Journal of Surgery Concepts & Practice >

2024 , Vol. 29 >Issue 06: 510 - 517

DOI: https://doi.org/10.16139/j.1007-9610.2024.06.09

Original article

Risk factors of postoperative delirium in elderly patients undergoing noncardiac surgery under general anesthesia

  • WU Xinwan ,
  • LI Xiang ,
  • ZHENG Minjia ,
  • YAO Junyan
Expand
  • Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China

Received date: 2024-01-19

  Online published: 2025-03-17

Fold

Abstract

Objective To investigate the incidence and related factors of postoperative delirium in elderly patients undergoing elective noncardiac surgery under general anesthesia. Methods Elderly patients aged ≥65 years old undergoing non-cardiac surgery under general anesthesia from December 31, 2017 to December 31, 2018 were retrospectively analyzed. The patients were divided into delirium group and control group according to whether delirium occurred after surgery. Paired t test was used to compare the laboratory test results between the delirium group and the control group. Logistic regression analysis was used to identify the independent risk factors for delirium after non-cardiac surgery in elderly patients. Results A total of 1 072 elderly patients undergoing elective non-cardiac surgery were enrolled in this study. Delirium occurred in 60 patients, and the incidence of delirium was 5.6%. Multivariate Logistic regression analysis showed that postoperative prothrombin time(PT), preoperative blood glucose, preoperative activated partial thromboplastin time(APTT) and postoperative C-reactive protein(CRP) were independent risk factors for delirium after non-cardiac surgery in elderly patients. Conclusions Postoperative PT, preoperative blood glucose, preoperative APTT and postoperative CRP are independent risk factors for POD in elderly patients undergoing non-cardiac surgery.

Key words： Delirium; Old population; General anesthesia; Non-cardiac surgery; Risk factor

Cite this article

WU Xinwan , LI Xiang , ZHENG Minjia , YAO Junyan . Risk factors of postoperative delirium in elderly patients undergoing noncardiac surgery under general anesthesia[J]. Journal of Surgery Concepts & Practice, 2024 , 29(06) : 510 -517 . DOI: 10.16139/j.1007-9610.2024.06.09

References

[1] UCHIDA M, MORITA T, AKECHI T, et al. Are common delirium assessment tools appropriate for evaluating delirium at the end of life in cancer patients?[J]. Psychooncology, 2020, 29(11):1842-1849.
[2] EVERED L, SILBERT B, KNOPMAN D S, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018[J]. Anesthesiology, 2018, 129(5):872-879.
[3] SPRUNG J, JANKOWSKI C J, ROBERTS R O, et al. Anesthesia and incident dementia: a population-based, nested, case-control study[J]. Mayo Clin Proc, 2013, 88(6):552-561.
[4] OH C S, PARK S, WAN HONG S, et al. Postoperative delirium in patients undergoing off-pump coronary artery bypass grafting according to the anesthetic agent:a retrospective study[J]. J Cardiothorac Vasc Anesth, 2017, 31(6):1988-1995.
[5] PARK E A, KIM M Y. Postoperative delirium is associated with negative outcomes and long-term mortality in elderly Koreans:a retrospective observational study[J]. Medicina (Kaunas), 2019, 55(10):618.
[6] COZOWICZ C, MEMTSOUDIS S G, POERAN J. Risk factors for postoperative delirium in patients undergoing lower extremityjoint arthroplasty:a retrospective population-based cohort study[J]. Reg Anesth Pain Med, 2021, 46(1):94-95.
[7] 崔小平, 荆志振, 宋洁富, 等. 老年患者脊柱手术术后谵妄危险因素分析的回顾性研究[J]. 中国骨伤, 2019, 32(6):549-554.
  CUI X P, JING Z Z, SONG J F, et al. A retrospective study on risk factors associated with postoperative delirium in elderly patients with spinal operation[J]. China J Orthop Traumatol, 2019, 32(6):549-554.
[8] ISHIBASHI-KANNO N, TAKAOKA S, NAGAI H, et al. Postoperative delirium after reconstructive surgery for oral tumor: a retrospective clinical study[J]. Int J Oral Maxillofac Surg, 2020, 49(9):1143-1148.
[9] LIM L, NAM K, LEE S, et al. The relationship between intraoperative cerebral oximetry and postoperative delirium in patients undergoing off-pump coronary artery bypass graft surgery:a retrospective study[J]. BMC Anesthesiol, 2020, 20(1):285.
[10] MEMTSOUDIS S, COZOWICZ C, ZUBIZARRETA N, et al. Risk factors for postoperative delirium in patients undergoing lower extremity joint arthroplasty:a retrospective population-based cohort study[J]. Reg Anesth Pain Med, 2019,44:934-943.
[11] KING C R, ESCALLIER K E, JU Y S, et al. Obstructive sleep apnoea, positive airway pressure treatment and postoperative delirium: protocol for a retrospective observational study[J]. BMJ Open, 2019, 9(8):e026649.
[12] LEE H, JU J W, OH S Y, et al. Impact of timing and duration of postoperative delirium: a retrospective observational study[J]. Surgery,2018:S0039- 6060(18)30035-7.
[13] LI X, DU W, PARKINSON A, et al. Postoperative delirium following joint replacement in patients with dementia in new south wales, australia:a state-wide retrospective cohort study[J]. Res Gerontol Nurs, 2020, 13(5):243-253.
[14] NAGAE M, EGI M, FURUSHIMA N, et al. The impact of intravenous isotonic and hypotonic maintenance fluid on the risk of delirium in adult postoperative patients: retrospective before-after observational study[J]. J Anesth, 2019, 33(2):287-294.
[15] LEI L, KATZNELSON R, FEDORKO L, et al. Cerebral oximetry and postoperative delirium after cardiac surgery: a randomised, controlled trial[J]. Anaesthesia, 2017, 72(12):1456-1466.
[16] EVERED L A, SILBERT B S. Postoperative cognitive dysfunction and noncardiac surgery[J]. Anesth Analg, 2018, 127(2):496-505.
[17] SILVA A R, REGUEIRA P, ALBUQUERQUE E, et al. Estimates of geriatric delirium frequency in noncardiac surgeries and its evaluation across the years: a systematic review and meta-analysis[J]. J Am Med Dir Assoc, 2021, 22(3):613-620.e9.
[18] PARK K H, SON H J, CHOI Y J, et al. Liver transplant patients with high preoperative serum bilirubin levels are at increased risk of postoperative delirium:a retrospective study[J]. Clin Med, 2020, 9(5):1591.
[19] SHI Q, MU X, ZHANG C, et al. Risk factors for post-operative delirium in type A aortic dissection patients:a retrospective study[J]. Med Sci Monit, 2019,25:3692-3699.
[20] YANG L, SUN D F, HAN J, et al. Effects of intraoperative hemodynamics on incidence of postoperative delirium in elderly patients: a retrospective study[J]. Med Sci Monit, 2016,22:1093-1100.
[21] WITLOX J, EURELINGS L S, DE JONGHE J F, et al. Delirium in elderly patients and the risk of postdischarge mortality,institutionalization,and dementia: a meta-analysis[J]. JAMA, 2010, 304(4):443-451.
[22] FONG T G, DAVIS D, GROWDON M E, et al. The interface between delirium and dementia in elderly adults[J]. Lancet Neurol, 2015, 14(8):823-832.
[23] TANG C, HU Y, ZHANG Z, et al. Dexmedetomidine with sufentanil in intravenous patient-controlled analgesia for relief from postoperative pain,inflammation and delirium after esophageal cancer surgery[J]. Biosci Rep, 2020, 40(5):BSR20193410.
[24] VANDUSEN K W, ELESWARPU S, MORETTI E W, et al. The MARBLE study protocol: modulating ApoE signaling to reduce brain inflammation, delirium, and postoperative cognitive dysfunction[J]. Alzheimers Dis, 2020, 75(4):1319-1328.
[25] COX G, TZIOUPIS C, CALORI G M, et al. Cerebral fat emboli: a trigger of post-operative delirium[J]. Injury, 2011, 42(Suppl 4):S6-S10.
[26] ARORA R C, DJAIANI G, RUDOLPH J L. Detection, prevention, and management of delirium in the critically ill cardiac patient and patients who undergo cardiac procedures[J]. Can J Cardiol, 2017, 33(1):80-87.
[27] ZENG K, LONG J, LI Y, et al. Preventing postoperative cognitive dysfunction using anesthetic drugs in elderly patients undergoing noncardiac surgery: a systematic review and meta-analysis[J]. Int J Surg, 2023, 109(1):21-31.
[28] HUMEIDAN M L, REYES J C, MAVAREZ-MARTINEZ A, et al. Effect of cognitive prehabilitation on the incidence of postoperative delirium among older adults undergoing major noncardiac surgery: the neurobics randomized clinical trial[J]. JAMA Surg, 2021, 156(2):148-156.
[29] SACZYNSKI J S, MARCANTONIO E R, QUACH L, et al. Cognitive trajectories after postoperative delirium[J]. N Engl J Med, 2012, 367(1),30-39.
[30] EVERED L A, SCOTT D A, SILBERT B, et al. Post-operative cognitive dysfunction is independent of type of surgery and anesthetic[J]. Anesth Analg, 2011, 112(5):1179-1185.
Options
Outlines

/

〈 〉