The association of chronic pain and postoperative delirium: a prospective observational cohort study

Eckert, Sophie C; Spies, Claudia; Mörgeli, Rudolf; Kruppa, Jochen; Heinrich, Maria

doi:10.23736/s0375-9393.22.16858-6

Cited by 3 publications

(1 citation statement)

References 37 publications

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“…Postoperative acute pain could worsen neuroin ammation and associated cognitive functional impairments in an animal study [43]. However, studies found that preoperative chronic pain was not an independent predictor of POD [44].…”

Section: Discussionmentioning

confidence: 98%

Predictors of postoperative delirium in patients undergoing radical prostatectomy: a prospective study

Wang,

Chen,

Chen

et al. 2024

Preprint

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Background Analyze the risk factors for postoperative delirium (POD) in elderly patients undergoing radical prostatectomy, built a predictive nomogram model for early identification of high-risk individuals and develop strategies for preventive interventions. Methods A total of 156 patients was recruited and categorized according to the development of POD within 7 days. After identifying independent risk factors through univariate and multivariate logistic regression analyses, predictive models were established. The discrimination and calibration were determined by C-index and calibration curve, with five-fold cross-validation executed. A nomogram model representing the optimal model was constructed based on the results. Results POD occurred in 24 (15.38%) patients. Significant differences were observed in age, anxiety, physical status, sleep disorders, blood glucose, age-adjusted Charlson comorbidity index (ACCI), anticholinergic, blood loss, postoperative infection, and numerical rating scale (NRS). Logistic regression analyses showed that sleep disorders (OR:12.931, 95% CI:1.191-140.351, P = 0.035), ACCI (OR:2.608, 95% CI:1.143–5.950, P = 0.023), postoperative infection (OR:19.298, 95% CI:2.53-147.202, P = 0.04), and NRS (OR:4.033, 95% CI:1.062–15.324, P = 0.041) were independent risk factors for POD. Model 1 (postoperative infection, ACCI, preoperative sleep disorder, NRS showed better diagnostic performance than the others, of which the area under the curve (AUC) was 0.973. The best diagnostic performance was found in model 1 through five-fold cross-validation, with a C-index of 0.963. Conclusions This prospective cohort study highlighted that ACCI, preoperative sleep disorder, postoperative pain, and postoperative infection were identified as independent risk factors for POD. Furthermore, the nomogram derived from model 1 proved to be effective in predicting POD in elderly patients undergoing radical prostatectomy.

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Section: Discussionmentioning

confidence: 98%

Predictors of postoperative delirium in patients undergoing radical prostatectomy: a prospective study

Wang,

Chen,

Chen

et al. 2024

Preprint

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Effect of Esketamine on Postoperative Delirium in Patients Undergoing Cardiac Valve Replacement with Cardiopulmonary Bypass: A Randomized Controlled Trial

Xiong,

Shao,

Chen

et al. 2024

Anesthesia &Amp; Analgesia

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BACKGROUND: The aim of this study was to investigate the effects of esketamine on the risk of postoperative delirium (POD) in adults undergoing on-pump cardiac valve surgery. METHODS: In this randomized, triple-blind, controlled trial, 116 adult patients with an American Society of Anesthesiologists (ASA) grade Ⅱ or Ⅲ and a New York Heart Association (NYHA) grade Ⅱ or Ⅲ who underwent cardiac valve surgery with cardiopulmonary bypass were included. Esketamine (0.25 mg/kg) or normal saline was administered intravenously before anesthesia induction. The primary outcome was POD, defined as a positive delirium assessment according to the 3-minute confusion assessment method (CAM) or the confusion assessment method for the intensive care unit (CAM-ICU) on a twice-daily basis for 7 days after surgery. Delirium duration and the delirium subtype were also recorded. The cognitive status of patients was measured according to the Mini-Mental State Examination at baseline, discharge, 30 days postoperatively and 3 months postoperatively. RESULTS: A total of 112 patients (mean age, 52 years; 53.6% female) were enrolled; 56 were assigned to receive esketamine, and 56 were assigned to receive placebo. POD occurred in 13 (23.2%) patients in the esketamine group and in 25 (44.6%) patients in the placebo group (relative risk [RR], 0.52, 95% confidence interval [CI], 0.28–0.91; P = .018). Thirteen patients (23.2%) in the esketamine group and 24 (42.9%) patients in the placebo group had multiple episodes of delirium (RR, 0.54, 95% CI, 0.28–0.92), and 13 (23.2%) vs 22 (39.3%) patients exhibited the hyperactive subtype. CONCLUSIONS: A single dose of esketamine (0.25 mg/kg) injected intravenously before anesthesia induction reduced the incidence of delirium in relatively young patients with ASA grade Ⅱ or Ⅲ who underwent on-pump cardiac surgery.

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A year in review in Minerva Anestesiologica 2023: anesthesia, analgesia, and perioperative medicine

CAVALIERE,

ALLEGRI,

APAN

et al. 2024

Minerva Anestesiol

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The association of chronic pain and postoperative delirium: a prospective observational cohort study

Cited by 3 publications

References 37 publications

Predictors of postoperative delirium in patients undergoing radical prostatectomy: a prospective study

Predictors of postoperative delirium in patients undergoing radical prostatectomy: a prospective study

Effect of Esketamine on Postoperative Delirium in Patients Undergoing Cardiac Valve Replacement with Cardiopulmonary Bypass: A Randomized Controlled Trial

A year in review in Minerva Anestesiologica 2023: anesthesia, analgesia, and perioperative medicine

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