diagnostic performance

Wongviriyawong

Suraarunsumrit

Chaiwat

et al. 2019

Geriatrics Gerontology Int

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Aim To evaluate the diagnostic performance of the Confusion Assessment Method for the intensive care unit (CAM‐ICU) among postoperative older patients in non‐ICU settings. Methods The CAM‐ICU was used by trained staff to prospectively evaluate postoperative patients for delirium. The patients were aged ≥60 years, were in general wards and had no critical illnesses. The assessments occurred for 7 consecutive days after surgery. The results were compared with delirium diagnoses obtained by geriatricians using Diagnostic and Statistical Manual of Mental Disorders 5th edition criteria as the reference standard. Results The sensitivity of delirium detection for the CAM‐ICU was 31.6% (95% confidence interval [CI] 12.6–56.6), while the specificity was 97.6% (95% CI 94.9–99.1), positive predictive value was 50.0% (95% CI 26.3–73.7) and negative predictive value was 95.0% (95% CI 93.3–96.3). Feature 4 (disorganized thinking) yielded the highest sensitivity (60%; 95% CI 14.7–94.7), whereas feature 2 (inattention) had low sensitivity (36.8%; 95% CI 16.3–61.6). Further analyses to explore the highest sensitive criteria showed that if CAM‐ICU diagnoses were made by the presence of any two out of feature 1 (acute change or fluctuation of cognition), feature 3 (altered level of consciousness) or feature 4, the sensitivity increased substantially to 80.0% (95% CI 28.4–99.5), with a reasonably high specificity of 81.8% (95% CI 48.2–97.7). Conclusions Modification of the flow of delirium diagnosis using the CAM‐ICU appears to offer a better sensitivity for detecting delirium in non‐ICU settings. Furthermore, changing feature 2 to evaluate patients’ attention levels over a longer period of time might yield a better diagnostic performance. Geriatr Gerontol Int 2019; 19: 762–767.

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“…A study by Liang et al showed that when comparing those who developed post-operative delirium with those who did not, the former had a poorer preexisting cognitive function (59.5% vs. 37.0% of MMSE scores < 24, P < 0.007) [13]. Koskderelioglu et al showed that patients with cognitive impairment defined as a low MMSE score were more likely to have postoperative delirium (P = 0.001; odds ratio 0.75, 95% CI 0.65-0.86) [14]. A study by Heng et al showed that delirium was significantly increased in patients with an abnormal Mini-Cog© test and had an odds ratio of 3.22 (95% 1.59-6.77, P = 0.001) [15].…”

Section: Association Of Cognitive Impairment With In-hospital Outcomesmentioning

confidence: 99%

Cognitive impairment and postoperative outcomes in patients undergoing primary total hip arthroplasty: A systematic review

Viramontes

Erfe

et al. 2019

Journal of Clinical Anesthesia

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Total hip arthroplasty (THA) is a common surgical procedure in the elderly. Varying degrees of cognitive impairment (CI) are frequently seen in this patient population. To date, there has been no systematic review of the literature specifically examining the impact of CI on outcomes after elective THA. The aim of this systematic review was to identify studies that compare the postoperative outcomes of patients with and without CI after undergoing elective primary THA. Design: We conducted a systematic review of prospective and retrospective studies. A systematic literature review was conducted by searching MEDLINE, PubMed, and Embase from between January 1, 1997 and January 1, 2018. A total of 234 articles were reviewed and 22 studies were selected. Setting: Operating room and short-term and long-term postoperative recovery up to 2 years. Patients: Patients with CI who underwent an elective primary THA that required general anesthesia with a comparator group of patients who did not have dementia. Interventions: Patients who underwent elective primary total hip arthroplasty. Measurements: Outcomes included post-operative delirium (POD), mortality and other complications, discharge disposition, length of stay (LOS), mortality, short-term (30 days) and long-term (1 month-2 years) complications. Main results: 22 studies with 5,705,302 participants were included in the systematic review. Sample sizes varied greatly, ranging from 14 to 2,924,995 participants. There was an association between patients with CI and an increase in POD, in-hospital mortality, complications during hospitalization, non-routine disposition, LOS, mortality between 1 month to 2 years, and worse postoperative functional status. Conclusions: We demonstrate that there are strong associations between patients with pre-existing CI undergoing THA and increased POD, hospital mortality, hospital complications, and hospital LOS. We report good quality evidence linking complications after THA to preexisting CI. Screening for CI can improve care and better predict the risk of developing postoperative complications such as delirium. Further investigations can address perioperative factors that can help reduce complications and show the utility of more widespread assessment of preoperative cognitive impairment.

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Screening for postoperative delirium in patients with acute hip fracture: Assessment of predictive factors

Cited by 29 publications

References 30 publications

Preoperative Cognitive Impairment As a Predictor of Postoperative Outcomes in a Collaborative Care Model

Preoperative Cognitive Impairment As a Predictor of Postoperative Outcomes in a Collaborative Care Model

Diagnosis of postoperative delirium in older adults using the Confusion Assessment Method for the intensive care unit in non‐intensive care unit settings: A test modification might improve its diagnostic performance

Cognitive impairment and postoperative outcomes in patients undergoing primary total hip arthroplasty: A systematic review

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