scholarly journals Validation of a Postoperative Delirium Prediction Model

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Ashok Biju, B.S. ◽  
Babar Khan, M.D. M.S. ◽  
Heidi . Lindroth, Ph.D. R.N
Keyword(s):  
Thoracic Surgery ◽  
Prediction Model ◽  
Postoperative Delirium ◽  
Rating Scale ◽  
Predictor Variable ◽  
Secondary Data ◽  
Assessment Method ◽  
Appreciable Effect ◽  
Improvement Program ◽  
Cognitive Measure

Background and Hypothesis: A prediction model utilizing the National Surgical Quality Improvement Program risk calculator for serious complications (NSQIPSC) and measures of cognitive function has been demonstrated to predict postoperative delirium incidence and severity in patients after non-cardiac surgery. The next step is to test this model’s generalizability by validating in different patient populations and evaluating the robustness of the model with and without parameters of cognition. We hypothesized that the prediction model would still function in predicting postoperative delirium in patients undergoing major thoracic surgery. Experimental Design or Project Methods: A secondary data analysis of a randomized clinical trial involving 135 individuals who underwent major thoracic surgery from October 2013 to June 2015 was done. Delirium incidence and severity were tracked postoperatively through the Confusion Assessment Method for the ICU (CAM-ICU) and the Delirium Rating Scale-R-98 (DRS), respectively. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to assess preoperative cognition. Linear regressions and specificity/sensitivity calculations were performed to evaluate the model. Results: One hundred and thirty-two patients with a mean age of 59±13 years, 33/132 CAM-ICU+, and a mean DRS peak of 3.12±3.43 were analyzed. Linear regression of NSQIP-SC scores moderately predicted delirium severity (P<0.001, Adjusted R2: 0.28). Addition of a cognitive measure did not significantly improve the model (P<0.001, Adjusted R2: 0.29). NSQIP-SC moderately predicted delirium incidence (sensitivity: 60.61%, specificity: 68.69%, AUROC: 0.73). Addition of a cognitive measure (sensitivity: 61.54%, specificity: 68.69%, AUROC: 0.73) did not significantly improve the model. Conclusion and Potential Impact: NSQIP-SC was a predictor variable for delirium incidence and severity. Addition of a cognitive measure did not have any appreciable effect on the prediction model. Further expanding the scope of the model can grant clinicians a tool to identify patients at risk for developing postoperative delirium.

scholarly journals Derivation of a simple postoperative delirium incidence and severity prediction model

2018 ◽  
Author(s):  
Lindroth H. ◽  
Bratzke L. ◽  
Twadell S. ◽  
Rowley P. ◽  
Kildow J. ◽  
...  
Keyword(s):  
Prediction Model ◽  
Postoperative Delirium ◽  
Rating Scale ◽  
Factor Model ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Improvement Program ◽  
Risk Of Death ◽  
Framingham Risk ◽  
Severity Prediction

SummaryBackgroundDelirium is an important postoperative complication, yet a simple and effective delirium prediction model remains elusive. We hypothesized that the combination of the National Surgical Quality Improvement Program (NSQIP) risk calculator for serious complications (NSQIP-SC) or risk of death (NSQIP-D), and cognitive tests of executive function (Trail Making Test A and B [TMTA, TMTB]), could provide a parsimonious model to predict postoperative delirium incidence or severity.MethodsData were collected from 100 adults (≥65yo) undergoing major non-cardiac surgery. In addition to NSQIP-SC, NSQIP-D, TMTA and TMTB, we collected participant age, sex, ASA score, tobacco use, type of surgery, depression, Framingham risk score, and preoperative blood pressure. Delirium was diagnosed with the Confusion Assessment Method (CAM), and the Delirium Rating Scale-R-98 (DRS) was used to assess symptom severity. LASSO and Best Subsets logistic and linear regression were employed in line with TRIPOD guidelines.ResultsThree participants were excluded due to intraoperative deaths (2) and alcohol withdrawal (1). Ninety-seven participants with a mean age of 71.68±4.55, 55% male (31/97 CAM+, 32%) and a mean Peak DRS of 21.5±6.40 were analyzed. Of the variables included, only NSQIP-SC and TMTB were identified to be predictors of postoperative delirium incidence (p<0.001, AUROC 0.81, 95% CI: 0.72, 0.90) and severity (p<0.001, Adj. R2: 0.30).ConclusionsIn this cohort, preoperative NSQIP-SC and TMTB were identified as predictors of postoperative delirium incidence and severity. Future studies should verify whether this two-factor model could be used for accurate delirium prediction.

Risk Factors and Incidence of Postoperative Delirium in Patients Undergoing Laryngectomy

2019 ◽  
Vol 161 (5) ◽  
pp. 807-813 ◽  
Author(s):  
Yiru Wang ◽  
Huiqian Yu ◽  
Hui Qiao ◽  
Chan Li ◽  
Kaizheng Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Delirium ◽  
Rating Scale ◽  
Multivariable Analysis ◽  
Diagnostic Algorithm ◽  
Target Population ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Factors Associated ◽  
The Mean

Objective To explore the risk factors and incidence of postoperative delirium (POD) in patients undergoing laryngectomy for laryngeal cancer. Study Design Prospective cohort study. Setting Shanghai Eye, Ear, Nose, and Throat Hospital, Fudan University. Subjects and Methods A total of 323 patients underwent laryngectomy from April 4, 2018, to December 28, 2018. Perioperative data were collected. The primary outcome was the presence of POD as defined by the Confusion Assessment Method diagnostic algorithm. Univariate and multivariable logistic regression analyses were used to identify risk factors associated with POD. Results Of the patients who underwent laryngectomy during the study period, 99.1% were male, with a mean age of 60.0 years. Of these patients, 28 developed POD, with most episodes (88.1%) occurring during the first 3 postoperative days. The type of POD was hyperactive in 7 cases and hypoactive in 21 cases. The mean duration of POD was 1 day. The mean Delirium Rating Scale-Revised-98 score (a measure of POD severity) was 11.5. For the multivariable analysis, risk factors associated with POD included advanced cancer stage, lower educational level, higher American Society of Anesthesiologists classification, and intraoperative hypotension lasting at least 30 minutes. Intraoperative dexmedetomidine use was protective against POD. Conclusion This study identified risk factors associated with POD, providing a target population for quality improvement initiatives. Furthermore, intraoperative dexmedetomidine use can reduce POD.

scholarly journals Preoperative Cerebrospinal Fluid Cortisol and the Risk of Postoperative Delirium: A Prospective Study of Older Hip Fracture Patients

2020 ◽  
Vol 49 (6) ◽  
pp. 604-610
Author(s):  
Joost Witlox ◽  
Dimitrios Adamis ◽  
Leo Koenderman ◽  
Kees Kalisvaart ◽  
Jos F.M. de Jonghe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Hip Fracture ◽  
Postoperative Delirium ◽  
Rating Scale ◽  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Cortisol Levels ◽  
A Prospective Study

<b><i>Background:</i></b> Ageing, depression, and neurodegenerative disease are common risk factors for delirium in the elderly. These risk factors are associated with dysregulation of the hypothalamic-pituitary-adrenal axis, resulting in higher levels of cortisol under normal and stressed conditions and a slower return to baseline. <b><i>Objectives:</i></b> We investigated whether elevated preoperative cerebrospinal fluid (CSF) cortisol levels are associated with the onset of postoperative delirium. <b><i>Methods:</i></b> In a prospective cohort study CSF samples were collected after cannulation for the introduction of spinal anesthesia of 75 patients aged 75 years and older admitted for surgical repair of acute hip fracture. Delirium was assessed with the confusion assessment method (CAM) and the Delirium Rating Scale-Revised-98 (DRS-R98). Because the CAM and DRS-R98 were available for time of admission and 5 postoperative days, we used generalized estimating equations and linear mixed modeling to examine the association between preoperative CSF cortisol levels and the onset of postoperative delirium. <b><i>Results:</i></b> Mean age was 83.5 (SD 5.06) years, and prefracture cognitive decline was present in one-third of the patients (24 [33%]). Postoperative delirium developed in 27 (36%) patients. We found no association between preoperative CSF cortisol levels and onset or severity of postoperative delirium. <b><i>Conclusions:</i></b> These findings do not support the hypothesis that higher preoperative CSF cortisol levels are associated with the onset of postoperative delirium in elderly hip fracture patients.

scholarly journals Is preoperative anxiety associated with postoperative delirium in older persons undergoing cardiac surgery? Secondary data analysis of a randomized controlled trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Koen Milisen ◽  
Bastiaan Van Grootven ◽  
Wim Hermans ◽  
Karen Mouton ◽  
Layth Al Tmimi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
State Anxiety ◽  
Postoperative Delirium ◽  
Controlled Trial ◽  
Secondary Data ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Preoperative Anxiety ◽  
Confusion Assessment

Abstract Background Although many studies have reported numerous risk factors for postoperative delirium, data are scarce about preoperative anxiety as a risk factor. The study aimed to investigate the association between preoperative anxiety and postoperative delirium in older patients undergoing cardiac surgery. Methods Secondary data analysis of a randomized, observer-blind, controlled trial. A total of 190 patients 65 years or older and admitted to the intensive care unit and cardiac surgery unit of a university hospital scheduled for elective on-pump cardiac surgery were included. State anxiety was measured preoperatively using the Amsterdam Preoperative Anxiety and Information Scale and the Visual Analogue Scale for anxiety. Incidence of delirium was measured during the first 5 postoperative days using the Confusion Assessment Method for Intensive Care Unit (when ventilated), or the 3 Minute Diagnostic Interview for Confusion Assessment Method (when extubated) and by daily chart review. Results Preoperative state anxiety was reported by 31% of the patients and 41% had postoperative delirium. A multiple step logistic regression analyses revealed no association between preoperative anxiety and postoperative delirium. Significant risk factors for postoperative delirium were age (OR = 1.10, 95% CI (1.03–1.18)), activities of daily living (0.69, 95% CI (0.50–0.96)), diabetes mellitus (OR = 3.15, 95% CI (1.42–7.00)) and time on cardiopulmonary bypass (OR = 1.01, 95% CI (1.00 to 1.02)). Conclusions No relationship could be found between preoperative anxiety and postoperative delirium.

scholarly journals Serum Biomarkers in Postoperative Delirium after Esophagectomy

2020 ◽  
Vol 3 ◽  
Author(s):  
Azhar Dalal ◽  
Sikandar Khan ◽  
Heidi Lindroth ◽  
Babar Khan
Keyword(s):  
Calcium Binding ◽  
Postoperative Delirium ◽  
Rating Scale ◽  
Controlled Trial ◽  
Assessment Method ◽  
Serum Biomarkers ◽  
University Hospital ◽  
Inflammatory Biomarkers ◽  
Double Blind ◽  
Necrosis Factor Alpha

Background: The pathophysiology of postoperative delirium in patients undergoing esophagectomy is not well understood but has been hypothesized to involve neuroinflammation. Inflammatory biomarkers may therefore be associated with delirium incidence and severity. We conducted this study to measure the association between serum inflammatory biomarkers and postoperative delirium and delirium severity.     Methods: Blood samples were obtained from patients enrolled in a randomized double-blind placebo-controlled trial undergoing elective esophagectomy at Indiana University Health University Hospital. S100 calcium-binding protein B, C-Reactive Protein (CRP), interleukins 8, 10, tumor necrosis factor-alpha, and insulin like growth factor 1 (IGF1) were analyzed at preoperative, and postoperative days 1 and 3 timepoints. Delirium status and severity were assessed using the Confusion Assessment Method for Intensive Care Unit and Delirium Rating Scale (DRS-R-98), respectively.     Results: Samples from 71 patients were included. Higher median CRP values were associated with delirium incidence at post-operative day 1 (no delirium: 22.7 IQR:2.2, 42.7; delirium: 35.4 IQR:25.0, 50.0, p=0.031) but not at post-operative day 3. Median CRP S100B serum values were correlated with mean delirium severity (-0.289, p=0.020). IGF-1 serum values were associated with delirium severity on post-operative day 1 (0.270, p=0.040).     Conclusion: Postoperative delirium incidence was associated with higher median CRP values at POD1. The findings of this study provide evidence for the early measurement of post-operative serum biomarkers to ascertain likely incidence and severity of delirium.  

scholarly journals Postoperative delirium after cardiac surgery of elderly patients as an independent risk factor for prolonged length of stay in intensive care unit and in hospital

2021 ◽  
Author(s):  
Andrea Kirfel ◽  
Jan Menzenbach ◽  
Vera Guttenthaler ◽  
Johanna Feggeler ◽  
Andreas Mayr ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Postoperative Delirium ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Hospital Length Of Stay ◽  
Confusion Assessment

Abstract Background Postoperative delirium (POD) is a relevant and underdiagnosed complication after cardiac surgery that is associated with increased intensive care unit (ICU) and hospital length of stay (LOS). The aim of this subgroup study was to compare the frequency of tested POD versus the coded International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis of POD and to evaluate the influence of POD on LOS in ICU and hospital. Methods 254 elective cardiac surgery patients (mean age, 70.5 ± 6.4 years) at the University Hospital Bonn between September 2018 and October 2019 were evaluated. The endpoint tested 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 Scale (DOS) was positive on one day. Results POD occurred in 127 patients (50.0%). LOS in ICU and hospital were significantly different based on presence (ICU 165.0 ± 362.7 h; Hospital 26.5 ± 26.1 days) or absence (ICU 64.5 ± 79.4 h; Hospital 14.6 ± 6.7 days) of POD (p < 0.001). The multiple linear regression showed POD as an independent predictor for a prolonged LOS in ICU (48%; 95%CI 31–67%) and in hospital (64%; 95%CI 27–110%) (p < 0.001). The frequency of POD in the study participants that was coded with the ICD F05.0 and F05.8 by hospital staff was considerably lower than tests revealed by the study personnel. Conclusion Approximately 50% of elderly patients who underwent cardiac surgery developed POD, which is associated with an increased ICU and hospital LOS. Furthermore, POD is highly underdiagnosed in clinical routine.

scholarly journals Correlates of the discrepancy between objective and subjective cognitive functioning in non-demented patients with Parkinson’s disease

2021 ◽  
Author(s):  
Mattia Siciliano ◽  
Lugi Trojano ◽  
Rosa De Micco ◽  
Valeria Sant’Elia ◽  
Alfonso Giordano ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Linear Regression ◽  
Cognitive Functioning ◽  
Rating Scale ◽  
Regression Analyses ◽  
Chi Square ◽  
Cognitive Measure ◽  
Objective Evidence ◽  
Cognitive Discrepancy

Abstract Background Subjective complaints of cognitive deficits are not necessarily consistent with objective evidence of cognitive impairment in Parkinson’s disease (PD). Here we examined the factors associated with the objective-subjective cognitive discrepancy. Methods We consecutively enrolled 90 non-demented patients with PD who completed the Parkinson’s Disease Cognitive Functional Rating Scale (subjective cognitive measure) and the Montreal Cognitive Assessment (MoCA; objective cognitive measure). The patients were classified as “Overestimators”, “Accurate estimators”, and “Underestimators” on the basis of the discrepancy between the objective vs. subjective cognitive measures. To identify the factors distinguishing these groups from each other, we used chi-square tests or one-way analyses of variance, completed by logistic and linear regression analyses. Results Forty-nine patients (54.45%) were classified as “Accurate estimators”, 29 (32.22%) as “Underestimators”, and 12 (13.33%) as “Overestimators”. Relative to the other groups, the “Underestimators” scored higher on the Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), and Parkinson Anxiety Scale (p < 0.01). Logistic regression confirmed that FSS and BDI scores distinguished the “Underestimators” group from the others (p < 0.05). Linear regression analyses also indicated that FSS and BDI scores positively related to objective-subjective cognitive discrepancy (p < 0.01). “Overestimators” scored lower than other groups on the MoCA’s total score and attention and working memory subscores (p < 0.01). Conclusion In more than 45% of consecutive non-demented patients with PD, we found a ‘mismatch’ between objective and subjective measures of cognitive functioning. Such discrepancy, which was related to the presence of fatigue and depressive symptoms and frontal executive impairments, should be carefully evaluated in clinical setting.

scholarly journals Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients

2017 ◽  
Vol 127 (4) ◽  
pp. 633-644 ◽  
Author(s):  
Keyword(s):  
Postoperative Pain ◽  
Postoperative Delirium ◽  
Intervention Group ◽  
Group Versus ◽  
Length Of Hospital Stay ◽  
Treated Group ◽  
Assessment Method ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Opioid Use

Abstract Background Postoperative pain and opioid use are associated with postoperative delirium. We designed a single-center, randomized, placebo-controlled, parallel-arm, double-blinded trial to determine whether perioperative administration of gabapentin reduced postoperative delirium after noncardiac surgery. Methods Patients were randomly assigned to receive placebo (N = 347) or gabapentin 900 mg (N = 350) administered preoperatively and for the first 3 postoperative days. The primary outcome was postoperative delirium as measured by the Confusion Assessment Method. Secondary outcomes were postoperative pain, opioid use, and length of hospital stay. Results Data for 697 patients were included, with a mean ± SD age of 72 ± 6 yr. The overall incidence of postoperative delirium in any of the first 3 days was 22.4% (24.0% in the gabapentin and 20.8% in the placebo groups; the difference was 3.20%; 95% CI, 3.22% to 9.72%; P = 0.30). The incidence of delirium did not differ between the two groups when stratified by surgery type, anesthesia type, or preoperative risk status. Gabapentin was shown to be opioid sparing, with lower doses for the intervention group versus the control group. For example, the morphine equivalents for the gabapentin-treated group, median 6.7 mg (25th, 75th quartiles: 1.3, 20.0 mg), versus control group, median 6.7 mg (25th, 75th quartiles: 2.7, 24.8 mg), differed on the first postoperative day (P = 0.04). Conclusions Although postoperative opioid use was reduced, perioperative administration of gabapentin did not result in a reduction of postoperative delirium or hospital length of stay.

RELATIONS OF MOTOR ABILITY OF BALANCE AND SUCCESS OF PERFORMANCE OF GYMNASTICS ELEMENTS ON THE FLOOR EXERCISE

sportlogia ◽  
2021 ◽  
Vol 17 (1) ◽  
pp. 34-43
Author(s):  
Saša Jovanović ◽  
◽  
Snežana Bijelić ◽  
Adriana Ljubojević ◽  
Dalibor Fulurija ◽  
...  
Keyword(s):  
Physical Education ◽  
Prediction Model ◽  
Motor Skills ◽  
Predictive Value ◽  
Predictor Variable ◽  
The Other ◽  
Motor Ability ◽  
Training Methodology ◽  
Balance Ability ◽  
The Relationship

The purpose of this study is to investigate the relationship between motor ability for balance and the performance of selected gymnastic elements on the floor in students aged 7-8 years, to provide an overview of the current motor status of the respondents at this age, and to develop suggestions for possible changes in the curriculum at this age, and to develop suggestions for supplementing training methodology. Training of selected gymnastics elements was conducted on a sample of 42 subjects who had no previous experience in performing gymnastics elements during regular physical education classes, and the predictor variable was tested using four tests assessing motor balance ability. The tests assessing motor balance ability showed a statistically significant predictive value for the performance of all three gymnastics exercises. It is noticeable that the value of the prediction model increased the more complex an item was derived, indicating the complexity of the motor balance space and the high and stable level of the same in the subjects at the time of testing. Regarding the tests used, it can be noted that the test FLAM was significantly involved in the prediction of performance success in all three gymnastic elements, while the other two tests showed their predictive value in the execution of the hand stand. On the other hand, the study shows that the gymnastic elements used should be used in physical education classes to contribute to the promotion and development of all motor skills of students and as part of the preparation for the execution of more complex elements on the floor and apparatus in higher grades.

Reduced electroencephalogram complexity in postoperative delirium

2021 ◽  
Author(s):  
Sean Tanabe ◽  
Maggie Parker ◽  
Richard Lennertz ◽  
Robert A Pearce ◽  
Matthew I Banks ◽  
...  
Keyword(s):  
Postoperative Delirium ◽  
Primary Outcome ◽  
Rating Scale ◽  
Monocyte Chemoattractant Protein 1 ◽  
Monocyte Chemoattractant ◽  
Monocyte Chemoattractant Protein ◽  
Eeg Data ◽  
Before And After ◽  
Electroencephalogram Eeg ◽  
Multiple Comparison Correction

Abstract Delirium is associated with electroencephalogram (EEG) slowing and impairments in connectivity. We hypothesized that delirium would be accompanied by a reduction in the available cortical information (i.e. there is less information processing occurring), as measured by a surrogate, Lempil-Ziv Complexity (LZC), a measure of time-domain complexity. Two ongoing perioperative cohort studies (NCT03124303, NCT02926417) contributed EEG data from 91 patients before and after surgery; 89 participants were used in the analyses. After cleaning and filtering (0.1-50Hz), the perioperative change in LZC and LZC normalized (LZCn) to a phase-shuffled distribution were calculated. The primary outcome was the correlation of within-patient paired changes in delirium severity (Delirium Rating Scale-98 [DRS]) and LZC. Scalp-wide threshold free cluster enhancement was employed for multiple comparison correction. LZC negatively correlated with DRS in a scalp-wide manner (peak channel r 2=0.199, p&lt;0.001). This whole brain effect remained for LZCn, though the correlations were weaker (peak channel r 2=0.076, p=0.010). Delirium diagnosis was similarly associated with decreases in LZC (peak channel p&lt;0.001). For LZCn, the topological significance was constrained to the midline posterior regions (peak channel p=0.006). We found a negative correlation of LZC in the posterior and temporal regions with monocyte chemoattractant protein-1 (peak channel r 2=0.264, p&lt;0.001, n=47) but not for LZCn. Complexity of the EEG signal fades proportionately to delirium severity implying reduced cortical information. Peripheral inflammation, as assessed by monocyte chemoattractant protein-1, does not entirely account for this effect, suggesting that additional pathogenic mechanisms are involved.

Sign in / Sign up

Export Citation Format

Share Document