Risk factors for postoperative delirium after elective major abdominal surgery in elderly patients: A cohort study
| Autor: | Ties L. Janssen, Ewout W. Steyerberg, L. van der Laan, Paul D. Gobardhan, G.H. Ho, Miriam C. Faes, J. H. Wijsman |
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| Přispěvatelé: | Public Health |
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Prehabilitation 030230 surgery Cohort Studies 03 medical and health sciences 0302 clinical medicine Postoperative Complications Risk Factors Internal medicine Abdomen medicine Humans Risk factor Aged Aged 80 and over business.industry Delirium General Medicine medicine.disease Comorbidity Abdominal aortic aneurysm Elective Surgical Procedures 030220 oncology & carcinogenesis Surgery Female medicine.symptom Complication business Colorectal Neoplasms Cohort study Abdominal surgery Aortic Aneurysm Abdominal |
| Zdroj: | International Journal of Surgery, 71, 29-35. Elsevier |
| ISSN: | 1743-9191 |
| Popis: | Background Prehabilitation programs have recently been suggested as potentially able to lower the incidence of delirium in elderly patients undergoing major abdominal surgery. For these prehabilitation programs to become successful, it is essential to identify those patients who are most likely to develop a delirium. Material and methods A single-centre cohort study was conducted. Inclusion criteria were: age ≥70 years and scheduled for abdominal surgery for colorectal cancer or an abdominal aortic aneurysm between January 2013 and June 2018. Baseline patient, surgical, anaesthesiologic and haematological characteristics were collected. A risk factor analysis was conducted, with postoperative delirium as primary outcome, by performing a multivariable logistic regression analysis. Results In this study, 627 patients were included, of whom 64 (10%) developed a delirium. Variables that differed significantly between delirious and non-delirious patients were age, burden of comorbidity, renal impairment, hypertension, cognitive impairment, history of delirium, physical and nutritional impairment, open surgery, preoperative anaemia and erythrocyte transfusion. After multivariable logistic regression analysis, risk factors for postoperative delirium after major abdominal surgery were renal impairment (OR 2.2; 95%CI 1.2–4.3), cognitive impairment (OR 4.1; 95%CI 1.8–9.2), an ASA score ≥ 3 (OR 2.0; 95% CI 1.0–3.9), being an active smoker (OR 2.7; 95%CI 1.3–5.8), ICU admission (OR 7.1; 95%CI 3.5–14.3), erythrocyte transfusion (OR 2.4; 95%CI 1.2–4.9) and a diagnosis of colorectal cancer (CRC); (OR 4.0; 95% CI 1.7–9.6). Prehabilitation had a protective effect (OR 0.5; 95% CI 0.3–0.9). Conclusion Postoperative delirium is a frequent complication after major abdominal surgery in the elderly, especially in octogenarians and after open procedures. Renal impairment, cognitive impairment, being an active smoker, ICU admission, erythrocyte transfusion and a diagnosis of CRC are important risk factors for the development of delirium. Prehabilitation lowers the risk of developing a delirium. |
| Databáze: | OpenAIRE |
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