scholarly journals Postoperative delirium in elderly patients is associated with subsequent cognitive impairment

2017 ◽  
Vol 119 (2) ◽  
pp. 316-323 ◽  
Author(s):  
J. Sprung ◽  
R.O. Roberts ◽  
T.N. Weingarten ◽  
A. Nunes Cavalcante ◽  
D.S. Knopman ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Elderly Patients ◽  
Postoperative Delirium

scholarly journals Postoperative delirium and cognitive impairment when using the regional postoperative analgesia

2021 ◽  
Vol 16 (7-8) ◽  
pp. 60-66
Author(s):  
I.N. Demiter ◽  
S.I. Vorotintsev ◽  
O.S. Dolya
Keyword(s):  
Cognitive Impairment ◽  
Elderly Patients ◽  
Epidural Analgesia ◽  
Abdominal Wall ◽  
Postoperative Analgesia ◽  
Postoperative Delirium ◽  
Anterior Abdominal Wall ◽  
Cognitive Status ◽  
Control Group ◽  
Regional Analgesia

Background. Postoperative delirium is one of the most common complications after surgery in elderly patients. The aim of the study was to evaluate the impact of different techniques of regional analgesia on the incidence of postoperative delirium and the level of cognitive impairment in elderly patients. Materials and methods. A single-center prospective study consistently included 70 elderly patients who underwent emergency abdominal surgery. Depending on the method of perioperative anesthesia, all patients were divided into two basic groups: control (n = 30) and research (n = 40), where one of the perioperative techniques of regional analgesia was used — blockade of the anterior abdominal wall (subgroup AA, n = 20) or epidural analgesia (subgroup EA, n = 20). Results. The initial cognitive status of patients in subgroup EA did not differ significantly from the same indicator in the control group and amounted to 3.0 [3.0; 4.0] points. Subsequently, it gradually improved, reaching 4.0 [3.0; 5.0] (p = 0.04) points on the fifth postoperative day. The cognitive status of patients in the AA subgroup before surgery was slightly better (4.0 [3.0; 4.5] points), but also did not differ significantly from that either in the control group or the EA subgroup. As it turned out, the patients of both subgroups had even better cognitive functioning on the 5th day than before surgery (p ˂ 0.05). This improvement is mostly due to the cessation of an important factor influencing cognitive status — pain. Conclusions. In elderly patients after emergency surgery with epidural analgesia, the incidence of postoperative delirium is 5 %, and when using the anterior abdominal wall blockade — 10 %. The cognitive function of patients received regional postoperative analgesia is restored on the third day after surgery and improves on the fifth postoperative day (p < 0.05).

scholarly journals Association between baseline cognitive impairment and postoperative delirium in elderly patients undergoing surgery for adult spinal deformity

2018 ◽  
Vol 28 (1) ◽  
pp. 103-108 ◽  
Author(s):  
Owoicho Adogwa ◽  
Aladine A. Elsamadicy ◽  
Victoria D. Vuong ◽  
Jared Fialkoff ◽  
Joseph Cheng ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Elderly Patients ◽  
Postoperative Delirium ◽  
Adult Spinal Deformity ◽  
Functional Decline ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Degenerative Scoliosis ◽  
Patient Reported

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.

Perioperative risk factors of postoperative delirium in elderly patients with hip fractures

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Esraa Sobhy Afifi Mohamed ◽  
Manar Mostafa Adel Maamoun ◽  
Waleed Elsayed Abd Elaleem ◽  
Walaa W Aly
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Elderly Patients ◽  
Hearing Impairment ◽  
Hip Fractures ◽  
Daily Living ◽  
Postoperative Delirium ◽  
Perioperative Risk ◽  
Perioperative Risk Factors ◽  
Significant Difference

Abstract Background Postoperative delirium (POD) is a common complication in elderly patients with hip fractures, it is characterized by disorders of consciousness, attention, perception, thinking, memory, mental activity and emotions. Objective Our aim was to identify the perioperative risk factors of postoperative delirium in elderly patients with hip fracture. Methods We carried out a prospective cohort study on 80 elderly patients 60 years and older with recent fragile hip fractures, who attended the orthopedic department of Ain shams university hospitals, Cairo, Egypt. Patients who were delirious on admission and those with major traumatic fractures were excluded from the study. Each patient gave an oral consent and then subjected to history taking with assessment of perioperative risk factors of delirium. Delirium was assessed in preoperative period, day 1 and 2 postoperative by CAM (confusion assessment method). Cognitive impairment was assessed by MiniMental-state-examination (MMSE), severity of pain by pain scale, depression by patient health Questionnaire 2 (PHQ2), functional assessment by activity of daily living (ADL) and instrumental activity of daily living (IADL), assessment of risk of delirium by DEAR score. Radiological assessment of the fracture femur by X-ray. Preoperative lab investigations including: CBC, serum electrolyte panel, kidney & liver function test & fasting blood glucose were done Results 38% of our study population developed delirium preoperatively after admission, 68% developed delirium at day 1 postoperative versus only 37% at day 2 postoperatively. There was a significant difference between delirious & non delirious patients preoperatively in presence of hypertension, IHD & COPD, presence of cognitive impairment by MMSE, severity of pain and presence of risk of delirium by DEAR score and there was a significant difference between delirious & non delirious patients in day one postoperative in presence of co-morbidities as diabetes, ischemic heart diseases (IHD), chronic obstructive pulmonary disease (COPD), visual & hearing impairment, while there was a statistically significant difference between delirious & non delirious patients in day two postoperative in presence of visual & hearing impairment and in presence of cognitive impairment by MMSE, depression by PHQ2, severity of pain & risk of delirium by DEAR score Logistic regression model revealed that cognitive impairment and severity of pain were independent predictors of POD preoperatively, while functional dependency by IADL, visual & hearing impairment & diabetes were independent predictors of POD in day 1 postoperative while depression by PHQ2 was independent factor of POD in day 2 postoperative. Conclusion Postoperative delirium is common in patients with hip fractures as 68% of patients developed delirium at day one postoperative and 37% at day two postoperatively. Logistic regression revealed that cognitive impairment and severity of pain were independent predictors of POD preoperatively.

scholarly journals An assessment of postoperative cognitive impairment in the elderly patients at the Port of Spain General Hospital

2019 ◽  
Author(s):  
Colin Ramoutar ◽  
Dale Ventour
Keyword(s):  
Cognitive Impairment ◽  
Elderly Patients ◽  
General Anaesthesia ◽  
General Hospital ◽  
Regional Anaesthesia ◽  
Postoperative Delirium ◽  
The Elderly ◽  
The Hours ◽  
Surgical Duration ◽  
Vasopressor Use

Objectives: Post-operative delirium (POD) is a relatively common occurrence particularly in the elderly, especially after prolonged surgery. This study aimed to determine the incidence of post-operative delirium at the Port of Spain General Hospital, Trinidad, West Indies. Methods: After obtaining consent, elderly patients (≥ 65 years of age) were prospectively screened using the 4AT questionnaire pre and post-operatively. Post-operative assessment was done on day 0, 1 and 2 between the hours of 18:00 and 22:00. Demographic and clinical data were recorded. Results: Sixty-one (61) patients were recruited. After exclusion, a total of 42 were included for the study. The incidence of POD in elderly patients at the Port-of-Spain General Hospital in Trinidad was 21.4%. Overall, eighteen (43%) patients displayed cognitive impairment post-operatively. The factors associated with development of POD were duration of anaesthesia, with surgery lasting >120 min having a 17% incidence. Delirium occurred more frequently after general anaesthesia (27%) compared to regional anaesthesia (8%). Vasopressor use and malignancy was also associated with a higher incidence of POD (33%). Conclusion: Elderly patients had a higher risk of developing postoperative delirium following general anaesthesia compared to regional anaesthesia, and where the surgical duration exceeded 2 hours. Other factors included hypotension requiring vasopressor use and gynaecological malignancy. The 4AT is a useful tool in detecting postoperative delirium in our setting.

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