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Journal articles on the topic 'Postoperative delirium'

Author: Grafiati

Published: 4 June 2021

Last updated: 1 February 2022

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1

Ren, Quan, Ya-zhou Wen, Jin Wang, Jing Yuan, Xu-hui Chen, Yubaraj Thapa, Meng-shuang Qiang, and Fei Xu. "Elevated Level of Serum C-reactive Protein Predicts Postoperative Delirium among Patients Receiving Cervical or Lumbar Surgery." BioMed Research International 2020 (August 10, 2020): 1–8. http://dx.doi.org/10.1155/2020/5480148.

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Objective. To explore the relationship between elevated serum C-reactive protein (CRP) level and postoperative delirium (POD). Methods. 206 patients scheduled to receive cervical or lumbar vertebra surgery under general anesthesia for more than 2 hours in a single medical center were observed and analyzed. Patients’ serum CRP, delirious status (using the confusion assessment method (CAM)), and delirious score (using the memorial delirium assessment scale (MDAS)) were examined before surgery and 1-2 days after surgery. The association of a serum CRP elevation value from before to after surgery (D-CRP) with delirium occurrence within 2 days after surgery was assessed with a binary logistic regression model, while the association of D-CRP with the postoperative delirious score was assessed with a linear regression model. The effect of D-CRP on predicting delirium occurrence was evaluated with the area under the receiver operating characteristic (ROC) curve (AUC). Results. D-CRP was significantly positively associated with postoperative delirium occurrence (OR=1.047, 95%CI=1.013, 1.082), and D-CRP was also significantly linearly associated with the postoperative delirious score (β=0.014, 95%CI=0.006, 0.023). AUC of ROC was 0.711 (P=0.014), suggesting that D-CRP had moderate efficacy on predicting postoperative delirium occurrence (P<0.05). Conclusions. Elevated serum CRP after surgery may be a risk factor for and a predictor of postoperative delirium.

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Cavaliere, F., F. D'Ambrosio, C. Volpe, and S. Masieri. "Postoperative Delirium." Current Drug Targets 6, no. 7 (November 1, 2005): 807–14. http://dx.doi.org/10.2174/138945005774574489.

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Oh, Seung-Taek, and Jin Young Park. "Postoperative delirium." Korean Journal of Anesthesiology 72, no. 1 (February 1, 2019): 4–12. http://dx.doi.org/10.4097/kja.d.18.00073.1.

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4

Winawer, Neil. "POSTOPERATIVE DELIRIUM." Medical Clinics of North America 85, no. 5 (September 2001): 1229–39. http://dx.doi.org/10.1016/s0025-7125(05)70374-6.

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Rengel, Kimberly F., Pratik P. Pandharipande, and Christopher G. Hughes. "Postoperative delirium." La Presse Médicale 47, no. 4 (April 2018): e53-e64. http://dx.doi.org/10.1016/j.lpm.2018.03.012.

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6

Tune, Larry E. "Postoperative Delirium." International Psychogeriatrics 3, no. 2 (December 1991): 325–32. http://dx.doi.org/10.1017/s1041610291000777.

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Postoperative delirium is a common syndrome that is often mistaken for other psychiatric conditions, particularly depression. Numerous investigators have found a clear convincing association between delirium and increased morbidity and mortality. For this reason, greater attention should be focused on accurate clinical diagnosis. In this article, pre- and postoperative risk factors are reviewed. Lastly, areas demanding immediate further investigation are identified. In particular, outcome studies with particular emphasis on the role of age and prior drug exposure are urgently needed.

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McDaniel, Mathew, and Charles Brudney. "Postoperative delirium." Current Opinion in Critical Care 18, no. 4 (August 2012): 372–76. http://dx.doi.org/10.1097/mcc.0b013e3283557211.

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8

Fricchione, Gregory L., Shamim H. Nejad, Justin A. Esses, Thomas J. Cummings, John Querques, Ned H. Cassem, and George B. Murray. "Postoperative Delirium." American Journal of Psychiatry 165, no. 7 (July 2008): 803–12. http://dx.doi.org/10.1176/appi.ajp.2008.08020181.

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9

DOB, D. "Postoperative delirium." British Journal of Anaesthesia 73, no. 3 (September 1994): 431. http://dx.doi.org/10.1093/bja/73.3.431-a.

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10

BROCK-UTNE, J. G. "Postoperative delirium." British Journal of Anaesthesia 73, no. 4 (October 1994): 565. http://dx.doi.org/10.1093/bja/73.4.565.

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11

&NA;. "Postoperative Delirium." Survey of Anesthesiology 50, no. 5 (October 2006): 264–65. http://dx.doi.org/10.1097/01.sa.0000238942.61799.3d.

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12

Rudra, A., S. Chatterjee, J. Kirtania, S. Sengupta, G. Moitra, S. Sirohia, R. Wankhade, and S. Banerjee. "Postoperative delirium." Indian Journal of Critical Care Medicine 10, no. 4 (2006): 235–40. http://dx.doi.org/10.4103/0972-5229.29842.

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Rudolph, James L., and Edward S. Marcantonio. "Postoperative Delirium." Survey of Anesthesiology 56, no. 1 (February 2012): 33. http://dx.doi.org/10.1097/sa.0b013e318242c23a.

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Marcantonio, Edward R. "Postoperative Delirium." Survey of Anesthesiology 56, no. 6 (December 2012): 286. http://dx.doi.org/10.1097/sa.0b013e3182751fb1.

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15

Dyer, Carmel Bitondo. "Postoperative Delirium." Archives of Internal Medicine 155, no. 5 (March 13, 1995): 461. http://dx.doi.org/10.1001/archinte.1995.00430050035004.

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16

Rudolph, James L., and Edward R. Marcantonio. "Postoperative Delirium." Anesthesia & Analgesia 112, no. 5 (May 2011): 1202–11. http://dx.doi.org/10.1213/ane.0b013e3182147f6d.

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17

Sleigh, Jamie W., and Amy Gaskell. "Postoperative Delirium." Anesthesiology 133, no. 2 (June 17, 2020): 255–57. http://dx.doi.org/10.1097/aln.0000000000003383.

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18

van der Mast, Rose C. "Postoperative Delirium." Dementia and Geriatric Cognitive Disorders 10, no. 5 (1999): 401–5. http://dx.doi.org/10.1159/000017178.

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19

Mashour, George A., and Michael S. Avidan. "Postoperative Delirium." Anesthesiology 121, no. 2 (August 1, 2014): 214–16. http://dx.doi.org/10.1097/aln.0000000000000330.

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20

Wong, Camilla L., and Maia Von Maltzahn. "Postoperative Delirium." Canadian Journal of General Internal Medicine 16, SP1 (March 16, 2021): 37–42. http://dx.doi.org/10.22374/cjgim.v16isp1.532.

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There is strong evidence to support prevention of postoperative delirium through comprehensive geriatric assessment and multicomponent nonpharmacologic interventions. Risk assessment must be accompanied by communication of the risk to the patient, caregivers, and perioperative interdisciplinary team to engage all in evidence-based prevention interventions. However, once postoperative delirium has developed, efforts should be focused on prevention of short- and long-term adverse effects. RÉSUMÉDes données probantes solides appuient la prévention du délire postopératoire en recourant à une évaluation gériatrique complète et à des interventions non pharmacologiques à plusieurs composantes. L’évaluation des risques doit s’accompagner d’une communication du risque au patient, aux soignants et à l’équipe interdisciplinaire périopératoire afin que tous participent aux interventions de prévention fondées sur des données probantes. Toutefois, une fois que le délire postopératoire s’est installé, les efforts doivent être axés sur la prévention des effets indésirables à court et à long terme.

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21

Tarasova, Natalia, Alexander Kulikov, and Federico Bilotta. "Postoperative Delirium." Current Anesthesiology Reports 11, no. 3 (May 8, 2021): 195–201. http://dx.doi.org/10.1007/s40140-021-00445-6.

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22

Daiello, Lori A., Annie M. Racine, Ray Yun Gou, Edward R. Marcantonio, Zhongcong Xie, Lisa J. Kunze, Kamen V. Vlassakov, Sharon K. Inouye, and Richard N. Jones. "Postoperative Delirium and Postoperative Cognitive Dysfunction." Anesthesiology 131, no. 3 (September 1, 2019): 477–91. http://dx.doi.org/10.1097/aln.0000000000002729.

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Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Postoperative delirium and postoperative cognitive dysfunction share risk factors and may co-occur, but their relationship is not well established. The primary goals of this study were to describe the prevalence of postoperative cognitive dysfunction and to investigate its association with in-hospital delirium. The authors hypothesized that delirium would be a significant risk factor for postoperative cognitive dysfunction during follow-up. Methods This study used data from an observational study of cognitive outcomes after major noncardiac surgery, the Successful Aging after Elective Surgery study. Postoperative delirium was evaluated each hospital day with confusion assessment method–based interviews supplemented by chart reviews. Postoperative cognitive dysfunction was determined using methods adapted from the International Study of Postoperative Cognitive Dysfunction. Associations between delirium and postoperative cognitive dysfunction were examined at 1, 2, and 6 months. Results One hundred thirty-four of 560 participants (24%) developed delirium during hospitalization. Slightly fewer than half (47%, 256 of 548) met the International Study of Postoperative Cognitive Dysfunction-defined threshold for postoperative cognitive dysfunction at 1 month, but this proportion decreased at 2 months (23%, 123 of 536) and 6 months (16%, 85 of 528). At each follow-up, the level of agreement between delirium and postoperative cognitive dysfunction was poor (kappa less than .08) and correlations were small (r less than .16). The relative risk of postoperative cognitive dysfunction was significantly elevated for patients with a history of postoperative delirium at 1 month (relative risk = 1.34; 95% CI, 1.07–1.67), but not 2 months (relative risk = 1.08; 95% CI, 0.72–1.64), or 6 months (relative risk = 1.21; 95% CI, 0.71–2.09). Conclusions Delirium significantly increased the risk of postoperative cognitive dysfunction in the first postoperative month; this relationship did not hold in longer-term follow-up. At each evaluation, postoperative cognitive dysfunction was more common among patients without delirium. Postoperative delirium and postoperative cognitive dysfunction may be distinct manifestations of perioperative neurocognitive deficits.

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Hudetz, Judith A., Alison J. Byrne, Kathleen M. Patterson, Paul S. Pagel, and David C. Warltier. "Postoperative Delirium is Associated with Postoperative Cognitive Dysfunction at One Week after Cardiac Surgery with Cardiopulmonary Bypass." Psychological Reports 105, no. 3 (December 2009): 921–32. http://dx.doi.org/10.2466/pr0.105.3.921-932.

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Postoperative delirium with cognitive impairment frequently occurs after cardiac surgery. It was hypothesized that delirium is associated with residual postoperative cognitive dysfunction in patients after surgery using cardiopulmonary bypass. Male cardiac surgical patients ( M age = 66 yr., SD = 8; M education = 13 yr., SD = 2) and nonsurgical controls ( M age = 62, SD = 7; M education = 12, SD = 2) 55 years of age or older were balanced on age and education. Delirium was assessed by the Intensive Care Delirium Screening Checklist preoperatively and for up to 5 days postoperatively. Recent verbal and nonverbal memory and executive functions were assessed (as scores on particular tests) before and 1 wk. after surgery. In 56 patients studied ( n = 28 Surgery; n=28 Nonsurgery), nine patients from the Surgery group developed delirium. In the Surgery group, the proportion of patients having postoperative cognitive dysfunction was significantly greater in those who experienced delirium (89%) compared with those who did not (37%). The odds of developing this dysfunction in patients with delirium were 14 times greater than those who did not. Postoperative delirium is associated with scores for residual postoperative cognitive dysfunction 1 wk. after cardiac surgery.

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Allen, Steven R., and Heidi L. Frankel. "Postoperative Complications: Delirium." Surgical Clinics of North America 92, no. 2 (April 2012): 409–31. http://dx.doi.org/10.1016/j.suc.2012.01.012.

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25

Steiner, Luzius A. "Postoperative delirium guidelines." European Journal of Anaesthesiology 34, no. 4 (April 2017): 189–91. http://dx.doi.org/10.1097/eja.0000000000000578.

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26

Austin, J. "Reducing postoperative delirium." Anaesthesia 69, no. 5 (April 17, 2014): 518–19. http://dx.doi.org/10.1111/anae.12700.

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27

Mangusan, Ralph Francis, Vallire Hooper, Sheri A. Denslow, and Lucille Travis. "Outcomes Associated With Postoperative Delirium After Cardiac Surgery." American Journal of Critical Care 24, no. 2 (March 1, 2015): 156–63. http://dx.doi.org/10.4037/ajcc2015137.

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Background Delirium after surgery is a common condition that leads to poor outcomes. Few studies have examined the effect of postoperative delirium on outcomes after cardiac surgery. Objectives To assess the relationship between delirium after cardiac surgery and the following outcomes: length of stay after surgery, prevalence of falls, discharge to a nursing facility, discharge to home with home health services, and use of inpatient physical therapy. Methods Electronic medical records of 656 cardiac surgery patients were reviewed retrospectively. Results Postoperative delirium occurred in 161 patients (24.5%). Patients with postoperative delirium had significantly longer stays (P < .001) and greater prevalence of falls (P < .001) than did patients without delirium. Patients with delirium also had a significantly greater likelihood for discharge to a nursing facility (P < .001) and need for home health services if discharged to home (P < .001) and a significantly higher need for inpatient physical therapy (P < .001). Compared with patients without postoperative delirium, patients who had this complication were more likely to have received zolpidem and benzodiazepines postoperatively and to have a history of arrhythmias, renal disease, and congestive heart failure. Conclusions Patients who have delirium after cardiac surgery have poorer outcomes than do similar patients without this complication. Development and implementation of an extensive care plan to address postoperative delirium is necessary for cardiac surgery patients who are at risk for or have delirium after the surgery.

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King, Christopher R., Krisztina E. Escallier, Yo-El S. Ju, Nan Lin, Ben Julian Palanca, Sherry Lynn McKinnon, and Michael Simon Avidan. "Obstructive sleep apnoea, positive airway pressure treatment and postoperative delirium: protocol for a retrospective observational study." BMJ Open 9, no. 8 (August 2019): e026649. http://dx.doi.org/10.1136/bmjopen-2018-026649.

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IntroductionObstructive sleep apnoea (OSA) is common among older surgical patients, and delirium is a frequent and serious postoperative complication. Emerging evidence suggests that OSA increases the risk for postoperative delirium. We hypothesise that OSA is an independent risk factor for postoperative delirium, and that in patients with OSA, perioperative adherence to positive airway pressure (PAP) therapy decreases the incidence of postoperative delirium and its sequelae. The proposed retrospective cohort analysis study will use existing datasets to: (i) describe and compare the incidence of postoperative delirium in surgical patients based on OSA diagnosis and treatment with PAP; (ii) assess whether preoperatively untreated OSA is independently associated with postoperative delirium; and (iii) explore whether preoperatively untreated OSA is independently associated with worse postoperative quality of life (QoL). The findings of this study will inform on the potential utility and approach of an interventional trial aimed at preventing postoperative delirium in patients with diagnosed and undiagnosed OSA.Methods and analysisObservational data from existing electronic databases will be used, including over 100 000 surgical patients and ~10 000 intensive care unit (ICU) admissions. We will obtain the incidence of postoperative delirium in adults admitted postoperatively to the ICU who underwent structured preoperative assessment, including OSA diagnosis and screening. We will use doubly robust propensity score methods to assess whether untreated OSA independently predicts postoperative delirium. Using similar methodology, we will assess if untreated OSA independently predicts worse postoperative QoL.Ethics and disseminationThis study has been approved by the Human Research Protection Office at Washington University School of Medicine. We will publish the results in a peer-reviewed venue. Because the data are secondary and high risk for reidentification, we will not publicly share the data. Data will be destroyed after 1 year of completion of active Institutional Review Board (IRB) approved projects.

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Szylińska, Aleksandra, Iwona Rotter, Mariusz Listewnik, Kacper Lechowicz, Mirosław Brykczyński, Sylwia Dzidek, Maciej Żukowski, and Katarzyna Kotfis. "Postoperative Delirium in Patients with Chronic Obstructive Pulmonary Disease after Coronary Artery Bypass Grafting." Medicina 56, no. 7 (July 9, 2020): 342. http://dx.doi.org/10.3390/medicina56070342.

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Background and Objectives: The incidence of postoperative delirium (POD) in patients with chronic obstructive pulmonary disease (COPD) is unclear. It seems that postoperative respiratory problems that may occur in COPD patients, including prolonged mechanical ventilation or respiratory-tract infections, may contribute to the development of delirium. The aim of the study was to identify a relationship between COPD and the occurrence of delirium after cardiac surgery and the impact of these combined disorders on postoperative mortality. Materials and Methods: We performed an analysis of data collected from 4151 patients undergoing isolated coronary artery bypass grafting (CABG) in a tertiary cardiac-surgery center between 2012 and 2018. We included patients with a clinical diagnosis of COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The primary endpoint was postoperative delirium; Confusion Assessment Method in the Intensive Care Unit (CAM-ICU) was used for delirium assessment. Results: Final analysis included 283 patients with COPD, out of which 65 (22.97%) were diagnosed with POD. Delirious COPD patients had longer intubation time (p = 0.007), more often required reintubation (p = 0.019), had significantly higher levels of C-reactive protein (CRP) three days after surgery (p = 0.009) and were more often diagnosed with pneumonia (p < 0.001). The CRP rise on day three correlated positively with the occurrence of postoperative pneumonia (r = 0.335, p = 0.005). The probability of survival after CABG was significantly lower in COPD patients with delirium (p < 0.001). Conclusions: The results of this study confirmed the relationship between chronic obstructive pulmonary disease and the incidence of delirium after cardiac surgery. The probability of survival in COPD patients undergoing CABG who developed postoperative delirium was significantly decreased.

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Devinney, Michael J., Joseph P. Mathew, and Miles Berger. "Postoperative Delirium and Postoperative Cognitive Dysfunction." Anesthesiology 129, no. 3 (September 1, 2018): 389–91. http://dx.doi.org/10.1097/aln.0000000000002338.

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Leung, Jacqueline M., Laura P. Sands, Yun Wang, Annie Poon, Pui-yan Kwok, John P. Kane, and Clive R. Pullinger. "Apolipoprotein E e4 Allele Increases the Risk of Early Postoperative Delirium in Older Patients Undergoing Noncardiac Surgery." Anesthesiology 107, no. 3 (September 1, 2007): 406–11. http://dx.doi.org/10.1097/01.anes.0000278905.07899.df.

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Background Whether patients who subsequently develop early postoperative delirium have a genetic predisposition that renders them at risk for postoperative delirium has not been determined. Methods The authors conducted a nested cohort study to include patients aged > or = 65 yr who were scheduled to undergo major noncardiac surgery requiring anesthesia. A structured interview was conducted preoperatively and for the first 2 days postoperatively to determine the presence of delirium, defined using the Confusion Assessment Method. Blood was drawn for measurement of the apolipoprotein genotypes. Bivariate tests of association were conducted between delirium and apolipoprotein genotypes and other potentially important risk factors. Variables that had significant bivariate association with postoperative delirium were entered in a forward multivariable logistic regression model. Results Of the 190 patients studied, 15.3% developed delirium on both days 1 and 2 after surgery. Forty-six patients (24.2%) had at least one copy of the apolipoprotein e4 allele. The presence of one copy of the e4 allele was associated with an increased risk of early postoperative delirium (28.3% vs. 11.1%; P = 0.005). Even after adjusting for covariates, patients with one copy of the e4 allele were still more likely to have an increased risk of early postoperative delirium (odds ratio, 3.64; 95% confidence interval, 1.51-8.77) compared with those without the e4 allele. Conclusions Apolipoprotein e4 carrier status was associated with an increased risk for early postoperative delirium after controlling for known demographic and clinical risk factors. These results suggest that genetic predisposition plays a role and may interact with anesthetic/surgical factors contributing to the development of early postoperative delirium.

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ten Broeke, Miarca, Sandra Koster, Thomas Konings, Ab G. Hensens, and Job van der Palen. "Can we predict a delirium after cardiac surgery? A validation study of a delirium risk checklist." European Journal of Cardiovascular Nursing 17, no. 3 (October 5, 2017): 255–61. http://dx.doi.org/10.1177/1474515117733365.

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Background: Delirium is a common temporary mental disorder that often occurs in patients who undergo cardiac surgery. It is important to prevent the negative side effects of delirium by identifying high-risk patients before surgery. Koster and colleagues designed a risk model to identify patients with an increased risk of postoperative delirium after cardiac surgery. Aim: The aim of this study was to validate the risk model for delirium and further improve the risk model. Methods: A delirium risk checklist containing predictors associated with postoperative delirium was used during the preoperative outpatient screening in 329 patients. The delirium observation screening scale was used preoperatively and postoperatively to assess delirium. Results: Compared with the model of Koster and colleagues age greater than 70 years and a history of delirium were confirmed as statistically significant predictors of postoperative delirium, while cognitive impairment and alcohol abuse were almost significant factors. The European system for cardiac operative risk evaluation (EuroSCORE), comorbidity and type of surgery could not predict a postoperative delirium again. The area under the curve of this model was 0.79 (95% confidence interval (CI) 0.73–0.86; P<0.001). Based on the data of this study the model was improved with the following independent predictors of postoperative delirium: age, more than one comorbidity, history of delirium and a lower standardised mini mental state examination score as with an area under the curve of 0.79 (95% CI 0.73–0.85; P<0.001). Conclusion: The risk model could not be fully validated. It is difficult to validate a risk model over time; there are different circumstances such as the increased focus on the prevention of delirium.

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Sugimura, Yukiharu, Nihat Firat Sipahi, Arash Mehdiani, Georgi Petrov, Mareike Awe, Jan Philipp Minol, Udo Boeken, Bernhard Korbmacher, Artur Lichtenberg, and Hannan Dalyanoglu. "Risk and Consequences of Postoperative Delirium in Cardiac Surgery." Thoracic and Cardiovascular Surgeon 68, no. 05 (March 29, 2020): 417–24. http://dx.doi.org/10.1055/s-0040-1708046.

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Abstract Background Delirium is a common complication after cardiac surgery that leads to increased costs and worse outcomes. This retrospective study evaluated the potential risk factors and postoperative impact of delirium on cardiac surgery patients. Methods One thousand two hundred six patients who underwent open-heart surgery within a single year were included. Uni- and multivariate analyses of a variety of pre, intra-, and postoperative parameters were performed according to differences between the delirium (D) and nondelirium (ND) groups. Results The incidence of delirium was 11.6% (n = 140). The onset of delirium occurred at 3.35 ± 4.05 postoperative days with a duration of 5.97 ± 5.36 days. There were two important risk factors for postoperative delirium: higher age (D vs. ND, 73.1 ± 9.04 years vs. 69.0 ± 11.1 years, p < 0.001) and longer aortic cross-clamp time (D vs. ND, 69.8 ± 49.9 minutes vs. 61.6 ± 53.8 minutes, p < 0.05). We found that delirious patients developed significantly more frequent postoperative complications, such as myocardial infarction (MI) (D vs. ND, 1.43% [n = 3] vs. 0.28% [n = 2], p = 0.05), cerebrovascular accident (D vs. ND, 10.7% [n = 15] vs. 3.75% [n = 40], p < 0.001), respiratory complications (D vs. ND, 16.4% [n = 23] vs. 5.72% [n = 61], p < 0.001), and infections (D vs. ND, 36.4% [n = 51] vs. 16.0% [n = 170], p < 0.001). The hospital stay was longer in cases of postoperative delirium (D vs. ND, 23.2 ± 13.6 days vs. 17.4 ± 12.8 days, p < 0.001), and fewer patients were discharged home (D vs. ND, 56.0% [n = 65] vs. 66.8% [n = 571], p < 0.001). Conclusions Because the propensity for delirium-related complications is high after cardiac surgery, a practical, preventative strategy should be developed for patients with perioperative risk factors, including higher age and a longer cross-clamp time.

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Aitken, Sarah Joy, Fiona M. Blyth, and Vasi Naganathan. "Incidence, prognostic factors and impact of postoperative delirium after major vascular surgery: A meta-analysis and systematic review." Vascular Medicine 22, no. 5 (August 7, 2017): 387–97. http://dx.doi.org/10.1177/1358863x17721639.

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Although postoperative delirium is a common complication and increases patient care needs, little is known about the predictors and outcomes of delirium in patients having vascular surgery. This review aimed to determine the incidence, prognostic factors and impact of postoperative delirium in vascular surgical patients. MEDLINE and EMBASE were systematically searched for articles published between January 2000 and January 2016 on delirium after vascular surgery. The primary outcome was the incidence of delirium. Secondary outcomes were contributing prognostic factors and impact of delirium. Study quality and risk of bias was assessed using the QUIPS tool for systematic reviews of prognostic studies, and MOOSE guidelines for reviews of observational studies. Quantitative analyses of extracted data were conducted using meta-analysis where possible to determine incidence of delirium and prognostic factors. A qualitative review of outcomes was performed. Fifteen articles were eligible for inclusion. Delirium incidence ranged between 5% and 39%. Meta-analysis found that patients with delirium were older than those without delirium (OR 3.6, p<0.001). Prognostic factors predicting delirium included increased age (OR 1.04, p<0.001), pre-existing cognitive impairment (OR 9.8, p=0.01), hypertension, pre-existing depression and open aortic surgery. Delirious patients remained in hospital 6 days longer ( p<0.001) and had more complications than patients without delirium. Data were limited on the impact of procedure complexity, endovascular compared to open surgery or type of anaesthetic. Postoperative delirium occurs frequently, resulting in major morbidity for vascular patients. Improved quality of prognostic studies may identify modifiable peri-operative factors to improve quality of care for vascular surgical patients.

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Farag, Ehab, Chen Liang, Edward J. Mascha, Maged Y. Argalious, Jacob Ezell, Kamal Maheshwari, Wael Ali Sakr Esa, Christopher A. Troianos, and Daniel I. Sessler. "Association between Use of Angiotensin-converting Enzyme Inhibitors or Angiotensin Receptor Blockers and Postoperative Delirium." Anesthesiology 133, no. 1 (April 24, 2020): 119–32. http://dx.doi.org/10.1097/aln.0000000000003329.

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Background Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers improve cognitive function. The authors therefore tested the primary hypothesis that preoperative use of angiotensin inhibitors is associated with less delirium in critical care patients. Post hoc, the association between postoperative use of angiotensin system inhibitors and delirium was assessed. Methods The authors conducted a single-site cohort study of adults admitted to Cleveland Clinic critical care units after noncardiac procedures between 2013 and 2018 who had at least one Confusion Assessment Method delirium assessment. Patients with preexisting dementia, Alzheimer’s disease or other cognitive decline, and patients who had neurosurgical procedures were excluded. For the primary analysis, the confounder-adjusted association between preoperative angiotensin inhibitor use and the incidence of postoperative delirium was assessed. Post hoc, the confounder-adjusted association between postoperative angiotensin system inhibitor use and the incidence of delirium was assessed. Results The incidence of delirium was 39% (551 of 1,396) among patients who were treated preoperatively with angiotensin system inhibitors and 39% (1,344 of 3,468) in patients who were not. The adjusted odds ratio of experiencing delirium during critical care was 0.98 (95% CI, 0.86 to 1.10; P = 0.700) for preoperative use of angiotensin system inhibitors versus control. Delirium was observed in 23% (100 of 440) of patients who used angiotensin system inhibitors postoperatively before intensive care discharge, and in 41% (1,795 of 4,424) of patients who did not (unadjusted P < 0.001). The confounder-adjusted odds ratio for experiencing delirium in patients who used angiotensin system inhibitors postoperatively was 0.55 (95% CI, 0.43 to 0.72; P < 0.001). Conclusions Preoperative use of angiotensin system inhibitors is not associated with reduced postoperative delirium. In contrast, treatment during intensive care was associated with lower odds of delirium. Randomized trials of postoperative angiotensin-converting enzymes inhibitors and angiotensin receptor blockers seem justified. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Pavlov, O. O., and S. A. Lutsyk. "Treatment of Postoperative Delirium." EMERGENCY MEDICINE, no. 8.79 (January 31, 2017): 69–72. http://dx.doi.org/10.22141/2224-0586.8.79.2016.90376.

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Türköz, Ayda, Riza Türköz, Oner Gülcan, and Ozcan Ersoy. "Postoperative delirium and defibrillation." Journal of Cardiothoracic and Vascular Anesthesia 13, no. 6 (December 1999): 802. http://dx.doi.org/10.1016/s1053-0770(99)90156-8.

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Marcantonio, E. R. "Statins and postoperative delirium." Canadian Medical Association Journal 179, no. 7 (September 23, 2008): 627–28. http://dx.doi.org/10.1503/cmaj.081101.

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Steiner, Luzius A. "Postoperative delirium. Part 2." European Journal of Anaesthesiology 28, no. 10 (October 2011): 723–32. http://dx.doi.org/10.1097/eja.0b013e328349b7db.

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Steiner, Luzius A. "Postoperative delirium. Part 1." European Journal of Anaesthesiology 28, no. 9 (September 2011): 628–36. http://dx.doi.org/10.1097/eja.0b013e328349b7f5.

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Makker, R., and W. Yanny. "Postoperative delirium mimicking epilepsy." Anaesthesia 55, no. 6 (June 15, 2000): 601. http://dx.doi.org/10.1046/j.1365-2044.2000.01479-18.x.

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Gleason, Ondria C. "Donepezil for Postoperative Delirium." Psychosomatics 44, no. 5 (September 2003): 437–38. http://dx.doi.org/10.1176/appi.psy.44.5.437.

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Colwill, Jennifer P., James F. Bena, Shannon L. Morrison, Faisal Bakaeen, and Nancy M. Albert. "Postoperative Cardiovascular Surgery Delirium." Clinical Nurse Specialist 35, no. 5 (September 2021): 238–45. http://dx.doi.org/10.1097/nur.0000000000000619.

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Zhang, Yan, Shu-Ting He, Bin Nie, Xue-Ying Li, and Dong-Xin Wang. "Emergence delirium is associated with increased postoperative delirium in elderly: a prospective observational study." Journal of Anesthesia 34, no. 5 (June 7, 2020): 675–87. http://dx.doi.org/10.1007/s00540-020-02805-8.

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Abstract Background The clinical significance of emergence delirium remains unclear. The purpose of this study was to investigate the association between emergence delirium and postoperative delirium in elderly after general anesthesia and surgery. Methods This prospective observational study was done in a tertiary hospital in Beijing, China. Elderly patients (65–90 years) who underwent major noncardiac surgery under general anesthesia and admitted to the postanesthesia care unit (PACU) after surgery were enrolled. Emergence delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit during PACU stay. Postoperative delirium was assessed with the Confusion Assessment Method during the first 5 postoperative days. The association between emergence delirium and postoperative delirium was analyzed with a multivariable logistic regression model. Results A total of 942 patients were enrolled and 915 completed the study. Emergence delirium developed in 37.0% (339/915) of patients during PACU stay; and postoperative delirium developed in 11.4% (104/915) of patients within the first 5 postoperative days. After adjusted confounding factors, the occurrence of emergence delirium is independently associated with an increased risk of postoperative delirium (OR 1.717, 95% CI 1.078–2.735, P = 0.023). Patients with emergence delirium stayed longer in PACU and hospital after surgery, and developed more non-delirium complications within 30 days. Conclusions Emergence delirium in elderly admitted to the PACU after general anesthesia and major surgery is independently associated with an increased risk of postoperative delirium. Patients with emergence delirium had worse perioperative outcomes. Chinese Clinical Trial Registry (chictr.org.cn) ChiCTR-OOC-17012734

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Adogwa, Owoicho, Aladine A. Elsamadicy, Victoria D. Vuong, Jared Fialkoff, Joseph Cheng, Isaac O. Karikari, and Carlos A. Bagley. "Association between baseline cognitive impairment and postoperative delirium in elderly patients undergoing surgery for adult spinal deformity." Journal of Neurosurgery: Spine 28, no. 1 (January 2018): 103–8. http://dx.doi.org/10.3171/2017.5.spine161244.

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OBJECTIVEPostoperative delirium is common in elderly patients undergoing spine surgery and is associated with a longer and more costly hospital course, functional decline, postoperative institutionalization, and higher likelihood of death within 6 months of discharge. Preoperative cognitive impairment may be a risk factor for the development of postoperative delirium. The aim of this study was to investigate the relationship between baseline cognitive impairment and postoperative delirium in geriatric patients undergoing surgery for degenerative scoliosis.METHODSElderly patients 65 years and older undergoing a planned elective spinal surgery for correction of adult degenerative scoliosis were enrolled in this study. Preoperative cognition was assessed using the validated Saint Louis University Mental Status (SLUMS) examination. SLUMS comprises 11 questions, with a maximum score of 30 points. Mild cognitive impairment was defined as a SLUMS score between 21 and 26 points, while severe cognitive impairment was defined as a SLUMS score of ≤ 20 points. Normal cognition was defined as a SLUMS score of ≥ 27 points. Delirium was assessed daily using the Confusion Assessment Method (CAM) and rated as absent or present on the basis of CAM. The incidence of delirium was compared in patients with and without baseline cognitive impairment.RESULTSTwenty-two patients (18%) developed delirium postoperatively. Baseline demographics, including age, sex, comorbidities, and perioperative variables, were similar in patients with and without delirium. The length of in-hospital stay (mean 5.33 days vs 5.48 days) and 30-day hospital readmission rates (12.28% vs 12%) were similar between patients with and without delirium, respectively. Patients with preoperative cognitive impairment (i.e., a lower SLUMS score) had a higher incidence of postoperative delirium. One- and 2-year patient reported outcomes scores were similar in patients with and without delirium.CONCLUSIONSCognitive impairment is a risk factor for the development of postoperative delirium. Postoperative delirium may be associated with decreased preoperative cognitive reserve. Cognitive impairment assessments should be considered in the preoperative evaluations of elderly patients prior to surgery.

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Kaźmierski, Jakub, Piotr Miler, Agnieszka Pawlak, Hanna Jerczyńska, Joanna Woźniak, Emilia Frankowska, Agnieszka Brzezińska, Katarzyna Woźniak, Michał Krejca, and Mirosław Wilczyński. "Elevated Monocyte Chemoattractant Protein-1 as the Independent Risk Factor of Delirium after Cardiac Surgery. A Prospective Cohort Study." Journal of Clinical Medicine 10, no. 8 (April 9, 2021): 1587. http://dx.doi.org/10.3390/jcm10081587.

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Background: The pathogenesis of postoperative delirium is largely unknown. The primary objective of this study is to assess whether increased levels of monocyte chemoattractant protein-1 (MCP-1) and high-sensitivity C-reactive protein (hsCRP) are associated with postoperative delirium in patients who have undergone cardiac surgery. The secondary objective is to investigate whether any association between raised inflammatory biomarkers levels and delirium is related to surgical and anesthetic procedures or mediated by pre-existing psychiatric conditions associated with raised pro-inflammatory markers levels. Methods: The patients were screened for cognitive impairment one day preoperatively with the use of the Mini-Mental State Examination Test and the Clock Drawing Test. A diagnosis of major depressive disorder (MDD) and anxiety disorders was established on the basis of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Blood samples were collected pre- and postoperatively for hsCRP and chemokine levels. Results: Postoperative delirium developed in 34% (61 of 177) of patients. Both pre- and postoperative hsCRP, and preoperative MCP-1 levels were associated with postoperative delirium in univariate comparisons; p = 0.001; p < 0.001; p < 0.001, respectively. However, according to a multivariable logistic regression analysis, only a raised MCP-1 concentration before surgery was independently associated with postoperative delirium, and related to advancing age, preoperative anxiety disorders and prolonged intubation. Conclusions: The present study suggests that an elevated preoperative MCP-1 concentration is associated with delirium after cardiac surgery. Monitoring of this inflammatory marker may reveal the cardiovascular disease (CVD) patients who are at risk of neuropsychiatric syndromes development.

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Aakerlund, Lars Peter, and Jacob Rosenberg. "Writing Disturbances: An Indicator for Postoperative Delirium." International Journal of Psychiatry in Medicine 24, no. 3 (September 1994): 245–57. http://dx.doi.org/10.2190/ptp2-gpb2-ga6q-nm87.

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Objective: To study the writing ability pre- and postoperatively in patients undergoing major surgery. Method: In an open study twenty-four consecutive patients undergoing thoracotomy for pulmonary malignancy were monitored for postoperative delirium throughout their stay in the hospital. The writing ability was tested on a preoperative day and on the third day after the operation. Main outcome measures were delirium according to the DSM-III-R criteria and writing ability assessed on items such as reluctance to write and motor-, spatial-, syntactical- and spelling disorders. Results: Five patients (21%) developed delirium according to the DSM-III-R criteria. The writing of all patients with delirium was severely impaired with features like reluctance to write, motor disability and spatial disturbances. No patient without delirium developed these disturbances. Conclusions: These results suggest that testing of writing ability may be useful in the diagnosis of delirium. The Delirium Writing Test is proposed as a diagnostic tool.

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Kin, Kyohei, Takao Yasuhara, Yousuke Tomita, Michiari Umakoshi, Jun Morimoto, and Isao Date. "SF-36 scores predict postoperative delirium after surgery for cervical spondylotic myelopathy." Journal of Neurosurgery: Spine 30, no. 6 (June 2019): 777–82. http://dx.doi.org/10.3171/2018.11.spine181031.

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OBJECTIVECervical spondylotic myelopathy (CSM) is one of the most common causes of spinal cord dysfunction. Surgery for CSM is generally effective, but postoperative delirium is a potential complication. Although there have been some studies that investigated postoperative delirium after spine surgery, no useful tool for identifying high-risk patients has been established, and it is unknown if 36-Item Short Form Health Survey (SF-36) scores can predict postoperative delirium. The objective of this study was to evaluate the correlation between preoperative SF-36 scores and postoperative delirium after surgery for CSM.METHODSSixty-seven patients who underwent surgery for CSM at the authors’ institution were enrolled in this study. Medical records of these patients were retrospectively reviewed. Patient background, preoperative laboratory data, preoperative SF-36 scores, the preoperative Japanese Orthopaedic Association (JOA) score for the evaluation of cervical myelopathy, and perioperative factors were selected as potential risk factors for postoperative delirium. These factors were evaluated using univariable and multivariable logistic regression analysis.RESULTSTen patients were diagnosed with postoperative delirium. Univariable analysis revealed that the physical functioning score (p = 0.01), general health perception score (p < 0.01), and vitality score (p < 0.01) of the SF-36 were significantly lower in patients with postoperative delirium than in those without. The total number of medications was significantly higher in the delirium group compared with the no-delirium group (p = 0.02). In contrast, there were no significant differences between the delirium group and the no-delirium group in cervical JOA scores (p = 0.20). Multivariable analysis revealed that a low general health perception score was an independent risk factor for postoperative delirium (p = 0.02; odds ratio 0.810, 95% confidence interval 0.684–0.960).CONCLUSIONSSome of the SF-36 scores were significantly lower in patients with postoperative delirium than in those without. In particular, the general health perception score was independently correlated with postoperative delirium. SF-36 scores could help identify patients at high risk for postoperative delirium and aid in the development of prevention strategies.

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Leung, Jacqueline M., Laura P. Sands, Sudeshna Paul, Tim Joseph, Sakura Kinjo, and Tiffany Tsai. "Does Postoperative Delirium Limit the Use of Patient-controlled Analgesia in Older Surgical Patients?" Anesthesiology 111, no. 3 (September 1, 2009): 625–31. http://dx.doi.org/10.1097/aln.0b013e3181acf7e6.

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Unlabelled BACKGROUNDPostoperative pain Is an independent predictor of postoperative delirium. Whether postoperative delirium limits patient-controlled analgesia (PCA) use has not been determined. Methods The authors conducted a nested cohort study in older patients undergoing noncardiac surgery and used PCA for postoperative analgesia. Delirium was measured by using the Confusion Assessment Method. The authors computed a structural equation model to determine the effects of pain and opioid consumption on delirium status and the effect of delirium on opioid use. Results Of 335 patients, 108 (32.2%) developed delirium on postoperative day (POD) 1, and 120 (35.8%) on POD 2. Postoperative delirium did not limit the use of PCA. Patients with postoperative delirium used more PCA in a 24-h period (POD 2) compared to those without delirium (mean dose of hydromorphone +/- SE adjusted for covariates was 2.24 +/- 0.71 mg vs. 1.25 +/- 0.67 mg, P = 0.02). Despite more opioid use, patients with delirium reported higher Visual Analogue Scale scores than those without delirium (POD 1: mean visual analog scale +/- SE at rest 4.2 +/- 0.23 vs. 3.3 +/- 0.22, P = 0.0051; POD 2: 3.3 +/- 0.23 vs. 2.5 +/- 0.19, P = 0.004). Path coefficients from structural equation model revealed that pain and opioid use affect delirium status, but delirium does not affect subsequent opioid dose. Conclusions Postoperative delirium did not limit PCA use. Despite more opioid use, visual analog scale scores were higher in patients with delirium. Future studies on delirium should consider the role of pain and pain management as potential etiologic factors.

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Kazmierski, Jakub, Andrzej Banys, Joanna Latek, Julius Bourke, and Ryszard Jaszewski. "Raised IL-2 and TNF-α concentrations are associated with postoperative delirium in patients undergoing coronary-artery bypass graft surgery." International Psychogeriatrics 26, no. 5 (December 17, 2013): 845–55. http://dx.doi.org/10.1017/s1041610213002378.

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ABSTRACTBackground:The knowledge base regarding the pathogenesis of postoperative delirium is limited. The primary aim of this study is to investigate whether increased levels of IL-2 and TNF-α are associated with delirium in patients who underwent coronary-artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB). The secondary aim is to establish whether any association between raised cytokine levels and delirium is related to surgical and anesthetic procedures or mediated by pre-existing conditions associated with raised cytokine levels, such as major depressive disorder (MDD), cognitive impairment, or aging.Methods:Patients were examined and screened for MDD and cognitive impairment one day preoperatively, using the Mini International Neuropsychiatric Interview and The Montreal Cognitive Assessment and Trail Making Test Part B. Blood samples were collected postoperatively for cytokine levels.Results:Postoperative delirium screening was found positive in 36% (41 of 113) of patients. A multivariate logistic regression revealed that an increased concentration of pro-inflammatory cytokines is associated with delirium, and related to advancing age, preoperative cognitive decline of participants, and duration of CPB. According to receiver operating characteristic analysis, the most optimal cut-off for IL-2 and TNF-α concentrations in predicting the development of delirium were 907.5 U/ml and 10.95 pg/ml, respectively.Conclusions:The present study suggests that raised postoperative cytokine concentrations are associated with delirium after CABG surgery. Postoperative monitoring of pro-inflammatory markers combined with regular surveillance may be helpful in the early detection of postoperative delirium in this patient group.

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