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. 2020 Feb 3;20(1):40.
doi: 10.1186/s12877-020-1449-8.

Incidence of and risk factors for postoperative delirium in older adult patients undergoing noncardiac surgery: a prospective study

Arissara Iamaroon  1 , Titima Wongviriyawong  2 , Patumporn Sura-Arunsumrit  2 , Nattikan Wiwatnodom  1 , Nichakarn Rewuri  1 , Onuma Chaiwat  3   4
Affiliations

Incidence of and risk factors for postoperative delirium in older adult patients undergoing noncardiac surgery: a prospective study

Arissara Iamaroon et al. BMC Geriatr. .

Abstract

Background: To identify the incidence of, risk factors for, and outcomes associated with postoperative delirium (POD) in older adult patients who underwent noncardiac surgery.

Methods: This prospective study recruited patients aged ≥ 60 years who were scheduled to undergo noncardiac surgery at Siriraj Hospital (Bangkok, Thailand). Functional and cognitive statuses were assessed preoperatively using Barthel Index (BI) and the modified Informant Questionnaire on Cognitive Decline in the Elderly, respectively. POD was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition criteria. Incidence of POD was reported. Univariate and multivariate analyses were used to identify risk factors for POD.

Results: Of the 249 included patients, 29 (11.6%) developed POD. Most patients (61.3%) developed delirium on postoperative day 1. Univariate analysis showed age ≥ 75 years, BI score ≤ 70, pre-existing dementia, preoperative use of opioid or benzodiazepine, preoperative infection, and hematocrit < 30% to be significantly associated with POD. Multivariate logistic analysis revealed pre-existing dementia (adjusted risk ratio [RR]: 3.95, 95% confidence interval [CI]: 1.91-8.17; p < 0.001) and age ≥ 75 years (adjusted RR: 2.54, 95% CI: 1.11-5.80; p = 0.027) to be independent risk factors for POD. Median length of hospital stay was 10 (range: 3-36) days for patients with POD versus 6 (range: 2-76) days for those without delirium (p < 0.001).

Conclusions: POD remains a common surgical complication, with an incidence of 11.6%. Patients with pre-existing dementia and age ≥ 75 years are the most vulnerable high-risk group. A multidisciplinary team consisting of anesthesiologists and geriatricians should implement perioperative care to prevent and manage POD.

Keywords: Collaborative approach; Incidence; Noncardiac surgery; Older adult patients; Postoperative delirium; Risk factors.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of patient enrollment
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curve of the age classification of delirious patients
See this image and copyright information in PMC

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