The association of preoperative delirium with postoperative outcomes following hip surgery in the elderly

Agrawal, Sarita; Turk, Robert; Burton, Brittany N.; Ingrande, Jerry; Gabriel, Rodney A.

doi:10.1016/j.jclinane.2019.08.015

Cited by 20 publications

(18 citation statements)

References 34 publications

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“…Previous cognitive decline and dementia are known risk factors for delirium (along with older age, comorbidities, and sensorial impairment) particularly in surgical settings. 32 Decreased cognitive reserve and a reduced baseline brain connectivity which has been documented in individuals with cognitive deficits might be a contributing factor to the development of POD. 31,33 Because of the lack of data we could not determine if previous cognitive impairment was associated with preoperative delirium.…”

Section: Discussionmentioning

confidence: 99%

Estimates of Geriatric Delirium Frequency in Noncardiac Surgeries and Its Evaluation Across the Years: A Systematic Review and Meta-Analysis

Silva

Regueira

Albuquerque

et al. 2021

Journal of the American Medical Directors Association

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Objectives: Delirium is an acute neuropsychiatric syndrome associated with poor outcomes. Older adults undergoing surgery have a higher risk of manifesting perioperative delirium, particularly those having associated comorbidities. It remains unclear whether delirium frequency varies across surgical settings and if it has remained stable across the years. We conducted a systematic review to (1) determine the overall frequency of delirium in older people undergoing noncardiac surgery; (2) explore factors explaining the variability of the estimates; and (3) determine the changing of the estimates over the past 2 decades. Design: Systematic review and meta-analysis. Literature search was performed in MEDLINE, PubMed, ISI Web of Science, EBSCO, ISRCTN registry, ScienceDirect, and Embase in January 2020 for studies published from 1995 to 2020. Setting: Noncardiac surgical settings. Participants: Forty-nine studies were included with a total of 26,865 patients screened for delirium. Methods: We included observational and controlled trials reporting incidence, prevalence, or proportion of delirium in adults aged !60 years undergoing any noncardiac surgery requiring hospitalization. Data extracted included sample size, reported delirium frequencies, surgery type, anesthesia type, delirium diagnosis method, length of hospitalization, and year of assessment. (PROSPERO registration no.: CRD42020160045). Results: We found an overall pooled frequency of preoperative delirium of 17.9% and postoperative delirium (POD) of 23.8%. The POD estimates increased between 1995 and 2020 at an average rate of 3% per year. Pooled estimates of POD were significantly higher in studies not excluding patients with lower cognitive performance before surgery (28% vs 16%) and when general anesthesia was used in comparison to local, spinal, or epidural anesthesia (28% vs 20%). Conclusions and Implications: Type of anesthesia and preoperative cognitive status were significant moderators of delirium frequency. POD in noncardiac surgery has been increasing across the years, suggesting that more resources should be allocated to delirium prevention and management.

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Section: Discussionmentioning

confidence: 99%

Estimates of Geriatric Delirium Frequency in Noncardiac Surgeries and Its Evaluation Across the Years: A Systematic Review and Meta-Analysis

Silva

Regueira

Albuquerque

et al. 2021

Journal of the American Medical Directors Association

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“…First, it would have been more interesting if we had assessed other clinical and laboratory data which are involved with the onset of delirium including the APACHE II severity score, baseline nutritional status, albumin levels, anesthetic events during the operation (hypotension, hypoxemia), as well as time of ambulation. Second, preoperative delirium was reported to be highly prevalent in hip fracture populations, namely between 12.7-58% (67,68) . Third, we obtained venous rather than arterial blood samples to assess the acid base and blood gas biomarkers of delirium.…”

Section: Discussionmentioning

confidence: 99%

Biomarkers and Clinical Features of Delirium in Elderly Individuals With Hip Fracture Surgery.

Thisayakorn¹

2021

Preprint

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Background: Post-operative delirium in elderly with hip fracture is associated with various adverse clinical outcomes. Nevertheless, the pathophysiological processes underpinning delirium have remained elusive. The aim of this study is to explore the associations between delirium and its features and immune-inflammatory and blood gas biomarkers.Methods: In this prospective study we examined 65 patients who underwent a hip fracture surgery and assessed the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), Richmond Agitation-Sedation Scale (RASS), and Delirium Rating Scale Revised-98 (DRS-R-98) before and during 4 days after the surgery. Complete Blood Count (CBC) and venous blood gas markers were obtained at the same time points.Results: Delirium was observed in 19 patients and was accompanied by significantly increased pO2, number of white blood cells, neutrophil percentage, and neutrophil/lymphocyte ratio, and lower mean platelet volume (MPV) (after adjusting for age, central nervous system (CNS) disease, blood loss during surgery, sleep disorders, and body mass index. The severity of delirium was associated with lowered number of platelets and MPV. Psychomotor disorders were associated with lower bicarbonate levels. The requirement of physical restraint of the patients was predicted by increased percentages of neutrophils and lymphocytes. Prior CNS disease was together with these biomarkers a significant predictor of delirium and severity of delirium. Conclusion: Delirium and psychomotor disorders following hip fracture and surgery may be caused by immune-inflammatory and oxidative stress pathways probably attributable to an aseptic inflammatory process. Oxygen administration may aggravate these pathways.

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“…Delirium has been shown to occur between 12 and 61% of HF patients before and after surgery, respectively [92,93].…”

Section: Deliriummentioning

confidence: 99%

Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus

Vincentis

Behr²,

Bellelli

et al. 2021

Aging Clin Exp Res

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Background Health outcomes of older subjects with hip fracture (HF) may be negatively influenced by multiple comorbidities and frailty. An integrated multidisciplinary approach (i.e. the orthogeriatric model) is, therefore, highly recommended, but its implementation in clinical practice suffers from the lack of shared management protocols and poor awareness of the problem. The present consensus document has been implemented to address these issues. Aim To develop evidence-based recommendations for the orthogeriatric co-management of older subjects with HF. Methods A 20-member Expert Task Force of geriatricians, orthopaedics, anaesthesiologists, physiatrists, physiotherapists and general practitioners was established to develop evidence-based recommendations for the pre-, peri-, intra-and postoperative care of older in-patients (≥ 65 years) with HF. A modified Delphi approach was used to achieve consensus, and the U.S. Preventive Services Task Force system was used to rate the strength of recommendations and the quality of evidence. Results A total of 120 recommendations were proposed, covering 32 clinical topics and concerning preoperative evaluation (11 topics), perioperative (8 topics) and intraoperative (3 topics) management, and postoperative care (10 topics). Conclusion These recommendations should ease and promote the multidisciplinary management of older subjects with HF by integrating the expertise of different specialists. By providing a convenient list of topics of interest, they might assist in identifying unmet needs and research priorities.

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The association of preoperative delirium with postoperative outcomes following hip surgery in the elderly

Cited by 20 publications

References 34 publications

Estimates of Geriatric Delirium Frequency in Noncardiac Surgeries and Its Evaluation Across the Years: A Systematic Review and Meta-Analysis

Estimates of Geriatric Delirium Frequency in Noncardiac Surgeries and Its Evaluation Across the Years: A Systematic Review and Meta-Analysis

Biomarkers and Clinical Features of Delirium in Elderly Individuals With Hip Fracture Surgery.

Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus

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