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Postoperative Delirium and Postoperative Cognitive Dysfunction in Patients with Elective Hip or Knee Arthroplasty: A Narrative Review of the Literature. Life (Basel) 2022; 12:life12020314. [PMID: 35207601 PMCID: PMC8878498 DOI: 10.3390/life12020314] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/06/2022] [Accepted: 02/18/2022] [Indexed: 12/31/2022] Open
Abstract
Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are common complications following total knee arthroplasty (TKA) and total hip arthroplasty (THA), affecting the length of hospital stay and increasing medical complications. Although many papers have been published on both conditions in this setting, no reviews have currently been written. Thus, the purpose of our study is to summarize the current literature and provide information about POD and POCD following elective THA or TKA. Our literature search was conducted in the electronic databases PubMed and the Cochrane library. We found that POD is a common complication following elective THA or TKA, with a median incidence of 14.8%. Major risk factors include older age, cognitive impairment, dementia, preoperative (pre-op) comorbidities, substance abuse, and surgery for fracture. Diagnosis can be achieved using tools such as the confusion assessment method (CAM), which is sensitive, specific, reliable, and easy to use, for the identification of POD. Treatment consists of risk stratification and the implementation of a multiple component prevention protocol. POCD has a median incidence of 19.3% at 1 week, and 10% at 3 months. Risk factors include older age, high BMI, and cognitive impairment. Treatment consists of reversing risk factors and implementing protocols in order to preserve physiological stability. POD and POCD are common and preventable complications following TKA and THA. Risk stratification and specific interventions can lower the incidence of both syndromes. Every physician involved in the care of such patients should be informed on every aspect of these conditions in order to provide the best care for their patients.
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Ma J, Li C, Zhang W, Zhou L, Shu S, Wang S, Wang D, Chai X. Preoperative anxiety predicted the incidence of postoperative delirium in patients undergoing total hip arthroplasty: a prospective cohort study. BMC Anesthesiol 2021; 21:48. [PMID: 33579195 PMCID: PMC7879687 DOI: 10.1186/s12871-021-01271-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/08/2021] [Indexed: 12/16/2022] Open
Abstract
Background Delirium was characterized with a series of symptoms of a sudden onset of disturbances in attention, a loss in memory loss and defects in other cognitive abilities that were also appeared in the syndrome of anxiety. Even though there are overlapped clinical symptoms existed in anxiety and delirium, the relationship between anxiety and delirium was still unclear. The propose of this study was to investigated the effect of preoperative anxiety on postoperative delirium. Methods Three hundred and seventy-two adults undergoing total hip arthroplasty were enrolled from October 2019 to May 2020 in the study. The preoperative anxiety was measured with the Hospital Anxiety and Depression Scale-Anxiety (HADS-A). The participants were allocated into anxiety group (HADS-A≧7) and non-anxiety group (HADS-A < 7). The primary outcome was the incidence of the postoperative delirium assessed with the Confusion Assessment Method (CAM). The secondary outcomes were the duration and the severity of delirium evaluated with the Memorial Delirium assessment Scale (MDAS). The risks of delirium were also evaluated with logistic regression analysis. Results There were 325 patients enrolled in the end, 95 of whom met the criteria for anxiety. The incidence of delirium was 17.8% in all participants. The patients with anxiety had a higher incidence of delirium than the non-anxiety patients (25.3% vs. 14.8%, odds ratio (OR) = 0.51, 95% confidence interval (CI) = 0.92–0.29, p = 0.025). However, no significant differences were found in the duration and the severity of the delirium between the above two groups. The age, alcohol abuse, history of stroke, scores of the HADS-A, and education level were considered to be predictors of delirium. Conclusions The preoperative anxiety predicted the incidence of the postoperative delirium in total hip arthroplasty patients. The related intervention may be a good point for delirium prophylaxis. Trial registration It was registered at Chinese Clinical Trial Registry (www.chictr.org.cn) with the name of “the effect of preoperative anxiety on the postoperative cognitive function” (ChiCTR1900026054) at September 19, 2019.
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Affiliation(s)
- Jun Ma
- Anhui Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.,Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China
| | - Chuanyao Li
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China
| | - Wei Zhang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China
| | - Ling Zhou
- Anhui Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.,Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China
| | - Shuhua Shu
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China
| | - Sheng Wang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China
| | - Di Wang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China
| | - Xiaoqing Chai
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China.
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Milisen K, Van Grootven B, Hermans W, Mouton K, Al Tmimi L, Rex S, Detroyer E. Is preoperative anxiety associated with postoperative delirium in older persons undergoing cardiac surgery? Secondary data analysis of a randomized controlled trial. BMC Geriatr 2020; 20:478. [PMID: 33208091 PMCID: PMC7672929 DOI: 10.1186/s12877-020-01872-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/05/2020] [Indexed: 11/18/2022] Open
Abstract
Background Although many studies have reported numerous risk factors for postoperative delirium, data are scarce about preoperative anxiety as a risk factor. The study aimed to investigate the association between preoperative anxiety and postoperative delirium in older patients undergoing cardiac surgery. Methods Secondary data analysis of a randomized, observer-blind, controlled trial. A total of 190 patients 65 years or older and admitted to the intensive care unit and cardiac surgery unit of a university hospital scheduled for elective on-pump cardiac surgery were included. State anxiety was measured preoperatively using the Amsterdam Preoperative Anxiety and Information Scale and the Visual Analogue Scale for anxiety. Incidence of delirium was measured during the first 5 postoperative days using the Confusion Assessment Method for Intensive Care Unit (when ventilated), or the 3 Minute Diagnostic Interview for Confusion Assessment Method (when extubated) and by daily chart review. Results Preoperative state anxiety was reported by 31% of the patients and 41% had postoperative delirium. A multiple step logistic regression analyses revealed no association between preoperative anxiety and postoperative delirium. Significant risk factors for postoperative delirium were age (OR = 1.10, 95% CI (1.03–1.18)), activities of daily living (0.69, 95% CI (0.50–0.96)), diabetes mellitus (OR = 3.15, 95% CI (1.42–7.00)) and time on cardiopulmonary bypass (OR = 1.01, 95% CI (1.00 to 1.02)). Conclusions No relationship could be found between preoperative anxiety and postoperative delirium.
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Affiliation(s)
- Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Kapucijnenvoer 35/4, B-3000, Leuven, Belgium. .,Department of Geriatric Medicine, KU Leuven - University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Bastiaan Van Grootven
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Kapucijnenvoer 35/4, B-3000, Leuven, Belgium.,Research Foundation Flanders, Brussels, Belgium
| | - Wim Hermans
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Kapucijnenvoer 35/4, B-3000, Leuven, Belgium
| | - Karen Mouton
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Kapucijnenvoer 35/4, B-3000, Leuven, Belgium
| | - Layth Al Tmimi
- Department of Anesthesiology, KU Leuven - University of Leuven, University Hospitals of Leuven, Herestraat 49, B-3000, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000, Leuven, Belgium
| | - Steffen Rex
- Department of Anesthesiology, KU Leuven - University of Leuven, University Hospitals of Leuven, Herestraat 49, B-3000, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000, Leuven, Belgium
| | - Elke Detroyer
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Kapucijnenvoer 35/4, B-3000, Leuven, Belgium.,Department of Geriatric Medicine, KU Leuven - University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium
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4
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Wada S, Inoguchi H, Sadahiro R, Matsuoka YJ, Uchitomi Y, Sato T, Shimada K, Yoshimoto S, Daiko H, Shimizu K. Preoperative Anxiety as a Predictor of Delirium in Cancer Patients: A Prospective Observational Cohort Study. World J Surg 2019; 43:134-142. [PMID: 30128769 DOI: 10.1007/s00268-018-4761-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Postoperative delirium is a common and important complication in cancer patients. We need to identify patients at high risk of postoperative delirium such that it can be prevented preoperatively or in early postoperative phase. The aim of this study was to investigate whether preoperative anxiety predicted onset of postoperative delirium in cancer patients, not only in order to identify high-risk groups but also to help develop new preventive approaches. METHODS This was a prospective observational cohort study of cancer patients undergoing tumor resections. Postoperative delirium was assessed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Preoperative anxiety was evaluated with the Hospital Anxiety and Depression Scale-Anxiety (HADS-A), and we defined HADS-A > 7 as clinical anxiety. We conducted multivariate logistic regression to determine which factors were predictors of delirium. RESULTS The final analysis included 91 patients, 29 of whom met the criteria for postoperative delirium. In multivariable logistic regression, age (5-year increments; odds ratio (OR) = 1.565, 95% confidence interval (CI) = 1.057-2.317, p = 0.025) and HADS-A > 7 (OR = 4.370, 95% CI = 1.051-18.178, p = 0.043) predicted delirium onset. These variables explained 74.2% of the variance. CONCLUSIONS Preoperative anxiety strongly predicted postoperative delirium in cancer patients. Our findings suggest that preoperative anxiety may be a new target for prevention of postoperative delirium. Trial registration number This study was registered at UMIN000018980.
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Affiliation(s)
- Saho Wada
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
- Division of Health Care Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Hironobu Inoguchi
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Ryoichi Sadahiro
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
- Division of Health Care Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Yutaka J Matsuoka
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
- Division of Health Care Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Yosuke Uchitomi
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
- Division of Health Care Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
- Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Tetsufumi Sato
- Department of Anesthesia and Intensive Care, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Kazuaki Shimada
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Seichi Yoshimoto
- Department of Head and Neck Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Hiroyuki Daiko
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Ken Shimizu
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan.
- Division of Health Care Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan.
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan.
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Van Grootven B, Detroyer E, Devriendt E, Sermon A, Deschodt M, Flamaing J, Dubois C, Milisen K. Is preoperative state anxiety a risk factor for postoperative delirium among elderly hip fracture patients? Geriatr Gerontol Int 2015; 16:948-55. [PMID: 26271367 DOI: 10.1111/ggi.12581] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2015] [Indexed: 11/30/2022]
Abstract
AIM To determine if preoperative state anxiety is a risk factor for postoperative delirium in older hip fracture patients. METHODS A secondary data analysis comprising data from a prospective non-randomized trial including 86 patients with a hip fracture aged 65 years and older was carried out. State anxiety was measured preoperatively using the State-Trait Anxiety Inventory. Delirium and its severity was measured pre- and postoperatively (day 1, 3, 5, 8) by trained research nurses using the Confusion Assessment Method and Delirium Index. RESULTS A total of 24 patients (27.9%) developed delirium postoperatively. Preoperative state anxiety (State-Trait Anxiety Inventory) was not associated with postoperative delirium (rb = 0.135, P = 0.353), duration of postoperative delirium (rho = 0.038, P = 0.861) or severity of postoperative delirium (rho = 0.153, P = 0.160). Independent predictors of postoperative delirium were lower MMSE scores (OR 0.75, 95% CI 0.60-0.95, P = 0.015), osteosynthesis surgery (OR 3.66, 95% CI 1.02-13.15, P = 0,047) and lowest intraoperative diastolic blood pressure (OR 0.92, 95% CI 0.85-0.99, P = 0.031). CONCLUSION No relationship between state anxiety and postoperative delirium was found, but significant methodological hurdles were observed and discussed providing important groundwork for further research in this area. Further research should focus on reliable measurement of state anxiety in cognitively impaired older populations. Geriatr Gerontol Int 2016; 16: 948-955.
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Affiliation(s)
- Bastiaan Van Grootven
- Department of Public Health and Primary Care, Health Services and Nursing Research, KU Leuven, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Elke Detroyer
- Department of Public Health and Primary Care, Health Services and Nursing Research, KU Leuven, Leuven, Belgium.,Department of Health Service, Katholieke Hogeschool Limburg, Hasselt, Belgium
| | - Els Devriendt
- Department of Public Health and Primary Care, Health Services and Nursing Research, KU Leuven, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - An Sermon
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Traumatology, University Hospitals Leuven, Leuven, Belgium
| | - Mieke Deschodt
- Department of Public Health and Primary Care, Health Services and Nursing Research, KU Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Christophe Dubois
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Koen Milisen
- Department of Public Health and Primary Care, Health Services and Nursing Research, KU Leuven, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
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Rooney S, Qadir M, Adamis D, McCarthy G. Diagnostic and treatment practices of delirium in a general hospital. Aging Clin Exp Res 2014; 26:625-33. [PMID: 24789220 DOI: 10.1007/s40520-014-0227-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 04/08/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Despite the increase in research on delirium, it remains underdiagnosed and difficult to manage, and the outcome is poor especially in older people. AIMS To identify the clinically diagnosed rates of delirium, the possible aetiologies, to describe treatment, number and type of psychotropic medication used and to investigate the reasons for referral to a liaison psychiatric team. METHODS Retrospective study of medical records of inpatients admitted to Sligo Regional Hospital during an 18-month period. RESULTS One hundred and fifty-six files had a documentation of delirium (time prevalence 2%). Mean age of the sample was 82 years (SD = 7.2), 66 (42%) were male. Sixty-nine (44.2%) of the total sample had a previous history of dementia, and 57 (36.5%) had a previous history of delirium. In 67 (43.2%) samples, the cause was infection, while in 4, no specific cause was identified. Ninety (58%) were referred to the liaison service, but only in 26 (28.9 %), the reason for referral was "acute confusion" or "delirium". In a majority of referrals, the reason was an affective disorder more often depression. There were no significant differences between delirium subtypes and referrals (χ(2) = 3.868, df 3, p = 0.28). Examination of the amount of antipsychotics prescribed before, during and after delirium shows that there was a significant increase in use during the delirium (χ(2) = 17.512, df 8, p = 0.025) and decrease in z-hypnotics medication (zopiclone/zolpidem), (χ(2) = 20.114, df 4, p < 0.001), while benzodiazepines and antidepressants remained the same. CONCLUSIONS Delirium is often misdiagnosed and unrecognized in hospital settings; however, when identified the pharmacological management is appropriate.
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Affiliation(s)
- Siobhan Rooney
- Medical Education, Sligo Medical Academy, NUI Galway, Galway, Ireland,
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Bagri AS, Rico A, Ruiz JG. Evaluation and Management of the Elderly Patient at Risk for Postoperative Delirium. Thorac Surg Clin 2009; 19:363-76, vi. [DOI: 10.1016/j.thorsurg.2009.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bagri AS, Rico A, Ruiz JG. Evaluation and management of the elderly patient at risk for postoperative delirium. Clin Geriatr Med 2009; 24:667-86, viii. [PMID: 18984380 DOI: 10.1016/j.cger.2008.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Geriatric patients are at a high risk for the development of postoperative delirium. By recognizing predisposing and precipitating risk factors, preventive measures can be undertaken to reduce this risk. Accurate and timely diagnosis is essential, and we offer therapeutic strategies to help reduce the high morbidity and mortality of this important condition.
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Affiliation(s)
- Anita S Bagri
- Veterans Affairs Health Care System, Geriatric Research, Education and Clinical Center (11GRC), 1201 NW 16 Street, Miami, FL 33125, USA.
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Detroyer E, Dobbels F, Verfaillie E, Meyfroidt G, Sergeant P, Milisen K. Is preoperative anxiety and depression associated with onset of delirium after cardiac surgery in older patients? A prospective cohort study. J Am Geriatr Soc 2009; 56:2278-84. [PMID: 19112653 DOI: 10.1111/j.1532-5415.2008.02013.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the prevalence of preoperative anxiety and depressive symptoms and their relationship with the occurrence of postcardiac delirium and to describe the evolution of these symptoms from preoperative admission until discharge. DESIGN Descriptive, prospective, longitudinal study. SETTING The intensive care unit and two cardiac surgery units in a university hospital setting. PARTICIPANTS One hundred four patients (median age 71; 78.8% men) admitted for elective cardiac surgery. MEASUREMENTS Anxiety measured preoperatively using the State-Trait Anxiety Inventory (STAI) and the Hospital Anxiety and Depression Scale (HADS); depression using the HADS; cognitive functioning using the Mini-Mental State Examination (MMSE); delirium using the Confusion Assessment Method (CAM), the CAM for the Intensive Care Unit (CAMICU), and the Delirium Index (DI); and activities of daily living using the Katz index of activities of daily living (Katz ADL scale). MMSE, CAM/CAM-ICU, and DI were obtained on postoperative Days 1, 3, and 7. On Day 7 and at discharge, the STAI, HADS, and Katz ADL scale were repeated. RESULTS Postoperative delirium occurred in 26%; 55.8% reported preoperative state anxiety, 25.2% generalized anxiety, and 15.5% depressive symptoms, but no association was found with delirium occurrence. Based on multivariable analysis, prolonged intubation time (odds ratio (OR)51.10, CI: 1.05-1.15, P5.001) and a low intraoperative lowest body temperature (OR50.86, CI: 0.74-0.99, P5.03) were independent predictors of delirium onset. At discharge, 35.7% and 12.2% of patients reported state anxiety and generalized, and 15.3% reported depressive symptoms. CONCLUSION Despite the high prevalence of preoperative anxiety and depressive symptoms in older patients with cardiac surgery, no association was found with postoperative delirium.
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Affiliation(s)
- Elke Detroyer
- Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium
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10
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Kudoh A, Takase H, Takahira Y, Takazawa T. Postoperative Confusion Increases in Elderly Long-Term Benzodiazepine Users. Anesth Analg 2004; 99:1674-1678. [PMID: 15562052 DOI: 10.1213/01.ane.0000136845.24802.19] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We investigated the relationship between postoperative confusion and duration of benzodiazepine exposure, preoperative anxiety, depressive state, and cognitive function in elderly patients regularly taking benzodiazepines. We studied 328 patients ranging in age from 65 to 80 yr who underwent orthopedic surgery. Information on benzodiazepine use was obtained by face-to-face interview and visual assessment of the patient's medicine chest. Postoperative confusion was assessed by using a confusion-assessment method. The patients were divided into two groups: those who regularly took benzodiazepines and those who did not. Fifty-seven (17%) of 328 patients were treated with benzodiazepines. There were no significant differences in preoperative Mini-Mental State (MMS) scores, anxiety scores, or depression scores between benzodiazepine users and nonusers. Postoperative confusion occurred in 15 (26%) of 57 benzodiazepine users and in 34 (13%) of 271 nonusers (P < 0.01). The patients who had a score <23 on the MMS were 5 (9%) of 57 benzodiazepine users and 8 (3%) of 271 nonusers (P < 0.05). Postoperative confusion occurred in 13 (35%) of 37 long-term benzodiazepine users (daily use for >1 yr) and in 2 (10%) of 20 short-term users (daily use for <1 yr). The incidence of postoperative confusion was significantly more frequent in long-term than in short-term benzodiazepine users or nonusers of benzodiazepines. The patients who developed a score <23 on the MMS were 5 (14%) of 37 long-term benzodiazepine users and 0 (0%) of 20 short-term benzodiazepine users. In conclusion, the incidence of postoperative confusion was significantly more frequent in long-term benzodiazepine users.
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Affiliation(s)
- Akira Kudoh
- Department of Anesthesiology, Hirosaki National Hospital, Hirosaki, Aomori, Japan
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11
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Abstract
OBJECTIVE To critically evaluate the interpretation of the findings reported in the peer-reviewed literature concerning the association of state and trait anxiety with surgical recovery and response to surgery. METHODS The Social Science Citation Index (SSCI), Science Citation Index (SCI), Medline and Psychological Abstracts (PsycInfo) databases were searched for studies published since 1981. Reference lists from previous reviews were also searched for additional references. Studies that were not in the public domain were not searched for. RESULTS Twenty-seven studies were identified by the search strategy, met the inclusion criteria and contributed to the review. CONCLUSIONS Associations between preoperative measures of anxiety and postoperative mood and pain have been consistently reported. Associations with regard to other recovery variables are less consistent. The existing evidence does not rule out an interpretation of the results as reflecting consistent self-reporting bias rather than causal association.
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Affiliation(s)
- M R Munafò
- University of Southampton, Southampton, UK.
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12
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Kaneko T, Takahashi S, Naka T, Hirooka Y, Inoue Y, Kaibara N. Postoperative delirium following gastrointestinal surgery in elderly patients. Surg Today 1997; 27:107-11. [PMID: 9017985 DOI: 10.1007/bf02385897] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Postoperative delirium is a common complication which can interfere with the surgical treatment and recovery of elderly patients, and is likely to prolong their hospitalization. Unfortunately, there is as yet no completely effective pre- and/or post operative technique of patient care to reduce or prevent postoperative delirium. In this study, 36 patients aged over 70 years undergoing gastrointestinal operations were assessed to examine the relationships between the preoperative cognitive state, the postoperative sleep cycle, and the occurrence of postoperative delirium. All patients were evaluated preoperatively using the revised version of Hasegawa's dementia scale (HDS-R). We correlated those test results and assessed the sleep-wakefulness disturbance postoperatively, to obtain a clinical DMS-III diagnosis of postoperative delirium. The incidence of postoperative delirium was 17% (6/36). The patients who developed postoperative delirium demonstrated preoperative cognitive impairment, and had a short sleep period during the night and a long sleep period during the day. Postoperatively, these results suggest that HDS-R is a useful method of evaluating preoperative cognition in elderly patients. Considering that sleep deficiency is likely to predispose elderly patients to postoperative delirium, techniques to prevent sleep deprivation may be of considerable value in minimizing the incidence of postoperative delirium.
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Affiliation(s)
- T Kaneko
- First Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
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13
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Smith MJ, Breitbart WS, Platt MM. A critique of instruments and methods to detect, diagnose, and rate delirium. J Pain Symptom Manage 1995; 10:35-77. [PMID: 7714346 DOI: 10.1016/0885-3924(94)00066-t] [Citation(s) in RCA: 139] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This document reviews existing instruments for evaluation of delirium. Instruments have been grouped into four categories: tests that screen for cognitive impairment, delirium diagnostic instruments, delirium-specific numerical rating scales, and laboratory and paraclinical exams. Analysis of instruments was based on comparison of their psychometric properties as well as subjective judgment. Guidelines are suggested for choosing the appropriate instrument according to the type of clinical evaluation or delirium research envisaged. Important factors in choosing an instrument, besides the appropriateness of its psychometric characteristics, include administration time constraints, level of rater expertise, and patient capabilities. By familiarizing investigators with the variety of evaluation instruments available, this work should permit more appropriate instrument selection in future studies on delirium.
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Affiliation(s)
- M J Smith
- Psychiatry Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Horne DJ, Vatmanidis P, Careri A. Preparing patients for invasive medical and surgical procedures. 1: Adding behavioral and cognitive interventions. Behav Med 1994; 20:5-13. [PMID: 7919635 DOI: 10.1080/08964289.1994.9934610] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The authors of three related articles look at various aspects of preparing adult and child patients psychologically for invasive surgical procedures. The first article is a review of the literature in the field, primarily from the last 30 years. Researchers have examined anxiety and coping mechanisms, patient-practitioner relationships, medical phobias, and the effectiveness of different types of psychological intervention. In the second article, the authors offer practical suggestions for implementing preparatory psychological interventions, describing effective communication techniques such as active listening, role plays, imaging, modeling, and progressive relaxation. In the final article in the series, the author considers policy, practice, and educational implications of the use of behavioral and cognitive interventions for patients, medical practitioners, and healthcare planners.
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Affiliation(s)
- D J Horne
- Royal Melbourne Hospital Medical Psychology Unit, School of Behavioural Science, University of Melbourne, Parkville, Victoria, Australia
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Cryns AG, Gorey KM, Goldstein MZ. Effects of surgery on the mental status of older persons. A meta-analytic review. J Geriatr Psychiatry Neurol 1990; 3:184-91. [PMID: 2149929 DOI: 10.1177/089198879000300402] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The data bases of 18 empirical studies were combined into one comprehensive data set and subjected to meta-analysis. The following trends were observed: (1) surgery has a significantly decompensating impact on the mental status of older persons, and the average effect size observed is modest (r = .37); (2) for all mental status measures included in the review (cognition, delirium and affect), effect size appears to be significantly moderated by patient age; (3) patient sex may be predictive of the kind of mental impairment that is most likely to occur within an older surgery population, with women manifesting a greater affinity for delirious and men for cognitive decompensation; (4) most existing research within this domain of study is either purely descriptive or anecdotal: of 46 studies reviewed, only 18, or 39.1% of the total published output, were of sufficient methodologic rigor to allow for scientifically valid effect-size computations. The implications of these findings for future research are discussed.
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Affiliation(s)
- A G Cryns
- Multidisciplinary Center on Aging, School of Medicine, State University of New York, Buffalo 14214
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