The Impact of Perioperative and Predisposing Risk Factors on the Development of Postoperative Delirium and a Possible Gender Difference

Abstract

(1) Background: Postoperative delirium (POD) is an undesirable event especially for older patients after surgery. Perioperative risks for POD development are multiple, but gender differences are still poorly considered. In this observational study, predisposing and precipitating risk factors of POD and the possible gender influence are distinguished. (2) Methods: This observational prospective trial enrolled 1097 patients in a tertiary hospital from September 2018 until October 2019. POD was considered positive, if one of the tests Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method (CAM), 4 ‘A’s Test (4AT) or Delirium Observation Screening (DOS) scale was positive on one of five assessment days. (3) Results: POD incidence was 23.5% and the mean age of study population was 72.3 ± 7.3 years. The multiple logistic regression model showed a significant impact of age (Odds Ratio (OR) 1.74; 95% Confidence Interval (CI): 1.37–2.22), American Society of Anesthesiologists (ASA) (OR 1.67; 95% CI: 1.25–2.26), surgery risk (OR 2.10; 95% CI: 1.52–2.95) and surgery duration (OR 1.17; 95% CI: 1.07–1.28), ventilation time (OR 1.64; 95% CI: 1.27–2.24), as well as the male sex (OR 1.74; 95% CI: 1.37–2.22) on POD risk. (4) Conclusions: Perioperative and predisposing risk factors had an impact on the development of POD. The influence of male sex should be considered in future research.

Multivariable model of postoperative delirium in cardiac surgery patients: proteomic and demographic contributions

“…From the demographic perspective, we found that age is associated with increased risk of delirium, as previously shown 27 . However, even though males represent the larger portion of patients undergoing cardiac surgery, our data indicate that females are more likely to experience delirium, differing from the current literature reporting male sex as an inconsistent risk factor for delirium in both cardiac and non-cardiac surgeries 28–30 . Here we highlight that the coronary bypass procedure is often technically more challenging in females compared to males.…”

Postoperative delirium in geriatric patients with hip fractures

“…The perioperative risk factors for POD in geriatric patients with hip fractures can be predisposing and precipitating. As is shown in the literature (Smith et al, 2017;Swarbrick and Partridge, 2022;Wittmann et al, 2022), predisposing risk factors include increased age, sensorial deficits, prior cognitive impairment, multimorbidity, malnutrition, and frailty, as well as precipitating risk factors including surgical procedures, ventilation time, and intensive care stay. In addition, there are also several independent predictors for POD in geriatric patients with hip fractures (Koskderelioglu et al, 2017;Mosk et al, 2017;Smith et al, 2017;Wang et al, 2018;Chen et al, 2020;Tantardini et al, 2020;Xing et al, 2020;Zhou et al, 2021; Table 1).…”

Prevalence of Delirium After Abdominal Surgery and Association With Ketamine: A Retrospective, Propensity-Matched Cohort Study

“…In the present study, delirium was prevalent in older male patients with multiple comorbidities, high SOFA scores, high NCS, and mechanical ventilation use. PSM created a balanced patient cohort based on ketamine administration, as many predisposing factors of delirium (26) were used as covariates for PSM, including age, dementia, depression, CKD, and mechanical ventilation use. After the PSM, the prevalence of delirium was 56.02 % (95% CI, 51.05-60.91%) among ICU patients following abdominal surgery.…”