Incidence and Risk Factors of Postoperative Delirium

Česká verzia

Authors: A. Mitášová ¹; L. Mitáš ²; I. Urbánek ¹; L. Ryba ³; I. Hanke ²; M. Ruber ⁴; R. Michalčáková ¹; M. Košťálováihash2 ^{1,5 1,5}
Authors place of work: Neurologická klinika LF MU a FN Brno ¹; Chirurgická klinika LF MU a FN Brno ²; Ortopedická klinika LF MU a FN Brno ³; Klinika úrazové chirurgie LF MU a FN Brno ⁴; CEITEC – Středoevropský technologický institut MU, Brno ⁵
Published in the journal: Cesk Slov Neurol N 2012; 75/108(5): 574-580
Category: Original Paper

Summary

Introduction:
Postoperative delirium (POD) is a frequent complication of a surgery with negative effect on postoperative treatment and rehabilitation, duration of hospitalization and long-term prognosis. The aim was to assess the incidence and evaluate importance of risk factors of POD in patients who underwent elective spine and pulmonary surgery and emergency hip fracture surgery, and to compare the incidence of POD with that of post-stroke delirium.

Patients and methods:
Development of POD was evaluated prospectively using the Czech version of the CAM-ICU – a screening test for detection of delirium and the DSM-IV criteria for delirium in a group of 94 patients (54 women; age: 69; 32–99 yrs – median; range) who had a surgery for symptomatic lumbar spine stenosis (23 patients – A1), pulmonary neoplasm (31 patients – A2) or a hip fracture (40 patients – B). The incidence of POD was compared with that of delirium in age- and sex-matched group of stroke patients (n = 94; 54 women; age: 70; 45–91 yrs – median; range). Significance of predisposing and precipitating perioperative risk factors for delirium was analysed.

Results:
The incidence of POD was 7.4%; 3.7% in elective surgery patients and 12.5% in emergency hip fracture surgery patients. The authors explain low incidence of POD by low prevalence of preoperative cognitive deficit in elective surgery subgroup (A1 + A2) – 7.4% compared to 17.5% in group B and 22.3% in stroke patients. The low incidence of perioperative complications (11.7%) was the other possible factor influencing low incidence of POD. However, no significant risk factor for POD was identified, possibly due to low incidence of POD. The incidence of post-stroke delirium was significantly higher compared to that of POD (33.0%; p <0.001).

Conclusions:
The incidence of POD in elective surgery patients remains low as a result of mini-invasive surgery, considerate anaesthesia and effective management and prevention of perioperative complications. On the contrary, the incidence of post-stroke delirium is significantly higher, thus confirming the role of primary brain involvement as an independent precipitating risk factor for delirium.

Key words:
postoperative delirium – risk factors – incidence

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