The predictors of postoperative delirium at surgical units in Sudan: A multicenter, cross-sectional, prospective study

Main Article Content

Asim Ahmed Elnour
Sara Babkir https://orcid.org/0000-0002-1003-041X
Al-Kubaissi Khalid A

Keywords

Delirium, Multicenter, Postoperative, Postoperative delirium (POD);, predictors, surgical units

Abstract

Background: Knowledge of potential and amenable risk factors involved in the development of postoperative delirium (POD) is imperative for successful prevention and subsequent management. Objective: The current study objective was to delineate the risk factors associated with the occurrence of POD among patients undergoing surgical procedures. Methods: This multi-center (6 hospitals), cross-sectional prospective hospital-based study recruited 415 subjects aged ≥50 years who were scheduled to undergo different types of surgery. Delirium Observational Screening Scale used for the diagnosis of POD. Short Nutritional Assessment Questionnaire used for assessing the nutritional and the hydration status of patients. Pre and postoperative risk factors analyzed by univariate (chi square) and then multivariate analyses and the incidence rate of POD, was reported. Results: The main outcome measure was the development of POD. Out of the 385, only 43 subjects (11.2%) developed POD. High American Society of Anesthesiologists score (OR: 10.76, 95% CI: 1.379-83.99, P =0.023), duration of surgery (OR: 5.426, 95% CI: [2.249-13.092]; P =0.0001), were the strongest independent risk factors for the development of POD. Katz Index of Independence in Activities of Daily Living score (OR: 3.227, 95% CI: [1.177-8.844], P =0.023), and age ≥ 70 years (OR: 1.174, 95% CI: [1.015-1.359]; P =0.027) were additional strongest independent risk factors for the development of POD. Conclusion: Based on analysis or study, we found High American Society of Anesthesiologist sore, Katz-ADL, duration of surgery, and advanced age were predictors of POD. Our findings suggest preventive measures initiated in subjects identified at risk of developing POD. These results support the healthcare providers in the early prevention, diagnosis, and timely management of POD.

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References

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edn. Text revision American Psychiatric Association, 2000. Washington, DC. Accessed 20 May 2020. https://www.bookdepository.com/Diagnostic-Statistical-Manual-Mental-Disorders-Fourth-Edition-Text-Revision-American-Psychiatric-Association/9780890420324?ref=grid-view&qid=1603491225548&sr=1-2
2. Maldonado JR. Delirium in The Acute Care Setting: Characteristics, Diagnosis and Treatment. Crit Care Clin. 2008;24(4):657-722. https://doi.org/10.1016/j.ccc.2008.05.008
3. Lat I, McMillian W, Taylor S, et al. The Impact of Delirium On Clinical Outcomes In Mechanically Ventilated Surgical And Trauma Patients. Crit Care Med. 2009;37(6):1898-1905. https://doi.org/10.1097/CCM.0b013e31819ffe38
4. Gonzalez M, Martinez G, Calderón J, et al. Impact of Delirium On Short-Term Mortality In Elderly Inpatients: A Prospective Cohort Study. Psychosomatics. 2009;50(3):234-238. https://doi.org/10.1176/appi.psy.50.3.234
5. Rudolph JL, Inouye SK, Jones RN, et al. Delirium: An Independent Predictor of Functional Decline After Cardiac Surgery. J Am Geriatr Soc. 2010;58(4):643-649. https://doi.org/10.1111/j.1532-5415.2010.02762.x
6. Pisani MA, Kong SY, Kasl SV, et al. Days of Delirium Are Associated with 1-Year Mortality In An Older Intensive Care Unit Population. Am J Respir Crit Care Med. 2009;180(11):1092-1097. https://doi.org/10.1164/rccm.200904-0537OC
7. Shehabi Y, Riker RR, Bokesch PM, et al. Delirium Duration and Mortality in Lightly Sedated, Mechanically Ventilated Intensive Care Unit Patients. Crit Care Med. 2010;38(12):2311-2318. https://doi.org/10.1097/CCM.0b013e3181f85759
8. Leslie DL, Marcantonio ER, Zhang Y, et al. One-Year Health Care Costs Associated with Delirium in The Elderly Population. Arch Intern Med. 2008;168(1):27-32. https://doi.org/10.1001/archinternmed.2007.4
9. Lee SJ, Jung SH, Lee SU, et al. Postoperative delirium after hip surgery is a potential risk factor for incident dementia: A systematic review and meta-analysis of prospective studies. Archives of gerontology and geriatrics. 2020;87:103977. https://doi.org/10.1016/j.archger.2019.103977
10. Yang Y, Zhao X, Dong T, et al. Risk factors for postoperative delirium following hip fracture repair in elderly patients: a systemati creview and meta-analysis. Aging clinical and experimental research. 2017;29(2):115-126. https://doi.org/10.1007/s40520-016-0541-6
11. Witlox J, Eurelings LS, de Jonghe JF, et al. Delirium in Elderly Patients and The Risk of Post-discharge Mortality, Institutionalization,And Dementia: A Meta-Analysis. JAMA. 2010;304(4):443-451.
12. Noimark D. Predicting the Onset of Delirium in The Post-Operative Patient. Age Ageing. 2009;38(4):368-373. https://doi.org/10.1093/ageing/afp024
13. Raats JW, Eijsden WA, Crolla RMPH, et al. Risk Factors and Outcomes for Postoperative Delirium After Major Surgery in Elderly Patients. PLoS ONE. 2015;10(8):1-12. https://doi.org/10.1371/journal.pone.0136071
14. Kaya M, Şenel GO, Ünver S. The Incidence of Delirium at The Postoperative Intensive Care Unit in Adult Patients. Turk J Anaesth Reanim. 2015;43(4):232-239. https://doi.org/10.5152/TJAR.2015.93798
15. Ravi B, Pincus D, Choi S, et al. Association of Duration of Surgery with Postoperative Delirium Among Patients Receiving Hip Fracture Repair. JAMA. 2019;2(2):e190111. https://doi.org/10.1001/jamanetworkopen.2019.0111
16. Robinson TN, Raeburn CD, Tran ZV, et al. Postoperative Delirium in The Elderly Risk Factors and Outcomes. Ann Surg. 2009;249(1):173-178. https://doi.org/10.1097/SLA.0b013e31818e4776
17. Korc-Grodzicki B, Sun SW, Zhou Q, et al. Geriatric Assessment as a Predictor of Delirium and Other Outcomes In Elderly Patients With Cancer. Ann Surg. 2014;303(8):763-770. https://doi.org/10.1097/SLA.0000000000000742
18. Koebrugge B, van Wensen RJ, Bosscha K, et al. Delirium After Emergency/Elective Open and Endovascular Aortoiliac Surgery at a Surgical Ward with a High-Standard Delirium Care Protocol. Vascular. 2010;18(5):279-287. https://doi.org/10.1097/SLA.0000000000000742
19. Olin K, Eriksdotter-Jonhagen M, Jansson A, et al. Postoperative Delirium in Elderly Patients After Major Abdominal Surgery. Br J Surg. 2005;92(4):1559-1564. https://doi.org/10.1002/bjs.5053
20. Yoshimura Y, Kubo S, Shirata K, et al. Risk Factors for Postoperative Delirium After Liver Resection for Hepatocellular Carcinoma. World J Surg. 2004;28(10):982-986. https://doi.org/10.1007/s00268-004-7344-1
21. Raats JW, Steunenberg SL, Crolla RM, et al. Postoperative Delirium in Elderly Patients After Elective and Emergency Colorectal Surgery. Journal of Gastrointestinal Surgery. 2015;72(18):1570-1575. https://doi.org/10.1016/j.surg.2016.09.010 
22. Ansaloni L, Catena F, Chattat R, et al. Risk Factors and Incidence of Postoperative Delirium in Elderly Patients After Elective And Emergency Surgery. Br J Surg. 2010;97(2):273-280. https://doi.org/10.1002/bjs.6843
23. Beishuizen SJE, van Munster BC, de Jonghe A, et al. Distinct cognitive trajectories in the first year after hip fracture. J Am
Geriatr Soc. 2017;65(5):1034-1042. https://doi.org/10.1111/jgs.14754
24. Sauër AC, Veldhuijzen DS, Ottens TH, et al. Association between delirium and cognitive change after cardiac surgery. Br J Anaesth 2017;119(2):308-315. https://doi.org/10.1093/bja/aex053
25. Matsuki M, Tanaka T, Takahashi A, et al. Incidence and risk factors of postoperative delirium in elderly patients undergoing urological surgery: A multi‐institutional prospective study. Inter J Urol. 2020;27(3):219-225. https://doi.org/10.1111/iju.14172
26. Kang T, Park SY, Lee JH, et al. Incidence & Risk Factors of Postoperative Delirium After Spinal Surgery in Older Patients. Sci Rep.2020;10(1):9232. https://doi.org/10.1038/s41598-020-66276-3

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