scholarly journals Evaluating Mechanisms of Postoperative Delirium and Cognitive Dysfunction Following Elective Spine Surgery in Elderly Patients (CONFESS): Protocol for a Prospective Observational Trial

10.2196/15488 ◽  
2020 ◽  
Vol 9 (2) ◽  
pp. e15488
Author(s):  
Jonas Müller ◽  
Stephan Nowak ◽  
Antje Vogelgesang ◽  
Bettina von Sarnowski ◽  
Eiko Rathmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Dysfunction ◽  
Spine Surgery ◽  
Postoperative Period ◽  
Postoperative Delirium ◽  
Psychiatric Disease ◽  
Individual Risk ◽  
Care Hospital ◽  
Risk Profiles ◽  
Surgical Strategies

Background Elderly people are at particular high risk for postoperative delirium (POD) following spine surgery, which is associated with longer hospital stays, higher costs, risk for delayed complications, long-term care dependency, and cognitive dysfunction (POCD). It is insufficiently understood which mechanisms and risk factors contribute to the development of POD and POCD following these major but plannable surgeries. Objective This study aims to identify modifiable risk factors in spine surgery. A better understanding thereof would help adapt medical management and surgical strategies to individual risk profiles. Methods This is a single-center observational study jointly conducted by the departments of neurosurgery, neurology, and anesthesiology at a tertiary care hospital in Germany. All patients aged 60 years and older presenting to the neurosurgery outpatient clinic or ward for elective spine surgery are screened for eligibility. Exclusion criteria include presence of neurodegenerative or history of psychiatric disease and medication with significant central nervous system activity (eg, antidepressants, antipsychotics, sedatives). Surgical and anesthetic procedures including duration of surgery as primary end point of this study are thoroughly documented. All patients are furthermore evaluated for their preoperative cognitive abilities by a number of tests, including the Consortium to Establish a Registry for Alzheimer's Disease Plus test battery. Physical, mental, and social health and well-being are assessed using the Patient-Reported Outcome Measurement Information System Profile 29 and Hospital Anxiety and Depression Scale. Patients additionally receive preoperative cerebrovascular ultrasound and structural and functional brain imaging. The immediate postoperative period includes screening for POD using the Nursing Delirium Screening Scale and validation through Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, criteria. We furthermore investigate markers of (neuro)inflammation (eg, interleukins, C-reactive protein, tumor necrosis factor alpha). Preoperative examinations are repeated 3 months postoperatively to investigate the presence of POCD and its mechanisms. Statistical analyses will compare delirious and nondelirious patients for predictors of immediate (POD) and delayed (POCD) cognitive dysfunction. Results This is the first study to prospectively evaluate risk factors for POD and POCD in spine surgery. Recruitment is ongoing, and data collection is estimated to be finished with the inclusion of 200 patients by mid-2020. Conclusions The identification of mechanisms, possibly common, underlying POD and POCD would be a major step toward defining effective interventional strategies early in or even before the postoperative period, including the adaptation of surgical strategies to individual risk profiles. Trial Registration ClinicalTrials.gov NCT03486288; https://clinicaltrials.gov/ct2/show/NCT03486288

scholarly journals Evaluating mechanisms of postoperative delirium and cognitive dysfunction following elective spine surgery in elderly patients (CONFESS): study protocol for a prospective observational trial

2018 ◽  
Author(s):  
Jonas Müller ◽  
Stephan Nowak ◽  
Maria Dewey ◽  
Antje Vogelgesang ◽  
Bettina von Sarnowski ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Dysfunction ◽  
Spine Surgery ◽  
Postoperative Period ◽  
Cognitive Abilities ◽  
Postoperative Delirium ◽  
Individual Risk ◽  
Risk Profiles ◽  
Surgical Strategies ◽  
Neuro Inflammation

Abstract Background Elderly people are a rapidly growing proportion of the world's population that increasingly undergo major elective spine surgery. They are yet at particular high risk for postoperative delirium (POD), which is associated with longer hospital stays, higher costs, risk for delayed complications, long-term care dependency and cognitive dysfunction (POCD). It is insufficiently understood, which mechanisms and, particularly modifiable, risk factors contribute to the development of POD and POCD following these major but plannable surgeries. A better understanding thereof would help to adapt medical management and surgical strategies to individual risk profiles. Methods This is a single-center observational study that is jointly conducted by the departments of Neurosurgery, Neurology and Anesthesiology at a tertiary care hospital in Germany. All patients presenting to the neurosurgery outpatient clinic or ward for elective spine surgery are screened for eligibility. Inclusion criteria are age ≥ 60 years, indication for elective spine surgery, ability to give informed consent without assistance and speaking German natively. Exclusion criteria include presence of neurodegenerative disease, diagnosis of any psychiatric disease, medication with central nervous system activity (e.g. antidepressants, antipsychotics, sedatives), impossibility to participate in follow-up, participation in an interventional trial, presence of electronic or displaceable metallic implants and active neoplasm. All patients are evaluated for their preoperative cognitive abilities and physical, mental and social health and wellbeing. They additionally receive preoperative cerebrovascular ultrasound and structural and functional brain imaging. The immediate postoperative period includes screening for POD and the investigation of markers of (neuro‑)inflammation. Preoperative examinations are repeated three months postoperatively to investigate the presence of POCD and its mechanisms. Discussion This is the first study to prospectively evaluate risk factors for POD and POCD in spine surgery including comprehensive pre- and postoperative assessments of cognitive abilities, markers of (neuro‑)inflammation, cerebral vasculature and structural and functional neuroimaging. The identification of, possibly common, mechanisms underlying POD and POCD would be a major step towards the definition of effective interventional strategies early in or even before the postoperative period, including the adaptation of surgical strategies to individual risk profiles.

Incidence and Risk Factors for Postoperative Delirium After Lumbar Spine Surgery

Spine ◽  
2013 ◽  
Vol 38 (20) ◽  
pp. 1790-1796 ◽  
Author(s):  
Steven J. Fineberg ◽  
Sreeharsha V. Nandyala ◽  
Alejandro Marquez-Lara ◽  
Matthew Oglesby ◽  
Alpesh A. Patel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Postoperative Delirium ◽  
Lumbar Spine Surgery

scholarly journals Incidence and Risk Factors of Postoperative Delirium in Cervical Spine Surgery

Spine ◽  
2009 ◽  
Vol 34 (23) ◽  
pp. 2500-2504 ◽  
Author(s):  
Takahiro Ushida ◽  
Takeshi Yokoyama ◽  
Yasuyo Kishida ◽  
Mika Hosokawa ◽  
Shinichirou Taniguchi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Spine ◽  
Spine Surgery ◽  
Postoperative Delirium ◽  
Cervical Spine Surgery

Individual Risk Profiles for Postoperative Delirium after Joint Replacement Surgery

2011 ◽  
Vol 52 (5) ◽  
pp. 410-416 ◽  
Author(s):  
Felipe A. Jain ◽  
John O. Brooks ◽  
Kenneth A. Larsen ◽  
Susan E. Kelly ◽  
Robert H. Bode ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Postoperative Delirium ◽  
Individual Risk ◽  
Risk Profiles ◽  
Joint Replacement Surgery ◽  
Replacement Surgery

scholarly journals Risk factors for postoperative delirium in elderly patients after spinal fusion surgery

2020 ◽  
Vol 15 (3) ◽  
pp. 275-282
Author(s):  
Sijin Choi ◽  
Inyoung Jung ◽  
Byunghoon Yoo ◽  
Sangseok Lee ◽  
Mun Cheol Kim
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Cognitive Dysfunction ◽  
Emergency Surgery ◽  
Spinal Surgery ◽  
Postoperative Delirium ◽  
Spinal Fusion Surgery ◽  
Diagnostic And Statistical Manual ◽  
Relevant Risk Factor ◽  
Anesthesia Time

Background: Postoperative delirium (POD) has an incidence rate of 9% to 41%. It is directly linked to decreasing cognitive function, increasing length of hospitalization and cost, as well as other complications and mortality. We aimed to assess the risk factors for POD among elderly patients by analyzing data from those who underwent spinal surgery.Methods: This study included 446 patients aged 65 years or older who underwent spinal surgery at our institution between March 2013 and May 2018. Data were collected retrospectively from the patients’ electronic medical records, and logistic regression was used to identify the risk factors associated with POD. The diagnosis of POD was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and was made through consultation with a psychiatrist during postoperative hospitalization and before discharge.Results: Seventy-eight (78/446, 17.4%) patients were diagnosed with POD. The most relevant risk factor for POD was preoperative cognitive dysfunction (odds ratio [OR], 4.37; 95% confidence interval [CI], 1.60 to 11.93; P = 0.004), followed by emergency surgery (OR, 2.70; 95% CI, 1.27 to 5.74; P = 0.01), age (OR, 1.19; 95% CI, 1.13 to 1.26; P < 0.001), and anesthesia time (OR, 1.01; 95% CI 1.00 to 1.01; P = 0.002).Conclusions: Preoperative cognitive dysfunction, emergency surgery, age, and anesthesia time were factors that affected POD occurrence after spinal surgery. Patients with such associated factors may be at a higher risk for POD when undergoing spinal surgery, and hence, careful management may be necessary for these patients.

Risk Factors of Postoperative Delirium in Older Adult Spine Surgery Patients: A Meta‐Analysis

AORN Journal ◽  
2020 ◽  
Vol 112 (6) ◽  
pp. 650-661
Author(s):  
Wonhee Baek ◽  
Young Man Kim ◽  
Hyangkyu Lee
Keyword(s):  
Risk Factors ◽  
Older Adult ◽  
Spine Surgery ◽  
Postoperative Delirium ◽  
Meta Analysis ◽  
Adult Spine

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

2019 ◽  
Vol 2019 ◽  
pp. 1-20 ◽  
Author(s):  
Xinjie Wu ◽  
Wei Sun ◽  
Mingsheng Tan
Keyword(s):  
Risk Factors ◽  
Spine Surgery ◽  
Postoperative Delirium ◽  
Meta Analysis ◽  
Final Analysis ◽  
Pooled Analysis ◽  
Cochrane Library ◽  
Opioid Use ◽  
Preoperative Pain ◽  
Factors Associated

Background. The present study aims to investigate the incidence and risk factors associated with postoperative delirium in patients undergoing spine surgery. Methods. PubMed, EMBASE, Cochrane Library, and Science Citation Index were searched up to August 2019 for studies examining postoperative delirium following spine surgery. Incidence and risk factors associated with delirium were extracted. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for outcomes. The Newcastle–Ottawa Scale (NOS) was used for the study quality evaluation. Results. The final analysis includes a total of 40 studies. The pooled analysis reveals that incidence of delirium is 8%, and there are significant differences for developing delirium in age (OR 1.07; 95% CI 1.04–1.09), age more than 65 (OR 4.77; 95% CI 4.37–5.16), age more than 70 (OR 15.87; 95% CI 6.03–41.73), and age more than 80 (OR 1.91; 95% CI 1.78–2.03) years, male (OR 0.81; 95% CI 0.76–0.86), a history of alcohol abuse (OR 2.11; 95% CI 1.67–2.56), anxiety (OR 1.74; 95% CI 1.04–2.44), congestive heart failure (OR 1.4; 95% CI 1.21–1.6), depression (OR 2.5; 95% CI 1.52–3.49), hypertension (OR 1.12; 95% CI 1.04–1.2), kidney disease (OR 1.41; 95% CI 1.16–1.66), neurological disorder (OR 4.66; 95% CI 4.22–5.11), opioid use (OR 1.86; 95% CI 1.18–2.54), psychoses (OR 2.77; 95% CI 2.29–3.25), pulmonary disease (OR 1.81; 95% CI 1.27–2.35), higher mini-mental state examination (OR 0.7; 95% CI 0.5–0.89), preoperative pain (OR 1.88; 95% CI 1.11–2.64), and postoperative urinary tract infection (OR 5.68; 95% CI 2.41–13.39). Conclusions. A comprehensive understanding of incidence and risk factors of delirium can improve prevention, diagnosis, and management. Risk of postoperative delirium can be reduced based upon identifiable risk factors.

Abstract 3837: Vascular Risk Profiles and Cognitive Impairment in a 20-year Follow-up of Three Ethnic Groups: the Southall and Brent REvisited (SABRE) Cohort

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Robert Stewart ◽  
Therese Tillin ◽  
Nish Chaturvedi
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Ethnic Groups ◽  
South Asian ◽  
Digit Span ◽  
Individual Risk ◽  
Vascular Risk ◽  
Risk Profiles ◽  
The Impact

Introduction: There is substantial ethnic variation in vascular risk profiles and their outcomes. For example, stroke risk is raised by 50-100% in Black and South Asian compared to White UK residents but is more strongly associated with diabetes than hypertension in the former two groups. Associations with cognitive outcomes have not been previously compared. Hypothesis: Mid-life hypertension and diabetes will be more strongly associated with later life cognitive impairment in Black and South Asian compared to White residents. Methods: SABRE is a UK community based tri-ethnic (White, Black and South Asian) cohort of male and female London residents aged 40-69 years at baseline (1988-1990), and 58-86 years at follow up (2008-2011). Hypertension at baseline (resting blood pressure >140/90 or antihypertensive treatment) and diabetes at either exam were investigated in relation to cognitive impairment at follow-up. Cognitive impairment was ascertained as the lowest 10% of averaged z-scores calculated separately within the 3 ethnic groups for 9 tests: immediate and delayed word list recall, digit span forwards and backwards, verbal fluency, Color Trailmaking Tests A and B, delayed visual recall and the Community Screening Instrument for Dementia. Age, gender and years of education were entered as covariates. Results: Prospective data were analysed on 570 White, 432 South Asian and 185 Black residents. Baseline hypertension prevalences in these three groups were 14.8%, 27.1% and 37.2% respectively and diabetes prevalences were 19.5%, 43.4% and 41.3% respectively. Hypertension (p=0.005) and diabetes (p=0.029) were associated with follow-up cognitive impairment after full adjustment. On stratifying by ethnic group, no significant associations were found in White participants, hypertension was only associated with cognitive impairment in South Asians and diabetes only in Black participants. Hypertension and diabetes in combination were associated with cognitive impairment to a similar extent in both South Asian and Black participants, but not in Europeans. Conclusion: Vascular risk factors vary in their impact on cognitive impairment between ethnic groups which may reflect underlying differences in risk profiles and modification of their impact on end-organ damage. Multi-ethnic cohorts present a valuable opportunity for investigating more heterogeneous risk profiles and better clarifying mechanisms underlying the impact of individual risk factors.

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