Clinical research studyIndependent Vascular and Cognitive Risk Factors for Postoperative Delirium
Section snippets
Recruitment
The International Study of Postoperative Cognitive Dysfunction (ISPOCD) recruited 1218 patients aged 60 years or more at 13 hospitals in 8 countries (Denmark, France, Germany, Great Britain, Greece, The Netherlands, Spain, and United States) undergoing noncardiac surgery between November 1, 1994, and May 31, 1996. This study has been described in detail.16 Eligible surgical procedures included orthopedic, abdominal, thoracic, vascular, or other noncardiac procedures with anticipated general
Results
The characteristics of the sample are summarized in Table 1. The resultant sample had a mean age of 68.9 (SD ± 5.9) years and a slight preponderance of males (53%). The mean preoperative MMSE score was 27.8 (±1.6). The cohort included subjects with vascular risk factors, such as a history of tobacco use in 685 (59%), diabetes in 86 (7%), hypertension in 398 (34%), previous myocardial infarction in 102 (9%), congestive heart failure in 132 (11%), and angina pectoris in 100 (9%). The sample
Discussion
In this study assessing preoperative risk factors for delirium in patients undergoing noncardiac surgery, tobacco exposure, the need for vascular surgery, and mildly impaired cognitive performance on 2 measures of executive function contributed independently to delirium risk.
Many studies have identified individual vascular risk factors for delirium,1, 3, 9, 10 but our study is unique in examining multiple vascular risk factors in a broad spectrum of noncardiac surgery patients. We identified
Conclusions
Delirium has been well recognized to pose a major risk in postoperative patients and is associated with substantial morbidity and mortality. The identification of vascular risk factors and mildly impaired cognitive performance as independent risk factors for delirium holds substantial clinical implications. Use of these risk factors will help to identify patients at high risk for postoperative delirium, who may benefit from interventions to prevent delirium and its attendant complications.
Acknowledgments
We thank the ISPOCD group for access to their data.
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These data were collected as a result of funding from multiple sources.16 The authors were supported in part by National Institute of Health grants: 5 K12 AG00294-18 (Dr Rudolph), 5 P60 AG08812-14 (Drs Marcantonio and Jones), RO1AG018772-04 (Dr Silverstein), and R21AG025193 and K24AG000949 (Dr Inouye).
- 1
Dr Rasmussen is supported in part by ongoing research studies on postoperative complications.
- 2
Dr Marcantonio is a Paul Beeson Physician Faculty Scholar in Aging Research.