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Risk for delirium increases in older patients following gastrointestinal surgery
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Postoperative delirium was found to be a common occurrence in older patients who underwent gastrointestinal surgery. Patients who experienced postoperative delirium also trended toward longer hospital stays and risk for dying earlier than patients who did not have postoperative delirium.
“The importance of delirium in critical care and older adult patients is well recognized. We have demonstrated that delirium is not exclusive to ‘medical’ health care settings; our review summarizes the available evidence in general surgery and highlights a number of areas where more research is urgently needed,” Anna Scholz, MD, from the Institute of Primary Care and Public Health, Cardiff University, University Hospital, Llandough, Cardiff, Wales, UK, said in a press release.
Five databases were searched for any published literature on the risk factors for postoperative delirium: MEDLINE, Web of Science, Embase, CINAHL and PsycINFO. The researchers then identified and evaluated 11 studies published between January 1987 and November 2014 of patients who underwent gastrointestinal surgery to examine risk factors for postoperative delirium in these patients. Within the 11 studies, the researchers analyzed data on 1,427 patients; 318 with delirium and 1,109 without. The mean age of the patients in the studies ranged from 68 to 81 years. Most patients underwent elective colorectal surgery. The Mantel Haenszel and inverse-variance methods were used to estimate pooled odds ratios or mean differences for individual risk factors.
The incidence rate of postoperative delirium was 8.2% to 54.4%. Of all risk factors present, some were found to be statistically significantly associated with postoperative delirium in patients undergoing gastrointestinal surgery, including: advanced age (mean difference [MD] = 4.83 years, 95% CI, 3.14-6.52 years); low mean serum albumin levels (MD = − 0.5 g/dL, 95% CI, – 0.74 to – 0.26 g/dL); intraoperative hypotension (OR = 3.06; 95% CI, 1.6-5.84); the need for a perioperative blood transfusion (OR = 3.17, 95% CI, 1.88-5.35); a history of alcohol excess (OR = 2.55, 95% CI, 1.28-5.06), poor physical status (ASA grade ≥ 3; pooled OR = 2.71, 95% CI, 1.64-4.48) and low BMI (MD = – 1.44 kg/m2, 95% CI, – 2·42 to – 0.47 kg/m2) also demonstrated significantly higher risks.
Patients who experienced postoperative delirium also had a statistically significant increase in the duration of hospital stay (MD = 4.56 days; 95% CI, 1.48-6.77 days) and an increased risk for perioperative mortality (OR = 4.03, 95% CI, 2.19-7.42).
“The risk factors identified in this review will aid the planning of future studies to explore the extent of their effect, but also the impact of tailored interventions. Inconsistency was seen in the present studies, particularly in measures of physical status and immobility, which have been found to be risk factors in other studies. By stratifying patients, intervention studies can be planned, which should result in improvements in patient care,” the researchers wrote.
Disclosures: The researchers report no relevant financial disclosures.
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