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Observational Study
. 2019 Sep;131(3):477-491.
doi: 10.1097/ALN.0000000000002729.

Postoperative Delirium and Postoperative Cognitive Dysfunction: Overlap and Divergence

Lori A Daiello  1 , Annie M Racine, Ray Yun Gou, Edward R Marcantonio, Zhongcong Xie, Lisa J Kunze, Kamen V Vlassakov, Sharon K Inouye, Richard N Jones, David Alsop, Thomas Travison, Steven Arnold, Zara Cooper, Bradford Dickerson, Tamara Fong, Eran Metzger, Alvaro Pascual-Leone, Eva M Schmitt, Mouhsin Shafi, Michele Cavallari, Weiying Dai, Simon T Dillon, Janet McElhaney, Charles Guttmann, Tammy Hshieh, George Kuchel, Towia Libermann, Long Ngo, Daniel Press, Jane Saczynski, Sarinnapha Vasunilashorn, Margaret O'Connor, Eyal Kimchi, Jason Strauss, Bonnie Wong, Michael Belkin, Douglas Ayres, Mark Callery, Frank Pomposelli, John Wright, Marc Schermerhorn, Tatiana Abrantes, Asha Albuquerque, Sylvie Bertrand, Amanda Brown, Amy Callahan, Madeline D'Aquila, Sarah Dowal, Meaghan Fox, Jacqueline Gallagher, Rebecca Anna Gersten, Ariel Hodara, Ben Helfand, Jennifer Inloes, Jennifer Kettell, Aleksandra Kuczmarska, Jacqueline Nee, Emese Nemeth, Lisa Ochsner, Kerry Palihnich, Katelyn Parisi, Margaret Puelle, Sarah Rastegar, Margaret Vella, Guoquan Xu, Margaret Bryan, Jamey Guess, Dee Enghorn, Alden Gross, Yun Gou, Daniel Habtemariam, Ilean Isaza, Cyrus Kosar, Christopher Rockett, Douglas Tommet, Ted Gruen, Meg Ross, Katherine Tasker, James Gee, Ann Kolanowski, Margaret Pisani, Sophia de Rooij, Selwyn Rogers, Stephanie Studenski, Yaakov Stern, Anthony Whittemore, Gary Gottlieb, John Orav, Reisa Sperling; SAGES Study Group*
Affiliations
Observational Study

Postoperative Delirium and Postoperative Cognitive Dysfunction: Overlap and Divergence

Lori A Daiello et al. Anesthesiology. 2019 Sep.

Abstract

Background: Postoperative delirium and postoperative cognitive dysfunction share risk factors and may co-occur, but their relationship is not well established. The primary goals of this study were to describe the prevalence of postoperative cognitive dysfunction and to investigate its association with in-hospital delirium. The authors hypothesized that delirium would be a significant risk factor for postoperative cognitive dysfunction during follow-up.

Methods: This study used data from an observational study of cognitive outcomes after major noncardiac surgery, the Successful Aging after Elective Surgery study. Postoperative delirium was evaluated each hospital day with confusion assessment method-based interviews supplemented by chart reviews. Postoperative cognitive dysfunction was determined using methods adapted from the International Study of Postoperative Cognitive Dysfunction. Associations between delirium and postoperative cognitive dysfunction were examined at 1, 2, and 6 months.

Results: One hundred thirty-four of 560 participants (24%) developed delirium during hospitalization. Slightly fewer than half (47%, 256 of 548) met the International Study of Postoperative Cognitive Dysfunction-defined threshold for postoperative cognitive dysfunction at 1 month, but this proportion decreased at 2 months (23%, 123 of 536) and 6 months (16%, 85 of 528). At each follow-up, the level of agreement between delirium and postoperative cognitive dysfunction was poor (kappa less than .08) and correlations were small (r less than .16). The relative risk of postoperative cognitive dysfunction was significantly elevated for patients with a history of postoperative delirium at 1 month (relative risk = 1.34; 95% CI, 1.07-1.67), but not 2 months (relative risk = 1.08; 95% CI, 0.72-1.64), or 6 months (relative risk = 1.21; 95% CI, 0.71-2.09).

Conclusions: Delirium significantly increased the risk of postoperative cognitive dysfunction in the first postoperative month; this relationship did not hold in longer-term follow-up. At each evaluation, postoperative cognitive dysfunction was more common among patients without delirium. Postoperative delirium and postoperative cognitive dysfunction may be distinct manifestations of perioperative neurocognitive deficits.

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Conflict of interest statement

Conflicts of Interest: The authors declare no competing interests.

Figures

Figure A1.
Figure A1.
SAGES Participant Flow (Primary Analyses)
Figure 1.
Figure 1.
Incidence of in-hospital POD and POCD during follow-up. Venn diagrams for overlap of POD and POCD at postoperative months 1 (left), 2 (center), and 6 (right). The three circles in each diagram illustrate the relative proportions of patients who a) met criteria for POCD (left) at 1, 2, or 6 months after surgery; b) developed POD while hospitalized (right); and c) developed in-hospital POD and also met criteria for POCD (center) at each follow-up. POCD = postoperative cognitive dysfunction, proportions estimated from multiply-imputed data; POD = postoperative delirium. Tetrachoric correlations (rtet) and kappa coefficients are displayed for each month.
See this image and copyright information in PMC

Comment in

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