Skip to main content
Erschienen in: Journal of Anesthesia 2/2014

01.04.2014 | Original Article

Incidence of postoperative delirium is high even in a population without known risk factors

verfasst von: Andrea Saporito, Evelina Sturini

Erschienen in: Journal of Anesthesia | Ausgabe 2/2014

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Postoperative delirium is a recognized complication in populations at risk. The aim of this study is to assess the prevalence of early postoperative delirium in a population without known risk factors admitted to the ICU for postoperative monitoring after elective major surgery. The secondary outcome investigated is to identify eventual independent risk factors among demographic data and anesthetic drugs used.

Methods

An observational, prospective study was conducted on a consecutive cohort of patients admitted to our ICU within and for at least 24 h after major surgical procedures. Exclusion criteria were any preexisting predisposing factor for delirium or other potentially confounding neurological dysfunctions. Patients were assessed daily using the confusion assessment method for the ICU scale for 3 days after the surgical procedure. Early postoperative delirium incidence risk factors were then assessed through three different multiple regression models.

Results

According to the confusion assessment method for the ICU scale, 28 % of patients were diagnosed with early postoperative delirium. The use of thiopentone was significantly associated with an eight-fold-higher risk for delirium compared to propofol (57.1 % vs. 7.1 %, RR = 8.0, χ 2 = 4.256; df = 1; 0.05 < p < 0.02).

Conclusion

In this study early postoperative delirium was found to be a very common complication after major surgery, even in a population without known risk factors. Thiopentone was independently associated with an increase in its relative risk.
Literatur
1.
Zurück zum Zitat American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edn (DSM IV). Washington, DC: American Psychiatric Association; 1994. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edn (DSM IV). Washington, DC: American Psychiatric Association; 1994.
2.
Zurück zum Zitat Meagher DJ, O'Hanlon D, O'Mahony E, Casey PR, Trzepacz PT. Relationship between symptoms and motoric subtype of delirium. J Neuropsychiatry Clin Neurosci. 2000;12:51–6.PubMed Meagher DJ, O'Hanlon D, O'Mahony E, Casey PR, Trzepacz PT. Relationship between symptoms and motoric subtype of delirium. J Neuropsychiatry Clin Neurosci. 2000;12:51–6.PubMed
3.
Zurück zum Zitat Inouye SK. The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalised elderly medical patients. Am J Med. 1994;97:278–88.PubMedCrossRef Inouye SK. The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalised elderly medical patients. Am J Med. 1994;97:278–88.PubMedCrossRef
4.
Zurück zum Zitat Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R. Delirium in mechanically ventilated patients: validity and reliability of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). JAMA. 2001;286:2703–10.PubMedCrossRef Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R. Delirium in mechanically ventilated patients: validity and reliability of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). JAMA. 2001;286:2703–10.PubMedCrossRef
5.
Zurück zum Zitat Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, Speroff T, Gautam S, Bernard GR, Inouye SK. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001;29:1370–9.PubMedCrossRef Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, Speroff T, Gautam S, Bernard GR, Inouye SK. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001;29:1370–9.PubMedCrossRef
6.
Zurück zum Zitat Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med. 2001;27:859–64.PubMedCrossRef Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med. 2001;27:859–64.PubMedCrossRef
7.
Zurück zum Zitat McNicoll L, Pisani MA, Zhang Y, Ely EW, Siegel MD, Inouye SK. Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc. 2003;51:591–8.PubMedCrossRef McNicoll L, Pisani MA, Zhang Y, Ely EW, Siegel MD, Inouye SK. Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc. 2003;51:591–8.PubMedCrossRef
8.
Zurück zum Zitat Thomas RI, Cameron DJ, Fahs MC. A prospective study of delirium and prolonged hospital stay. Arch Gen Psychiatry. 1988;45:937–40.PubMedCrossRef Thomas RI, Cameron DJ, Fahs MC. A prospective study of delirium and prolonged hospital stay. Arch Gen Psychiatry. 1988;45:937–40.PubMedCrossRef
9.
Zurück zum Zitat Inouye SK, Rushing JT, Foreman MD, Palmer RM, Pompei P. Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. J Gen Intern Med. 1998;13:234–42.PubMedCentralPubMedCrossRef Inouye SK, Rushing JT, Foreman MD, Palmer RM, Pompei P. Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. J Gen Intern Med. 1998;13:234–42.PubMedCentralPubMedCrossRef
10.
Zurück zum Zitat American Psychiatric Association. Practice guidelines for the treatment of patients with delirium. Am J Psychiatry. 1999;156:1–20. American Psychiatric Association. Practice guidelines for the treatment of patients with delirium. Am J Psychiatry. 1999;156:1–20.
11.
Zurück zum Zitat Pandharipande P, Jackson J, Ely EW. Delirium: acute cognitive dysfunction in the critically ill. Curr Opin Crit Care. 2005;11:360–8.PubMed Pandharipande P, Jackson J, Ely EW. Delirium: acute cognitive dysfunction in the critically ill. Curr Opin Crit Care. 2005;11:360–8.PubMed
12.
Zurück zum Zitat Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalised elderly patients: predictive model and interrelationship with the baseline vulnerability. JAMA. 1996;275:852–7.PubMedCrossRef Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalised elderly patients: predictive model and interrelationship with the baseline vulnerability. JAMA. 1996;275:852–7.PubMedCrossRef
13.
Zurück zum Zitat Francis J, Martin D, Kapoor WN. A prospective study of delirium in hospitalised elderly. JAMA. 1990;263:1097–101.PubMedCrossRef Francis J, Martin D, Kapoor WN. A prospective study of delirium in hospitalised elderly. JAMA. 1990;263:1097–101.PubMedCrossRef
14.
Zurück zum Zitat Ely EW, Gautam S, Margolin R, Francis J, May L, Speroff T, Truman B, Dittus R, Bernard R, Inouye SK. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med. 2001;27:1892–900.PubMedCrossRef Ely EW, Gautam S, Margolin R, Francis J, May L, Speroff T, Truman B, Dittus R, Bernard R, Inouye SK. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med. 2001;27:1892–900.PubMedCrossRef
15.
Zurück zum Zitat Blachly P, Starr A. Post-cardiotomy delirium. Am J Psychiatry. 1964;121:371–5. Blachly P, Starr A. Post-cardiotomy delirium. Am J Psychiatry. 1964;121:371–5.
16.
Zurück zum Zitat Roach GW, Kanchuger M, Mangano CM, Newman M, Nussmeier N, Wolman R, Aggarwal A, Marschall K, Graham SH, Ley C. Adverse cerebral outcomes after coronary bypass surgery. Multicenter study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. NEJM. 1996;335:1857–63.PubMedCrossRef Roach GW, Kanchuger M, Mangano CM, Newman M, Nussmeier N, Wolman R, Aggarwal A, Marschall K, Graham SH, Ley C. Adverse cerebral outcomes after coronary bypass surgery. Multicenter study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. NEJM. 1996;335:1857–63.PubMedCrossRef
17.
Zurück zum Zitat Layne O, Yudofsky S. Postoperative psychosis in cardiotomy patients. N Engl J Med. 1971;284(10):518–20.PubMedCrossRef Layne O, Yudofsky S. Postoperative psychosis in cardiotomy patients. N Engl J Med. 1971;284(10):518–20.PubMedCrossRef
18.
Zurück zum Zitat Sadler P. Incidence, degree and duration of postcardiotomy delirium. Heart Lung. 1981;10(6):1084–92.PubMed Sadler P. Incidence, degree and duration of postcardiotomy delirium. Heart Lung. 1981;10(6):1084–92.PubMed
19.
Zurück zum Zitat Herrmann M, Ebert AD, Tober D, Hann J, Huth C. A contrastive analysis of release patterns of biochemical markers of brain damage after coronary artery bypass grafting and valve replacement and their association with the neurobehavioral outcome after cardiac surgery. Eur J Cardiothor Surg. 1999;16:513–8.CrossRef Herrmann M, Ebert AD, Tober D, Hann J, Huth C. A contrastive analysis of release patterns of biochemical markers of brain damage after coronary artery bypass grafting and valve replacement and their association with the neurobehavioral outcome after cardiac surgery. Eur J Cardiothor Surg. 1999;16:513–8.CrossRef
20.
Zurück zum Zitat Kazmierski J, Kowman M, Banach M, Pawelczyk T, Okonski P, Iwaszkiewicz A, Zaslonka J, Sobow T, Kloszewska I. Incidence of and preoperative predictors for delirium after cardiac surgery. J Psychosom Res. 1999;46(5):479–83. Kazmierski J, Kowman M, Banach M, Pawelczyk T, Okonski P, Iwaszkiewicz A, Zaslonka J, Sobow T, Kloszewska I. Incidence of and preoperative predictors for delirium after cardiac surgery. J Psychosom Res. 1999;46(5):479–83.
21.
Zurück zum Zitat Sockalingam S, Parekh N, Bogoch II, Sun J, Mahtani R, Beach C, Bollegalla N, Turzanski S, Seto E, Kim J, Dulay P, Scarrow S, Bhalerao S. Delirium in the postoperative cardiac patient: a review. J Cardiac Surg. 2005;20:560–7. Sockalingam S, Parekh N, Bogoch II, Sun J, Mahtani R, Beach C, Bollegalla N, Turzanski S, Seto E, Kim J, Dulay P, Scarrow S, Bhalerao S. Delirium in the postoperative cardiac patient: a review. J Cardiac Surg. 2005;20:560–7.
22.
Zurück zum Zitat Litaker D, Locala J, Franco K, Bronson DL, Tannous Z. Preoperative risk factors for postoperative delirium. Gen Hosp Psychiatry. 2001;23:84–9.PubMedCrossRef Litaker D, Locala J, Franco K, Bronson DL, Tannous Z. Preoperative risk factors for postoperative delirium. Gen Hosp Psychiatry. 2001;23:84–9.PubMedCrossRef
23.
Zurück zum Zitat Dyer CB, Ashton CM, Teasdale TA. Postoperative delirium: a review of 80 primary data-collection studies. Arch Intern Med. 1995;155:461–5.PubMedCrossRef Dyer CB, Ashton CM, Teasdale TA. Postoperative delirium: a review of 80 primary data-collection studies. Arch Intern Med. 1995;155:461–5.PubMedCrossRef
24.
Zurück zum Zitat Wang H, Wang G, Wang C, Wei Y, Wen Z, Wang C, Zhu A. The early stage formation of PI3K-AMPAR GluR2 subunit complex facilitates the long-term neuroprotection induced by propofol post-conditioning in rats. PLoS One. 2013;8(6):e65187.PubMedCentralPubMedCrossRef Wang H, Wang G, Wang C, Wei Y, Wen Z, Wang C, Zhu A. The early stage formation of PI3K-AMPAR GluR2 subunit complex facilitates the long-term neuroprotection induced by propofol post-conditioning in rats. PLoS One. 2013;8(6):e65187.PubMedCentralPubMedCrossRef
Metadaten
Titel
Incidence of postoperative delirium is high even in a population without known risk factors
verfasst von
Andrea Saporito
Evelina Sturini
Publikationsdatum
01.04.2014
Verlag
Springer Japan
Erschienen in
Journal of Anesthesia / Ausgabe 2/2014
Print ISSN: 0913-8668
Elektronische ISSN: 1438-8359
DOI
https://doi.org/10.1007/s00540-013-1706-5

Weitere Artikel der Ausgabe 2/2014

Journal of Anesthesia 2/2014 Zur Ausgabe

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.