The risk factors associated with delirium after lumbar spine surgery in elderly patients

Abstract

Background: To prospectively explore the incidence and risk factors for postoperative delirium in elderly patients following lumbar spine surgery.Methods: This prospective study enrolled 148 consecutive patients over the age of 65 who were scheduled to undergo spine surgery. Patients were screened for delirium using the short Confusion Assessment Method (CAM) postoperatively. Patient demographics and relevant medical information were collected. Logistic regression analysis was used to identify the risk factors associated with postoperative delirium.Results: Eighty-three patients (56.1%) who underwent lumbar spine surgery (not coexisting with cervical or thoracic spine surgery) were enrolled in our study. Post-operative delirium was noted in 14.5% of patients over 65 years old. The presence of preoperative Parkinsonism was significantly higher in the delirium group (41.7% vs. 8.5%, P=0.002), as was a higher preoperative C-reactive protein (CRP) (7.0±15.2 vs. 1.3±2.3 mg/L, P=0.017) when compared with the non-delirium group. Of the risk factors, male sex [odds ratio (OR) =0.10, 95% confidence interval (CI): 0.01-0.66, P=0.017], Parkinsonism (OR =5.83, 95% CI: 1.03-32.89, P=0.046), and lower baseline MMSE score (OR =0.71, 95% CI: 0.52-0.97, P=0.032) were independently associated with postoperative delirium in elderly patients undergoing lumbar spine surgery.Conclusions: Post-operative delirium occurred in 14.5% of elderly patients who underwent lumbar spine surgery. Male sex, Parkinsonism, and lower baseline MMSE score were identified as independent risk factors for postoperative delirium in elderly patients following lumbar surgery.

Incidence and Risk Factors for Postoperative Delirium in Patients Undergoing Spine Surgery: A Systematic Review and Meta-Analysis

“…However, diabetes mellitus, history of surgery, and cerebral vascular diseases were not found to be related to developing delirium, which was consistent with the previous meta-analysis [47]. For the cardiovascular comorbidity, the pooled result of 10 studies [8, 11, 15, 23, 26, 30, 31, 34, 43, 45] showed no significance (OR 0.81; 95% CI 0.34–1.29) with low heterogeneity ( I 2 0%) (Figure 4(a)). Only one study found cardiovascular comorbidity as a risk factor for delirium [11].…”

“…Delirium is thought to be a less transient disorder than previously believed in several studies [8, 11]. In addition, it has been reported that patients with postoperative delirium have a higher mortality rate than in those without it [4].…”

“…The final meta-analysis included 40 studies [1, 8–46] from 7 different countries, and the pooled incidence was 8% (Figure 2). There was high heterogeneity ( I -squared > 50%, P < 0.001).…”

Intoxication by hand sanitizer due to delirium after infectious spondylitis surgery during the COVID-19 pandemic: A case report and literature review

“…[ 13 ]. In elderly patients after lumbar spine surgery, risk factors associated with delirium were male gender and parkinsonism, and lower baseline Mini-Mental State Examination (MMSE) scores showed a more regular occurrence rate [ 14 ].…”

A Comparative Study of Enhanced Recovery After Surgery (ERAS) Program and None-ERAS Traditional Care in Elderly Patients Undergoing Lumbar Arthrodesis

“…Thrombosis-related complications can be decreased by active/passive limb movement, antithrombotic stockings and early ambulation. Notably, advanced age is one of the main risk factors for postoperative delirium, and the incidence of postoperative delirium after elective lumbar surgery can be as high as 15%, which can lead to nursing di culties and lower compliance with the ERAS protocols [24][25][26].…”