The Association of Preoperative Frailty and Postoperative Delirium: A Meta-analysis

Gracie, Thomas J.; Caufield-Noll, Christine; Wang, Nae Yuh; Sieber, Frederick E.

doi:10.1213/ane.0000000000005609

Cited by 77 publications

(50 citation statements)

References 34 publications

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“…For example, Montreal Cognitive Assessment (MoCA) in combination with Trial Making Test B may be more suitable for detection of mild cognitive impairment. 40 , 41 Further, frailty is a recognized concept in cardiac surgery, which has been associated with postoperative complications, 42 , 43 and other physiological parameters, such as impaired cerebral autoregulation or cerebrovascular reserve capacity have also been related to an increased risk of postoperative delirium. 44 , 45 Thus, a combination of tests capable of complementing each other may be the best way forward given the multifactorial nature of delirium.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Postoperative Delirium After Cardiac Surgery with A Quick Test of Cognitive Speed, Mini-Mental State Examination and Hospital Anxiety and Depression Scale

Segernäs

Skoog

Andersson

et al. 2022

CIA

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Purpose To evaluate if preoperative assessment with A Quick Test of Cognitive Speed (AQT) could increase the accuracy of predicting delirium after cardiac surgery compared to Mini-Mental State Examination (MMSE), and examine if a composite of variables, including cognitive function and depressive symptoms, could be useful to predict delirium. Patients and Methods Cardiac surgery was performed in 218 patients (mean age 72 years). Preoperative evaluation involved AQT, MMSE and Hospital Anxiety And Depression Scale (HADS). Postoperative delirium was assessed using Nursing Delirium Screening Scale (Nu-DESC) and Confusion Assessment Method-ICU (CAM-ICU). Logistic regression was performed to detect predictors of postoperative delirium and receiver operator characteristic curves (ROC) with area under the curve (AUC) to determine the accuracy. Results Postoperative delirium occurred in 47 patients (22%) who had lower MMSE scores (median (range), 27 (19–30) vs 28 (20–30), p =0.009) and slower AQT (median (range), 76 (48–181) vs 70 (40–182) seconds, p =0.030) than patients without delirium. Predictive power measured as AUC (95% CI) was 0.605 (0.51–0.70) for AQT and 0.623 (0.53–0.72) for MMSE. Logistic regression (OR, 95% CI) showed MMSE <27 points (2.72, 1.27–5.86), AQT >70 sec (2.26, 1.03–4.95), HADS-D >4 points (2.60, 1.21–5.58) and longer cardiopulmonary bypass-time (1.007, 1.002–1.013) to be associated with postoperative delirium. Combining these parameters yielded an AUC of 0.736 (0.65–0.82). Conclusion The ability of predicting delirium using AQT was similar to MMSE, and only slightly higher by combining AQT and MMSE. Adding HADS-D and cardiopulmonary bypass-time to MMSE and AQT increased the predictive power to a borderline acceptable discriminatory value. Preoperative cognitive tests and screening for depressive symptoms may help identify patients at risk of postoperative delirium. Yet, there is still a need to establish useful preoperative tests.

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Section: Discussionmentioning

confidence: 99%

Prediction of Postoperative Delirium After Cardiac Surgery with A Quick Test of Cognitive Speed, Mini-Mental State Examination and Hospital Anxiety and Depression Scale

Segernäs

Skoog

Andersson

et al. 2022

CIA

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“…Gracie et al conducted a review that suggests the relationship b/n preoperative weakness and POD in patients undergoing surgery with the age of 65 and above with an odds ratio for POD in weakness vs non-weakness patients with an odds of 2.14. 13 Level 1a…”

Section: Discussionmentioning

confidence: 99%

“…Identifying patients at the highest risk of developing delirium is a necessary first step, risk reduction technique by the non-pharmacological and pharmacological second step, early diagnosis is critical to trigger focused and effective treatment is an important technique in the management of postoperative delirium. 13 …”

Section: Introductionmentioning

confidence: 99%

Evidence-Based Guideline on Management of Postoperative Delirium in Older People for Low Resource Setting: Systematic Review Article

Mossie¹,

Regasa²,

Neme³

et al. 2022

IJGM

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Background Postoperative delirium is the highest prevalence and life-threatening complication following geriatric surgery. The overall incidence rate varies from 5% to 52% of hospitalized surgical patients based on the type of surgery that often began in the postanesthesia care unit and continues up to 5 days post-surgery. Postoperative delirium manifests as a hypoactive, hyperactive and mixed subtype. The mechanism of delirium development is not clear, but it is accepted that delirium is a result of the patient’s underlying vulnerabilities or risk factors combined with an outside stressor such as infection or surgery. Objective To develop evidence-based recommendations for the prevention, diagnosis, and treatment of postoperative delirium. Methods Literature was searched from PubMed, CINAH, Google Scholar, and Cochrane databases that are published from 2010 to 2021 by formulating inclusion and exclusion criteria. Filtering was made depending on methodological quality, outcome, and data on population. Finally, 11 meta-analysis, 11 systematic reviews, 7 interventional studies, 11 observational studies, and recommendations of the previous clinical practice guideline developed by the American and European are included in this review. Results A total of 43 studies were considered in this evaluation. The development of this guideline was based on nine studies on risk stratification for postoperative delirium, eighteen studies on risk minimization and prevention for postoperative delirium, five studies on diagnosis for postoperative delirium, and eleven studies on treatments for postoperative delirium. Conclusion Postoperative delirium management can be categorized into risk assessment, risk minimization, early diagnosis, and treatment. Early diagnosis is critical to trigger focused and effective treatment. Non-pharmacological interventions are the first-line management for both hypoactive and hyperactive postoperative with considering contributory factors and underlying causes. Antipsychotics should only be used for hyperactive delirium individuals who try to harm themselves. Current evidence suggested that dexmedetomidine can be used as a treatment option for postoperative delirium.

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“…Whether frailty is associated with PND is being actively investigated. Gracie et al recently conducted a meta-analysis of nine qualified clinical studies and demonstrated evidence of an association between preoperative frailty and POD in elective surgical patients aged 65 years or older when compared to nonfrail control patients [43]. The association of frailty with POD has also been suggested in multiple other recent studies [48][49][50][51][52].…”

Section: Preoperative Cognitive Assessmentmentioning

confidence: 95%

“…Frailty syndrome is measured as the sum of various indicators, including unintentional weight loss, fatigue, muscle weakness, low physical activity, low gait speed, poor balance, visual impairment, and cognitive impairment [41,42]. The prevalence of preoperative frailty varies significantly (up to 50-60%) depending on age and the type of surgery, with a steep increase observed in older patients [43][44][45][46]. Preoperative frailty is known to be associated with poor postoperative morbidity and mortality [47].…”

Section: Preoperative Cognitive Assessmentmentioning

confidence: 99%

Does Preoperative Cognitive Optimization Improve Postoperative Outcomes in the Elderly?

Ishizawa

2022

JCM

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Perioperative neurocognitive disorder (PND) is a growing concern, affecting several million elderly patients each year in the United States, but strategies for its effective prevention have not yet been established. Humeidan et al. recently demonstrated that preoperative brain exercise resulted in a decrease in postoperative delirium incidence in elderly surgical patients, suggesting the potential of presurgical cognitive optimization to improve postoperative cognitive outcomes. This brief review summarizes the current knowledge regarding preoperative cognitive optimization and highlights landmark studies, as well as current ongoing studies, as the field is rapidly growing. This review further discusses the benefit of cognitive training in non-surgical elderly populations and the role of cognitive training in patients with preexisting cognitive impairment or dementia. The review also examines preclinical evidence in support of cognitive training, which can facilitate understanding of brain plasticity and the pathophysiology of PND. The literature suggests positive impacts of presurgical cognitive optimization, but further studies are encouraged to establish effective cognitive training programs for elderly presurgical patients.

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The Association of Preoperative Frailty and Postoperative Delirium: A Meta-analysis

Cited by 77 publications

References 34 publications

Prediction of Postoperative Delirium After Cardiac Surgery with A Quick Test of Cognitive Speed, Mini-Mental State Examination and Hospital Anxiety and Depression Scale

Prediction of Postoperative Delirium After Cardiac Surgery with A Quick Test of Cognitive Speed, Mini-Mental State Examination and Hospital Anxiety and Depression Scale

Evidence-Based Guideline on Management of Postoperative Delirium in Older People for Low Resource Setting: Systematic Review Article

Does Preoperative Cognitive Optimization Improve Postoperative Outcomes in the Elderly?

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