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Sugiyama M, Nishijima TF, Kasagi Y, Uehara H, Yoshida D, Nagai T, Koga N, Kimura Y, Morita M, Toh Y. Impact of comprehensive geriatric assessment on treatment strategies and complications in older adults with colorectal cancer considering surgery. J Surg Oncol 2024. [PMID: 38881197 DOI: 10.1002/jso.27736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/01/2024] [Accepted: 06/06/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND AND OBJECTIVES This study aimed to assess the effectiveness of Comprehensive Geriatric Assessment (CGA) in customizing care for elderly cancer patients, specifically focusing on colorectal cancer. The research compared treatment strategies and outcomes in older adults considered for surgery before and after the initiation of a Geriatric Oncology Service (GOS). METHODS Conducting a comparative study, two cohorts of consecutive colorectal cancer patients aged 75 or older were examined: the control group (n = 156) and the GOS group (n = 158). Upon the treating surgeon's GOS consultation request, a geriatrician and an oncologist performed CGA, guiding treatment decisions and perioperative interventions. Postoperative complications were compared using propensity score matching (PSM). RESULTS In the GOS group, 91% (n = 116) underwent CGA consultations, influencing decisions to forego surgery in 12 patients. After PSM for surgical cases (controls n = 146, GOS n = 146), each group comprised 128 patients. Perioperative physical therapy and pharmacist referrals were more frequent in the GOS group. The GOS group exhibited a significantly lower incidence of postoperative complications (22%) compared to the control group (33%) (p = 0.0496). CONCLUSION Patients undergoing colorectal surgery post-GOS implementation experienced a notable reduction in postoperative complications, highlighting the positive impact of personalized geriatric assessment on surgical outcomes in the elderly.
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Affiliation(s)
- Masahiko Sugiyama
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Tomohiro F Nishijima
- Geriatric Oncology Service, NHO Kyushu Cancer Center, Fukuoka, Japan
- Department of Gastrointestinal and Medical Oncology, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Yuta Kasagi
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Hideo Uehara
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, Fukuoka, Japan
- Department of Gastrointestinal Surgery, NHO Kyushu Medical Center, Fukuoka, Japan
| | - Daisuke Yoshida
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, Fukuoka, Japan
- Department of Gastrointestinal Surgery, Oita, Japan
| | - Taichiro Nagai
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Naomichi Koga
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Yasue Kimura
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Masaru Morita
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Yasushi Toh
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, Fukuoka, Japan
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Girombelli A, Vetrone F, Saglietti F, Galimberti A, Fusaro A, Umbrello M, Pezzi A. Pericapsular nerve group block and lateral femoral cutaneous nerve block versus fascia iliaca block for multimodal analgesia after total hip replacement surgery: A retrospective analysis. Saudi J Anaesth 2024; 18:218-223. [PMID: 38654885 PMCID: PMC11033891 DOI: 10.4103/sja.sja_881_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 04/26/2024] Open
Abstract
Background Optimal pain control with limited muscle weakness is paramount for a swift initiation of physical therapy and early discharge. Fascia iliaca compartment block (FICB) has been recommended since it offers good pain control with a low risk of motor block. Pericapsular nerve group (PENG) block with lateral femoral cutaneous block (LFCN) has been proposed as an effective alternative to FICB that offers better pain control with a considerably lower risk of motor block. We aimed to compare the aforementioned blocks and determine which one yielded the lowest numeric rating scale (NRS) score. Methods We designed a retrospective analysis of patients undergoing elective total hip arthroplasty. The primary outcome was the NRS score at 6, 12, and 24 hours. The secondary outcomes were total opioid consumption, time to first PRN opioid, and time to first postoperative ambulation. Results 52 patients were recruited, (13 PENG plus LFCN, 39 FICB). PENG plus LCFN resulted in a lower NRS at all three-time points (mean difference and 95%CI at 6 h 0.378 [-0.483; 1.240], at 12 h 0.336 [-0.378; 1.050], and at 24 h 0.464 [0.013; 0.914] P = 0.02). Moreover, less PRN opioids were requested in the PENG plus LCFN vs. FICB group (0 [0;7.5] vs 60 [15;80] milligrams of morphine equivalents, P = 0.001). No delay in the first ambulation or initiation of physical rehabilitation was reported in either group. Conclusions PENG plus LCFN seems to offer better pain control and lead to less PRN opioids. Neither block hindered physical therapy nor ambulation. These results need to be confirmed with a larger prospective and randomized study.
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Affiliation(s)
- Alessandro Girombelli
- Department of Anesthesiology, Division of Anesthesiology, Intensive Care and Emergency Medicine, EOC, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Francesco Vetrone
- Department of Surgery and Emergency, Anesthesiology and Critical Care Medicine, ASST Nord Milano, Bassini Hospital, Cinisello Balsamo (MI), Italy
| | - Francesco Saglietti
- Department of Anesthesiology and Critical Care Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo (CN), Italy
| | - Andrea Galimberti
- Department of Surgery and Emergency, Anesthesiology and Critical Care Medicine, ASST Nord Milano, Bassini Hospital, Cinisello Balsamo (MI), Italy
| | - Andrea Fusaro
- Orthopedic Surgery Division, ASST Nord Milano, Ospedale Bassini, Cinisello Balsamo (MI), Italy
| | - Michele Umbrello
- Anesthesiology and Critical Care Medicine, SC Anestesia e Rianimazione II, ASST Santi Paolo e Carlo – Polo Universitario, Ospedale San Carlo Borromeo, Milano (MI), Italy
| | - Angelo Pezzi
- Department of Surgery and Emergency, Anesthesiology and Critical Care Medicine, ASST Nord Milano, Bassini Hospital, Cinisello Balsamo (MI), Italy
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Frost SA, Brennan K, Sanchez D, Lynch J, Hedges S, Hou YC, El Sayfe M, Shunker SA, Bogdanovski T, Hunt L, Alexandrou E, Rolls K, Chroinin DN, Aneman A. Frailty in the prediction of delirium in the intensive care unit: A secondary analysis of the Deli study. Acta Anaesthesiol Scand 2024; 68:214-225. [PMID: 37903745 DOI: 10.1111/aas.14343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Delirium is an acute disorder of attention and cognition with an incidence of up to 70% in the adult intensive care setting. Due to the association with significantly increased morbidity and mortality, it is important to identify who is at the greatest risk of an acute episode of delirium while being cared for in the intensive care. The objective of this study was to determine the ability of the cumulative deficit frailty index and clinical frailty scale to predict an acute episode of delirium among adults admitted to the intensive care. METHODS This study is a secondary analysis of the Deli intervention study, a hybrid stepped-wedge cluster randomized controlled trial to assess the effectiveness of a nurse-led intervention to reduce the incidence and duration of delirium among adults admitted to the four adult intensive care units in the south-west of Sydney, Australia. Important predictors of delirium were identified using a bootstrap approach and the absolute risks, based on the cumulative deficit frailty index and the clinical frailty scale are presented. RESULTS During the 10-mth data collection period (May 2019 and February 2020) 2566 patients were included in the study. Both the cumulative deficit frailty index and the clinical frailty scale on admission, plus age, sex, and APACHE III (AP III) score were able to discriminate between patients who did and did not experience an acute episode of delirium while in the intensive care, with AUC of 0.701 and 0.703 (moderate discriminatory ability), respectively. The addition of a frailty index to a prediction model based on age, sex, and APACHE III score, resulted in net reclassified of risk. Nomograms to individualize the absolute risk of delirium using these predictors are also presented. CONCLUSION We have been able to show that both the cumulative deficits frailty index and clinical frailty scale predict an acute episode of delirium among adults admitted to intensive care.
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Affiliation(s)
- Steven A Frost
- Critical Care Research in Collaboration and Evidence Translation, Sydney, Australia
- Department of Intensive Care, Liverpool Hospital, Sydney, Australia
- School of Nursing, Western Sydney University, Sydney, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
- South Western Sydney Nursing and Midwifery Research Alliance, Ingham Institute of Applied Medical Research, Sydney, Australia
- School of Nursing, University of Wollongong, Wollongong, Australia
| | - Kathleen Brennan
- Critical Care Research in Collaboration and Evidence Translation, Sydney, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
- Department of Intensive Care, Bankstown-Lidcombe Hospital, Sydney, Australia
| | - David Sanchez
- Critical Care Research in Collaboration and Evidence Translation, Sydney, Australia
- Department of Intensive Care, Campbelltown-Camden Hospital, Sydney, Australia
| | - Joan Lynch
- Critical Care Research in Collaboration and Evidence Translation, Sydney, Australia
- Department of Intensive Care, Liverpool Hospital, Sydney, Australia
- School of Nursing, Western Sydney University, Sydney, Australia
| | - Sonja Hedges
- Critical Care Research in Collaboration and Evidence Translation, Sydney, Australia
- Department of Intensive Care, Bankstown-Lidcombe Hospital, Sydney, Australia
| | - Yu Chin Hou
- Critical Care Research in Collaboration and Evidence Translation, Sydney, Australia
- Department of Intensive Care, Liverpool Hospital, Sydney, Australia
- School of Nursing, Western Sydney University, Sydney, Australia
| | - Masar El Sayfe
- Department of Intensive Care, Fairfield Hospital, Sydney, Australia
| | | | - Tony Bogdanovski
- Department of Intensive Care, Liverpool Hospital, Sydney, Australia
| | - Leanne Hunt
- Critical Care Research in Collaboration and Evidence Translation, Sydney, Australia
- Department of Intensive Care, Liverpool Hospital, Sydney, Australia
- School of Nursing, Western Sydney University, Sydney, Australia
| | - Evan Alexandrou
- Critical Care Research in Collaboration and Evidence Translation, Sydney, Australia
- Department of Intensive Care, Liverpool Hospital, Sydney, Australia
- School of Nursing, Western Sydney University, Sydney, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Kaye Rolls
- School of Nursing, University of Wollongong, Wollongong, Australia
| | - Danielle Ni Chroinin
- Department of Intensive Care, Liverpool Hospital, Sydney, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Anders Aneman
- Department of Intensive Care, Liverpool Hospital, Sydney, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
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Hunter CL, Ni Chroinin D, McEvoy L, Chuan A. Poorer outcomes in patients with early postoperative delirium: 120-day follow-up of the Delirium Reduction by Analgesia Management in Hip Fracture (DRAM-HF) study. Australas J Ageing 2023; 42:736-741. [PMID: 37708340 DOI: 10.1111/ajag.13239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/25/2023] [Accepted: 08/15/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVES The Delirium Reduction by Analgesia Management-Hip Fracture (DRAM-HF) model of care, which incorporated a multicomponent intervention focussing on perioperative analgesia and medication optimisation, was associated with reduced Day 3 postoperative delirium (POD) amongst hip fracture patients. We investigated whether this effect was seen at 120 days postoperatively. METHODS We assessed 120-day outcomes in all patients who were included in the DRAM-HF study, by telephone, supplemented by electronic medical records, to include death (primary outcome), residential aged care facility (RACF) residence, patient/carer-reported frailty, hospital readmission and new dementia diagnosis. RESULTS Amongst 300 patients (mean age 81.1, 70% female, none lost to follow-up), by 120 days, 8% (n = 24) had died; 25% of survivors (n = 68/276) were RACF residents. Twenty-two per cent were readmitted (n = 61/281). A new dementia diagnosis was reported by 6% (n = 17/281). Intervention status in the DRAM-HF trial (intervention/control) was not associated with death by 120 days (OR 0.83, 95% CI 0.36-1.93, p = 0.67) or other outcomes assessed. POD was independently associated with 120-day death (aOR 3.3, 95% CI 1.2-9.2, p = 0.02), RACF residence (aOR 2.2, 95% CI 1.1-4.7, p = 0.03) and patient/carer-reported frailty (aOR 5.6, 95% CI 1.0-30.7, p = 0.05), but not readmission (p = 0.21) or new diagnosis of dementia (p = 0.08). CONCLUSIONS In this cohort, while the DRAM-HF bundle of care did not influence 120-day outcomes, patients who experienced POD had poorer clinical outcomes 120-day postfracture. Given that delirium was associated with death, RACF residence and frailty, models of care which have the potential to reduce POD may have benefits beyond the acute admission, and further investigation is needed.
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Affiliation(s)
- Carol Lu Hunter
- Department of Geriatric Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Danielle Ni Chroinin
- Department of Geriatric Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Lynette McEvoy
- Department of Orthopaedic Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Alwin Chuan
- Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Department of Anaesthetics, Liverpool Hospital, Sydney, New South Wales, Australia
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Wang Y, Zhu H, Xu F, Ding Y, Zhao S, Chen X. The effect of anesthetic depth on postoperative delirium in older adults: a systematic review and meta-analysis. BMC Geriatr 2023; 23:719. [PMID: 37932677 PMCID: PMC10629190 DOI: 10.1186/s12877-023-04432-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Postoperative delirium (POD) is an important complication for older patients and recent randomised controlled trials have showed a conflicting result of the effect of deep and light anesthesia. METHODS We included randomised controlled trials including older adults that evaluated the effect of anesthetic depth on postoperative delirium from PubMed, Embase, Web of Science and Cochrane Library. We considered deep anesthesia as observer's assessment of the alertness/ sedation scale (OAA/S) of 0-2 or targeted bispectral (BIS) < 45 and the light anesthesia was considered OAA/S 3-5 or targeted BIS > 50. The primary outcome was incidence of POD within 7 days after surgery. And the secondary outcomes were mortality and cognitive function 3 months or more after surgery. The quality of evidence was assessed via the grading of recommendations assessment, development, and evaluation approach. RESULTS We included 6 studies represented 7736 patients aged 60 years and older. We observed that the deep anesthesia would not increase incidence of POD when compared with the light anesthesia when 4 related studies were pooled (OR, 1.40; 95% CI, 0.63-3.08, P = 0.41, I2 = 82%, low certainty). And no significant was found in mortality (OR, 1.12; 95% CI, 0.93-1.35, P = 0.23, I2 = 0%, high certainty) and cognitive function (OR, 1.13; 95% CI, 0.67-1.91, P = 0.64, I2 = 13%, high certainty) 3 months or more after surgery between deep anesthesia and light anesthesia. CONCLUSIONS Low-quality evidence suggests that light general anesthesia was not associated with lower POD incidence than deep general anesthesia. And High-quality evidence showed that anesthetic depth did not affect the long-term mortality and cognitive function. SYSTEMATIC REVIEW REGISTRATION CRD42022300829 (PROSPERO).
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Affiliation(s)
- Yafeng Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation, Huazhong University of Science and Technology, Ministry of Education, Wuhan, China
| | - Hongyu Zhu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation, Huazhong University of Science and Technology, Ministry of Education, Wuhan, China
- Department of Anesthesiology, Linhe District People's Hospital, Bayannur City, 015000, China
| | - Feng Xu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation, Huazhong University of Science and Technology, Ministry of Education, Wuhan, China
| | - Yuanyuan Ding
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation, Huazhong University of Science and Technology, Ministry of Education, Wuhan, China
| | - Shuai Zhao
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation, Huazhong University of Science and Technology, Ministry of Education, Wuhan, China
| | - Xiangdong Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Key Laboratory of Anesthesiology and Resuscitation, Huazhong University of Science and Technology, Ministry of Education, Wuhan, China.
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Labaste F, Delort F, Ferré F, Bounes F, Reina N, Valet P, Dray C, Minville V. Postoperative delirium is a risk factor of institutionalization after hip fracture: an observational cohort study. Front Med (Lausanne) 2023; 10:1165734. [PMID: 37649978 PMCID: PMC10464946 DOI: 10.3389/fmed.2023.1165734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/10/2023] [Indexed: 09/01/2023] Open
Abstract
Introduction Hip fracture is a common clinical problem in geriatric patients often associated with poor postoperative outcomes. Postoperative delirium (POD) and postoperative neurocognitive disorders (NCDs) are particularly frequent. The consequences of these disorders on postoperative recovery and autonomy are not fully described. The aim of this study was to determine the role of POD and NCDs on the need for institutionalization at 3 months after hip fracture surgery. Method A population-based prospective cohort study was conducted on hip fracture patients between March 2016 and March 2018. The baseline interview, which included a Mini-Mental State Examination (MMSE), was conducted in the hospital after admission for hip fracture. NCDs were appreciated by MMSE scoring evolution (difference between preoperative MMSE and MMSE at day 5 >2 points). POD was evaluated using the Confusion Assessment Method. The primary endpoint was the rate of new institutionalization at 3 months. We used a multivariate analysis to assess the risk of new institutionalization. Results A total of 63 patients were included. Thirteen patients (20.6%) were newly institutionalized at 3 months. Two factors were significantly associated with the risk of postoperative institutionalization at 3 months: POD (OR = 5.23; 95% CI 1.1-27.04; p = 0.04) and IADL evolution (OR = 1.8; 95% CI 1.23-2.74; p = 0.003). Conclusion Only POD but not NCDs was associated with the risk of dependency and institutionalization after hip fracture surgery. The prevention of POD appears to be essential for improving patient outcomes and optimizing the potential for returning home.
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Affiliation(s)
- François Labaste
- Anesthesiology and Intensive Care Department CHU Toulouse, Toulouse, France
- Institut RESTORE UMR 1301-Inserm 5070-CNRS EFS Univ. P. Sabatier, Toulouse, France
| | - François Delort
- Anesthesiology and Intensive Care Department CHU Toulouse, Toulouse, France
| | - Fabrice Ferré
- Anesthesiology and Intensive Care Department CHU Toulouse, Toulouse, France
| | - Fanny Bounes
- Anesthesiology and Intensive Care Department CHU Toulouse, Toulouse, France
| | - Nicolas Reina
- Orthopedic Surgery Department, CHU Toulouse, Toulouse, France
| | - Philippe Valet
- Institut RESTORE UMR 1301-Inserm 5070-CNRS EFS Univ. P. Sabatier, Toulouse, France
| | - Cédric Dray
- Institut RESTORE UMR 1301-Inserm 5070-CNRS EFS Univ. P. Sabatier, Toulouse, France
| | - Vincent Minville
- Anesthesiology and Intensive Care Department CHU Toulouse, Toulouse, France
- Institut RESTORE UMR 1301-Inserm 5070-CNRS EFS Univ. P. Sabatier, Toulouse, France
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Wang N, Xiao H, Lu H, Chen K, Zhang S, Liu F, Zhang N, Zhang H, Chen S, Xu X. Effect of PI3K/AKT/mTOR signaling pathway-based clustered nursing care combined with papaverine injection on vascular inflammation and vascular crisis after replantation of severed fingers. Mol Cell Biochem 2023:10.1007/s11010-023-04796-y. [PMID: 37490177 DOI: 10.1007/s11010-023-04796-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/18/2023] [Indexed: 07/26/2023]
Abstract
This research aimed to investigate the effect of PI3K (phosphatidylinositol 3-kinase)/AKT (protein kinase B)/mTOR (mammalian target protein of rapamycin) signaling pathway-based clustering care combined with papaverine injection on vascular inflammation and vascular crisis after finger amputation and replantation. 100 patients admitted in General Hospital of Ningxia Medical University from April 2022 to December 2022 for replantation of severed fingers were selected and divided into a control group (n = 50) and an observation group (n = 50) using the randomized grouping principle. The control group received a papaverine injection and general nursing care, the observation group received a papaverine injection and clustered care. The pain score; constipation incidence; replantation finger survival rate; physician, nurse, and patient satisfaction; serum inflammatory factors; vascular crisis parameters; and occurrence of adverse reactions were compared between the two patient groups. Enzyme-linked immunosorbent assay was performed to detect PI3K, AKT, and mTOR protein concentrations in the venous blood of the two groups, and statistical analysis of the data was performed. On postoperative day 7, the pain score and incidence of constipation in the observation group were lower than those in the control group (P < 0.05); the survival rate of reimplanted fingers in the observation group was 88.00%, which was higher than that in the control group 80.00% (P < 0.05); the satisfaction of doctors, nurses, and patients in the observation group was higher than that in the control group; the concentrations of interleukin-1 (IL-1), tumor necrosis factor (TNF-α), blood flow resistance index (RI), and arterial pulsatility index (PI) in the observation group were lower than those in the control group, while the concentration of interleukin-10 (IL-10), vascular diameter, and Vm (mean blood flow velocity) were higher in the observation group than those in the control group; the differences were statistically significant (P < 0.05). The difference in the incidence of adverse reactions between the two groups was not statistically significant (P > 0.05). The concentrations of PI3K, AKT, and mTOR proteins in the observation group were higher than those in the control group (P < 0.05). The concentrations of PI3K, AKT, and mTOR proteins in the observation group were higher than those in the control group (P < 0.05). Overall, these findings suggest that clustered care combined with papaverine injection reduces vascular inflammatory symptoms and vascular crisis in the treatment of severed finger replantation through the PI3K/AKT/mTOR signaling pathway.
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Affiliation(s)
- Na Wang
- Department of Hand, Foot and Ankle Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Haijing Xiao
- Outpatient Department of the People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Hongyan Lu
- Nursing Department, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan, 750004, Ningxia, China.
| | - Kai Chen
- Department of Hand, Foot and Ankle Surgery, General Hospital of Ningxia Medical University, Yinchuan, China.
| | - Shuhong Zhang
- Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Fei Liu
- Department of Hand, Foot and Ankle Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Ning Zhang
- Department of Hand, Foot and Ankle Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Haijing Zhang
- Department of Hand, Foot and Ankle Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Siyu Chen
- Department of Hand, Foot and Ankle Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xiaoli Xu
- Department of Stomatology, General Hospital of Ningxia Medical University, Yinchuan, China
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Dodsworth BT, Reeve K, Falco L, Hueting T, Sadeghirad B, Mbuagbaw L, Goettel N, Schmutz Gelsomino N. Development and validation of an international preoperative risk assessment model for postoperative delirium. Age Ageing 2023; 52:7192246. [PMID: 37290122 DOI: 10.1093/ageing/afad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Postoperative delirium (POD) is a frequent complication in older adults, characterised by disturbances in attention, awareness and cognition, and associated with prolonged hospitalisation, poor functional recovery, cognitive decline, long-term dementia and increased mortality. Early identification of patients at risk of POD can considerably aid prevention. METHODS We have developed a preoperative POD risk prediction algorithm using data from eight studies identified during a systematic review and providing individual-level data. Ten-fold cross-validation was used for predictor selection and internal validation of the final penalised logistic regression model. The external validation used data from university hospitals in Switzerland and Germany. RESULTS Development included 2,250 surgical (excluding cardiac and intracranial) patients 60 years of age or older, 444 of whom developed POD. The final model included age, body mass index, American Society of Anaesthesiologists (ASA) score, history of delirium, cognitive impairment, medications, optional C-reactive protein (CRP), surgical risk and whether the operation is a laparotomy/thoracotomy. At internal validation, the algorithm had an AUC of 0.80 (95% CI: 0.77-0.82) with CRP and 0.79 (95% CI: 0.77-0.82) without CRP. The external validation consisted of 359 patients, 87 of whom developed POD. The external validation yielded an AUC of 0.74 (95% CI: 0.68-0.80). CONCLUSIONS The algorithm is named PIPRA (Pre-Interventional Preventive Risk Assessment), has European conformity (ce) certification, is available at http://pipra.ch/ and is accepted for clinical use. It can be used to optimise patient care and prioritise interventions for vulnerable patients and presents an effective way to implement POD prevention strategies in clinical practice.
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Affiliation(s)
| | - Kelly Reeve
- Institute of Data Analysis and Process Design, Zurich University of Applied Sciences, Winterthur 8400, Switzerland
| | - Lisa Falco
- Zühlke Engineering AG, Zürcherstrasse 39J, Schlieren 8952, Switzerland
| | - Tom Hueting
- Evidencio, Irenesingel 19, Haaksbergen 7481 GJ, Netherlands
| | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton ON L8S 4L8, Canada
- Department of Anesthesia, McMaster University, Hamilton ON L8S 4L8, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton ON L8S 4L8, Canada
- Department of Anesthesia, McMaster University, Hamilton ON L8S 4L8, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON L8S 4L8, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé 12117, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town 7600, South Africa
| | - Nicolai Goettel
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville FL 32610, USA
- Department of Clinical Research, University of Basel, Basel 4031, Switzerland
| | - Nayeli Schmutz Gelsomino
- PIPRA AG, Zurich 8005, Switzerland
- Department of Anaesthesia, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland
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9
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Ní Chróinín D, Alexandrou E, Frost SA. Delirium in the intensive care unit and its importance in the post-operative context: A review. Front Med (Lausanne) 2023; 10:1071854. [PMID: 37064025 PMCID: PMC10098316 DOI: 10.3389/fmed.2023.1071854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/10/2023] [Indexed: 04/18/2023] Open
Abstract
The burden of delirium in the intensive care setting is a global priority. Delirium affects up to 80% of patients in intensive care units; an episode of delirium is often distressing to patients and their families, and delirium in patients within, or outside of, the intensive care unit (ICU) setting is associated with poor outcomes. In the short term, such poor outcomes include longer stay in intensive care, longer hospital stay, increased risk of other hospital-acquired complications, and increased risk of hospital mortality. Longer term sequelae include cognitive impairment and functional dependency. While medical category of admission may be a risk factor for poor outcomes in critical care populations, outcomes for surgical ICU admissions are also poor, with dependency at hospital discharge exceeding 30% and increased risk of in-hospital mortality, particularly in vulnerable groups, with high-risk procedures, and resource-scarce settings. A practical approach to delirium prevention and management in the ICU setting is likely to require a multi-faceted approach. Given the good evidence for the prevention of delirium among older post-operative outside of the intensive care setting, simple non-pharmacological interventions should be effective among older adults post-operatively who are cared for in the intensive care setting. In response to this, the future ICU environment will have a range of organizational and distinct environmental characteristics that are directly targeted at preventing delirium.
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Affiliation(s)
- Danielle Ní Chróinín
- Liverpool Hospital, Liverpool, NSW, Australia
- South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia
- *Correspondence: Danielle Ní Chróinín,
| | - Evan Alexandrou
- Liverpool Hospital, Liverpool, NSW, Australia
- South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia
- Centre for Applied Nursing Research, School of Nursing and Midwifery, Western Sydney University and Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Steven A. Frost
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- SWS Nursing and Midwifery Research Alliance, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
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10
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Khaled M, Sabac D, Marcucci M. Postoperative pain and pain management and neurocognitive outcomes after non-cardiac surgery: a protocol for a series of systematic reviews. Syst Rev 2022; 11:280. [PMID: 36564810 PMCID: PMC9789645 DOI: 10.1186/s13643-022-02156-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/13/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Postoperative delirium (POD) is common after non-cardiac surgery in older adults and can result in increased risk of adverse outcomes including postoperative cognitive dysfunction (POCD). Pain after surgery is also frequent and can persist as chronic postsurgical pain (CPSP). Evidence is inconsistent and controversial on whether acute and chronic postsurgical pain, and different postoperative pain management strategies (including opioid versus opioid-sparing strategies), is associated with the occurrence of POD and POCD. In this protocol, we propose a series of systematic reviews to answer the following research questions: In adults undergoing non-cardiac surgery, (1) is acute postsurgical pain associated with POD and/or POCD? (2) Are opioid-sparing/avoidance strategies of acute postoperative pain management associated with lower incidence and/or severity of POD and POCD, compared to predominantly opioid-based strategies? (3) Is CPSP associated with POCD? (4) Are opioid-sparing management strategies of CPSP associated with lower incidence and/or severity of POCD compared to standard of care or strategies not aiming at reduced opioid use? METHODS We will search MEDLINE, EMBASE, Cochrane (CENTRAL), CINAHL, and PSYCHINFO. According to the research question, we will include cohort and case-control studies (questions 1 and 3) or randomized controlled trials and non-randomized studies (questions 2 and 4). The risk of bias will be assessed independently and in duplicate using the revised Cochrane risk-of-bias tool, the Newcastle-Ottawa Scale, and the Joanna-Briggs Institute critical appraisal checklist. Disagreements will be resolved by a third reviewer. Findings will be reported narratively, and where possible and appropriate, meta-analyses will be performed. Certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. We will conduct the reviews in accordance with the guideline of the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols. DISCUSSION Our systematic reviews will summarize available evidence to date on the association of postoperative pain and its management strategies with the incidence of POD and POCD in non-cardiac surgery. We will evaluate the existing evidence and its limitations and inform the design of future interventional studies comparing the effects of different pain management strategies on postoperative neurocognitive outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021192105.
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Affiliation(s)
- Maram Khaled
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, L8S4L8, Canada. .,Perioperative and Surgery Research Program, Population Health Research Institute, Hamilton, ON, Canada.
| | - Denise Sabac
- Bachelor of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Maura Marcucci
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, L8S4L8, Canada.,Perioperative and Surgery Research Program, Population Health Research Institute, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
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11
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Ní Chróinín D, Chuan A. Post-operative delirium in the patient with hip fracture: The journey from hospital arrival to discharge. Front Med (Lausanne) 2022; 9:1080253. [PMID: 36507517 PMCID: PMC9728584 DOI: 10.3389/fmed.2022.1080253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
Delirium- an acute disorder of attention and cognition- is the commonest complication following hip fracture. Patients with hip fracture are particularly vulnerable to delirium, and many of the lessons from the care of the patient with hip fracture will extend to other surgical cohorts. Prevention and management of delirium for patients presenting with hip fracture, extending along a continuum from arrival through to the post-operative setting. Best practice guidelines emphasize multidisciplinary care including management by an orthogeriatric service, regular delirium screening, and multimodal interventions. The evidence base for prevention is strongest in terms of multifaceted interventions, while once delirium has set in, early recognition and identification of the cause are key. Integration of effective strategies is often suboptimal, and may be supported by approaches such as interactive teaching methodologies, routine feedback, and clear protocol dissemination. Partnering with patients and carers will support person centered care, improve patient experiences, and may improve outcomes. Ongoing work needs to focus on implementing recognized best practice, in order to minimize the health, social and economic costs of delirium.
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Affiliation(s)
- Danielle Ní Chróinín
- Liverpool Hospital, Liverpool, NSW, Australia,South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia,*Correspondence: Danielle Ní Chróinín,
| | - Alwin Chuan
- Liverpool Hospital, Liverpool, NSW, Australia,South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia,Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
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12
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Schultz C, Yang E, Mantuani D, Miraflor E, Victorino G, Nagdev A. Single injection, ultrasound-guided planar nerve blocks: An essential skill for any clinician caring for patients with rib fractures. Trauma Case Rep 2022; 41:100680. [PMID: 35958272 PMCID: PMC9361308 DOI: 10.1016/j.tcr.2022.100680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 11/24/2022] Open
Abstract
In patients with acute rib fractures, regional anesthesia has the potential to reduce suffering, decrease opiate use, lower rates of in-hospital delirium, and improve pulmonary function. While many regional anesthesia techniques are complex and time consuming, two single injection nerve blocks, the serratus anterior plane block and erector spinae plane block, are particularly fast, safe, and simple methods to anesthetize the chest wall. Herein we describe two cases in which the serratus anterior plane block and erector spinae plane block were each used with great success in achieving improved pain control in trauma patients with multiple rib fractures. We believe that any provider who routinely cares for patients with rib fractures (emergency physicians and trauma surgeons alike) can and should learn to use these straightforward nerve blocks.
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13
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Impacto do comanejo multidisciplinar em desfechos de pacientes com fratura de quadril. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao014566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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14
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Rajeev A, Railton C, Devalia K. The crucial factors influencing the development and outcomes of postoperative delirium in proximal femur fractures. Aging Med (Milton) 2022; 5:94-100. [PMID: 35783117 PMCID: PMC9245175 DOI: 10.1002/agm2.12206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 01/09/2023] Open
Abstract
Objective The aim of this study is to find the incidence, risks, and reasons for prolonged length of hospital stay, short, long‐term mortality, and the factors contributing to mortality of postoperative delirium in proximal femoral fractures. Methods The data for the study was obtained from National Hip Fracture Database (NHFD) and internal hospital computer systems (Medway, ICE, Clinic letters) between January 2018 and December 2019. One hundred seventy‐five patients were found have developed postoperative delirium. The outcomes measured were postoperative anemia, lower respiratory tract infection, urinary tract infection, acute kidney injury, urinary retention, cardiac event and stroke, alcohol or drug withdrawal, length of hospital stay, and 30 day and 1 year mortality. Results The patients who developed delirium were 68 (38.9%) with American Society of Anesthesiologists (ASA) grade 4 and 94 (22.3%) without delirium (p < 0.05). The average length of stay after developing postoperative delirium was 19.69 days compared to 17.4 days for patients without delirium. The mortality at 30 days and 1 year was 10.9% and 37% in patients who had postoperative delirium compared to 2.1% and 2.8% to those without delirium, respectively. Conclusion Postoperative delirium is three times more common in hip fractures. Early detection and timely management are crucial in the improvement of functional outcomes and mortality.
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Affiliation(s)
- Aysha Rajeev
- Department of Trauma and Orthopaedics Gateshead Health Foundation NHS Trust Tyne and Wear UK
| | - Catherine Railton
- Department of Trauma and Orthopaedics Gateshead Health Foundation NHS Trust Tyne and Wear UK
| | - Kailash Devalia
- Department of Trauma and Orthopaedics Gateshead Health Foundation NHS Trust Tyne and Wear UK
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15
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Miles LF, Story DA. Reviewer recommendations: how to design and publish quality science studies. Anaesthesia 2022; 77:929-933. [DOI: 10.1111/anae.15754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 12/18/2022]
Affiliation(s)
- L. F. Miles
- Department of Anaesthesia Austin Health Melbourne Australia
- Department of Critical Care, Melbourne Medical School University of Melbourne Melbourne Australia
| | - D. A. Story
- Department of Anaesthesia Austin Health Melbourne Australia
- Department of Critical Care, Melbourne Medical School University of Melbourne Melbourne Australia
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16
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Luo J, Xie N, Yang L. Observation of the Intervention Effect of Biofeedback Therapy Combined With Cluster Nursing on Perioperative Constipation in Patients With Thoracolumbar Fracture. Front Surg 2022; 9:847068. [PMID: 35321074 PMCID: PMC8934880 DOI: 10.3389/fsurg.2022.847068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To discuss the intervention effect of biofeedback therapy combined with cluster nursing on perioperative constipation in patients with thoracolumbar fracture. Methods From June 2019 to June 2020, a total of 482 patients with thoracolumbar fracture who were treated by surgery in our department were selected. The random number table method was used to divide into experimental group (n = 241) and control group (n = 241). The control group was given routine constipation care, the experimental group was given biofeedback therapy combined with cluster nursing based on the control group. The constipation score, Bristol stool scale score, the short health questionnaire (SF-36) scale score, and the satisfaction of two groups were observed. Results The constipation scores of the experimental group were lower than those of the control group, while the Bristol stool scale score, SF-36 score, and satisfaction degree of the experimental group were higher than those of the control group (p < 0.05). Conclusion Biofeedback therapy combined with cluster nursing has a good intervention effect in perioperative constipation of patients with thoracolumbar fracture, which can reduce the degree of constipation, improve stool traits, improve the quality of life, and improve the satisfaction of patients.
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Affiliation(s)
- Jin Luo
- Department of Spine Surgery, Suining Central Hospital, Suining, China
| | - Nan Xie
- Nursing Department, Suining Central Hospital, Suining, China
| | - Liping Yang
- Department of Arthrosurgery, Zhuji People's Hospital of Zhejiang Province, Zhuji, China
- *Correspondence: Liping Yang
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17
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Wei W, Zheng X, Gu Y, Fu W, Tang C, Yao Y. Effect of general anesthesia with thoracic paravertebral block on postoperative delirium in elderly patients undergoing thoracoscopic lobectomy: a randomized-controlled trial. BMC Anesthesiol 2022; 22:1. [PMID: 34979943 PMCID: PMC8722018 DOI: 10.1186/s12871-021-01532-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 11/29/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Postoperative delirium (POD) is characterized by acute brain dysfunction, especially in elderly patients. Postoperative pain is an important factor in the development of delirium, and effective pain management can reduce the risk of POD. Thoracic paravertebral block (TPVB) can effectively relieve postoperative pain and inhibit the perioperative stress and inflammatory response. We investigated whether the combination of TPVB with general anesthesia reduced the occurrence of POD following thoracoscopic lobectomy. METHODS A total of 338 elderly patients, aged 65-80 years, who underwent elective surgery for video-assisted thoracoscopic lobectomy (VATS) were randomly assigned to either a patient-controlled intravenous analgesia group (PIA) or a patient-controlled paravertebral-block analgesia group (PBA). POD was evaluated using the 3-min diagnostic confusion assessment method (3D-CAM). The postoperative quality of recovery (QoR) was assessed with Chinese version of QoR-40 scale. Pain intensity was measured using the visual analog scale (VAS) score. Tumor necrosis factor-α (TNF-α) and neurofilament light (NFL) levels were determined using enzyme-linked immunosorbent assay (ELISA) kits. RESULTS Delirium occurred in 47 (28%) of 168 cases in the PIA group and 28 (16.5%) of 170 cases in the PBA group (RR 1.7, p = 0.03). PBA was also associated with a higher rate of overall recovery quality at day 7 after surgery (27.1% vs. 17.3%, P = 0.013) compared with PIA. The incremental change in surgery-induced TNF-α and NFL was greater in the PIA group than PBA group (p < 0.05). CONCLUSION Thoracic paravertebral block analgesia is associated with lower incidence of postoperative delirium, probably due to its anti-neuroinflammatory effects. Furthermore, as a component of multimodal analgesia, TPVB provides not only superior analgesic but also opioid-sparing effects. TRIAL REGISTRATION The study was registered on the Chinese Clinical Trial Registry Center ( www.chictr.org.cn ; registration number: ChiCTR 2,000,033,238 ) on 25/05/2018.
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Affiliation(s)
- Wei Wei
- Department of anesthesiology, cancer hospital and institute of Guangzhou medical university, Guangzhuou, 510000, Guangdong, China
| | - Xi Zheng
- Department of anesthesiology, cancer hospital and institute of Guangzhou medical university, Guangzhuou, 510000, Guangdong, China
| | - Yu Gu
- Department of anesthesiology, cancer hospital and institute of Guangzhou medical university, Guangzhuou, 510000, Guangdong, China
| | - Wenting Fu
- Department of anesthesiology, cancer hospital and institute of Guangzhou medical university, Guangzhuou, 510000, Guangdong, China
| | - Chunlin Tang
- Department of anesthesiology, cancer hospital and institute of Guangzhou medical university, Guangzhuou, 510000, Guangdong, China
| | - Yonghua Yao
- Department of anesthesiology, cancer hospital and institute of Guangzhou medical university, Guangzhuou, 510000, Guangdong, China.
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18
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He J, Ling Q, Chen Y. Construction and Application of a Model for Predicting the Risk of Delirium in Postoperative Patients With Type a Aortic Dissection. Front Surg 2021; 8:772675. [PMID: 34869569 PMCID: PMC8636852 DOI: 10.3389/fsurg.2021.772675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/11/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Postoperative delirium (POD), an alteration in a patient's consciousness pattern, can affect the treatment and prognosis of a disease. Objective: To construct a prediction model for delirium in patients with type A aortic dissection after surgery and to validate its effectiveness. Methods: A retrospective cohort design was used to study 438 patients undergoing surgical treatment for type A aortic dissection from April 2019 to June 2020 in tertiary care hospitals. POD (n = 78) and non-delirium groups (n = 360) were compared and analyzed for each index in the perioperative period. A prediction model was established using multifactorial logistic regression, and 30 patients' perioperative data were collected for model validation. Results: Eight predictors were included in this study: smoking, diabetes, previous cardiovascular surgery, ejection fraction (EF), time to aortic block, acute kidney injury, low cardiac output syndrome, and pulmonary complications. The area under the receiver operating characteristic (ROC) curve of the constructed prediction model was 0.98 ± 0.005, and the Youden index was 0.91. The validation results showed 97% sensitivity, 100% specificity, and 93% accuracy. The expression of the model was Z = Smoking assignment* – 2.807 – 6.009*Diabetes assignment – 2.994*Previous cardiovascular surgery assignment – 0.129*Ejection fraction assignment + 0.071*Brain perfusion time assignment – 2.583*Acute kidney injury assignment – 2.916*Low cardiac output syndrome assignment – 3.461*Pulmonary related complications assignment + 20.576. Conclusion: The construction of an effective prediction model for the risk of delirium in patients after type A aortic stratification can help identify patients at high risk of POD early. It also provides a reference for healthcare professionals in the prevention and care of these patients.
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Affiliation(s)
- Junfeng He
- Department of Nursing, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Qing Ling
- Department of Nursing, Nanjing First Hospital, Nanjing, China
| | - Yuhong Chen
- Department of Nursing, Nanjing First Hospital, Nanjing, China
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19
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Bilotta F, Russo G, Verrengia M, Sportelli A, Foti L, Villa G, Romagnoli S. Systematic review of clinical evidence on postoperative delirium: literature search of original studies based on validated diagnostic scales. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2021; 1:18. [PMID: 37386536 DOI: 10.1186/s44158-021-00021-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/09/2021] [Indexed: 07/01/2023]
Abstract
BACKGROUND Postoperative delirium is a serious complication that can occur within the 5th postoperative day. In 2017, the European Society of Anesthesiologists delivered dedicated guidelines that reported the need for routine monitoring using validated scales. OBJECTIVE Aim of this systematic review is to identify clinical studies related to postoperative delirium that included postoperative monitoring with validated scales. DESIGN Systematic review METHODS: Searched keywords included the following terms: postoperative, postsurgical, post anesthesia, anesthesia recovery, delirium, and confusion. Two researchers independently screened retrieved studies using a data extraction form. RESULTS Literature search led to retrieve 6475 hits; of these, 260 studies (5.6% of the retrieved), published between 1987 and 2021, included in their methods a diagnostic workup with the use of a postoperative delirium validated scale and monitored patients for more than 24 h, therefore are qualified to be included in the present systematic review. CONCLUSION In conclusion, available clinical literature on postoperative delirium relies on a limited number of studies, that included a validated diagnostic workup based on validated scales, extracted from a large series of studies that used inconsistent diagnostic criteria. In order to extract indications based on reliable evidence-based criteria, these are the studies that should be selectively considered. The analysis of these studies can also serve to design future projects and to test clinical hypothesis with a more standardized methodological approach.
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Affiliation(s)
- F Bilotta
- Department of Anesthesiology and Intensive Care Medicine, Policlinico Umbero I, "Sapienza", University of Rome, Rome, Italy.
| | - G Russo
- Department of Anesthesiology and Intensive Care Medicine, Policlinico Umbero I, "Sapienza", University of Rome, Rome, Italy
| | - M Verrengia
- Department of Anesthesiology and Intensive Care Medicine, Policlinico Umbero I, "Sapienza", University of Rome, Rome, Italy
| | - A Sportelli
- Department of Anesthesiology and Intensive Care Medicine, Policlinico Umbero I, "Sapienza", University of Rome, Rome, Italy
| | - L Foti
- Department of Health Science section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy
- Department of Anesthesiology and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - G Villa
- Department of Health Science section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy
- Department of Anesthesiology and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - S Romagnoli
- Department of Health Science section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy
- Department of Anesthesiology and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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20
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Curtis K, Moules P, McKenzie J, Weidl L, Selak T, Binks S, Hernandez D, Rijsdijk J, Risi D, Wright J, O'Rourke L, Knapman M, Ristevski M, Stephens T, Harris I, Close JCT. Development of an Early Activation Hip Fracture Care Bundle and Implementation Strategy to Improve Adherence to the National Hip Fracture Clinical Care Standard. J Multidiscip Healthc 2021; 14:2891-2903. [PMID: 34703242 PMCID: PMC8524060 DOI: 10.2147/jmdh.s323678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022] Open
Abstract
Objective To develop and implement a multidisciplinary early activation mechanism and bundle of care (eHIP) to improve adherence to ACSQHC standards in a regional trauma centre. Methods Barriers to implementation were categorised using the Theoretical Domains Framework, then linked to specific strategies guided by the Behaviour Change Wheel and Behaviour Change Technique Taxonomy (BCTT). The resulting implementation strategies were assessed using Affordable, Practical, Effective, Acceptable, had Side-effects (APEASE) criteria. Results Eighty-three barriers to implementation of the hip fracture care bundle were identified. The behaviour change wheel process resulted in the identification of 41 techniques to address these barriers. The predominant mechanisms to achieve this were development and implementation of 1) formal policy that outlines eHIP roles; 2) video promotion; 3) pager group; 4) fascia iliaca block enabling; 5) eMR modifications; 6) face-to-face reinforcement and modelling; 7) communication and prompts; 8) environmental restructuring. Conclusion We applied behaviour change theory through a pragmatic evidence-based process. This resulted in a codesigned strategy to overcome staff and organisational barriers to the implementation of a multidisciplinary early activation mechanism and bundle of care (eHIP). Future work will include evaluation of the uptake and clinical impact of the care bundle.
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Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.,George Institute for Global Health, Newtown, NSW, Australia
| | - Peter Moules
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - John McKenzie
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Lauren Weidl
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Tanya Selak
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Simon Binks
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Daniel Hernandez
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Joshua Rijsdijk
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Dante Risi
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - James Wright
- Agency for Clinical Innovation, St Leonards, NSW, Australia
| | - Lauren O'Rourke
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Myles Knapman
- Western NSW LHD, Department of Surgery, Dubbo, NSW, Australia
| | - Meagan Ristevski
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Teala Stephens
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Ian Harris
- Ingham Institute of Applied Medical Research, South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia
| | - Jacqueline C T Close
- Prince Wales Clinical School, UNSW, Sydney, NSW, Australia.,Neuroscience Research Australia, UNSW, Sydney, NSW, Australia
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21
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Hunter CL, Ni Chroinin D, McEvoy L, Chuan A. Delirium Reduction by Analgesia Management in Hip Fracture surgery (DRAM-HF): Exploration of perceived facilitators and barriers. Australas J Ageing 2021; 40:e332-e340. [PMID: 34397137 DOI: 10.1111/ajag.12991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 06/29/2021] [Accepted: 07/22/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES In tandem with the implementation of a multidisciplinary protocol which was successful in reducing delirium after hip fracture surgery (DRAM-HF), we sought to investigate enablers and barriers to same. METHODS Single-centre, prospective, before-and-after questionnaire targeted at health-care professionals involved in DRAM-HF. We assessed respondent-reported enablers and barriers to the multidisciplinary protocol, using 0-100 agreement scales and free-text responses. RESULTS A total of 134 preintervention and 124 postintervention responses were collated (out of 200, response rates 67% and 62%, respectively). Preintervention support for DRAM-HF was 100% (n = 130) and postintervention 95.9% (n = 116). Study design was well received with a mean score of 76.7 (SD 19.7) for being easy to understand. Support for additional computer alert systems was also high (mean 73.6, SD 23.9). Free-text responses emphasised the need for integration of ward pharmacists into medication optimisation (n = 31) and upskilling nurse practitioners (n = 23). CONCLUSION Whilst generally supported, DRAM-HF implementation may be streamlined by optimising electronic delivery, offering targeted education and expanding roles.
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Affiliation(s)
- Carol Lu Hunter
- Department of Geriatric Medicine, Liverpool Hospital, Liverpool, Australia.,Faculty of Medicine, UNSW Sydney, Kensington, Australia
| | - Danielle Ni Chroinin
- Department of Geriatric Medicine, Liverpool Hospital, Liverpool, Australia.,Faculty of Medicine, UNSW Sydney, Kensington, Australia
| | - Lynette McEvoy
- Department of Orthopaedic Surgery, Liverpool Hospital, Liverpool, Australia
| | - Alwin Chuan
- Faculty of Medicine, UNSW Sydney, Kensington, Australia.,Department of Anaesthetics, Liverpool Hospital, Liverpool, Australia
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22
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Unal N, Guvenc G, Ilkin Naharci M. Evaluation of the effectiveness of delirium prevention care protocol for the patients with hip fracture: A randomised controlled study. J Clin Nurs 2021; 31:1082-1094. [PMID: 34302312 DOI: 10.1111/jocn.15973] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 06/20/2021] [Accepted: 07/05/2021] [Indexed: 01/09/2023]
Abstract
AIMS AND OBJECTIVES This study aimed to investigate the effectiveness of a delirium prevention care protocol on pain, functional status, sleep quality and delirium prevention in patients with hip fractures. BACKGROUND The development of delirium following hip fracture is common among older patients. According to the National Institute for Health and Care Excellence, 30% of delirium cases are preventable. The prevention of delirium, a multifactorial syndrome, can be achieved through a multicomponent care protocol that targets specific risk factors for delirium. DESIGN A randomised controlled study was conducted according to the CONSORT 2010 guidelines. The Clinical Trial Registry number is NCT04188795. METHODS A total of 84 patients were assigned to two groups by block randomisation. The intervention group (n = 41) received nursing care according to a protocol and the control group (n = 43) received standard nursing care. Study data were collected using the demographic information form, the Confusion Assessment Method-Intensive Care Unit (CAM-ICU), the Barthel Index, the Mini Nutritional Assessment-short form and the Richards-Campbell Sleep Questionnaire (RCSQ). The pain of the patients was assessed by using a Visual Analog Scale (VAS). RESULTS The mean age of the patients was 80.6 years (standard deviation 8.0; range 65.0- 97.5 years), and the percentage of the male patients were 36.3%. No statistically significant differences were found between the groups in terms of pain and functional status in the preoperative period, on the first postoperative day, or in the predischarge period (p > 0.05 for each). The sleep quality of patients in the intervention group was significantly better than in the control group for all three time measurements (p < 0.05 for each). While 15% of patients in the control group developed delirium, no patient in the intervention group developed delirium (x2 =6.486, p = 0.026). CONCLUSION This study demonstrated that a delirium prevention care protocol may reduce the incidence of delirium and improve sleep quality. RELEVANCE TO PRACTICE The study highlighted that nurses can contribute to preventing patients' delirium using nonpharmacologic and independent nursing interventions.
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Affiliation(s)
- Nursemin Unal
- Faculty of Health Sciences, School of Nursing, Ankara Medipol University, Ankara, Turkey
| | - Gulten Guvenc
- Gulhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Turkey
| | - Mehmet Ilkin Naharci
- Geriatrics Department, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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23
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Ukwuoma Ekeozor C, Jeyaruban D, Lasserson D. Where should patients with or at risk of delirium be treated in an acute care system? Comparing the rates of delirium in patients receiving usual care vs alternative care: A systematic review and meta-analysis. Int J Clin Pract 2021; 75:e13859. [PMID: 33236458 DOI: 10.1111/ijcp.13859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/10/2020] [Accepted: 11/22/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Delirium is an acute condition that occurs in hospitalised patients and leads to poor patient outcomes that can last long term. Therefore, the importance of prevention is undeniable and adopting new models of care for at-risk patients should be prioritised. OBJECTIVES This systematic review and meta-analysis will assess the effectiveness of different interventions designed to prevent or manage delirium in acutely unwell hospitalised patients. METHODS MEDLINE, EMBASE, PsycINFO, OpenGrey, Web of Science and reference lists of journals were searched. Eligible studies reported on incidence or duration of delirium, used a validated delirium diagnostic tool and compared an intervention to either a control or another intervention group. Meta-analyses were conducted, and GRADEpro software was used to assess the certainty of evidence. This review is registered on PROSPERO. RESULTS A total of 59 studies were included and 33 were eligible for meta-analysis. Delirium incidence was most significantly reduced by non-pharmacological multicomponent interventions compared with usual care, with pooled risk ratios of 0.57 (95% CI: 0.44 to 0.73, 10 randomised controlled trials) and 0.47 (95% CI: 0.35 to 0.64, six observational studies). Single-component interventions did not significantly reduce delirium incidence compared with usual care in seven randomised trials (risk ratio = 0.92, 95% CI: 0.81 to 1.04). The most effective single-component intervention in reducing delirium incidence was a hospital-at-home intervention (risk ratio = 0.29, 95% CI: 0.09 to 0.87). CONCLUSIONS Non-pharmacological multicomponent interventions are effective in preventing delirium; however, the same cannot be said for other interventions because of uncertain results. There is some evidence that providing multicomponent interventions in patients' homes is more effective than in a hospital setting. Therefore, researching the benefits of hospital-at-home interventions in delirium prevention is recommended.
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Affiliation(s)
| | - Darshana Jeyaruban
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Daniel Lasserson
- Health Sciences Division, University of Warwick, Coventry, UK
- Department of Geratology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
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24
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Pipanmekaporn T, Punjasawadwong Y, Wongpakaran N, Wongpakaran T, Suwannachai K, Chittawatanarat K, Mueankwan S. Risk factors and adverse clinical outcomes of postoperative delirium in Thai elderly patients: A prospective cohort study. Perspect Psychiatr Care 2021; 57:1073-1082. [PMID: 33111390 DOI: 10.1111/ppc.12658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/05/2020] [Accepted: 10/11/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To determine the incidence, risk factors, and adverse clinical outcomes of postoperative delirium (POD) in elderly patients. DESIGN AND METHODS A total of 429 patients scheduled to undergo noncardiac surgery were recruited. Delirium was assessed using the confusion assessment method. FINDINGS The incidence of POD was 5.4%. Risk factors of POD were age over 70 years, an American Society of Anesthesiologist physical status 2 and 3, cognitive impairment, history of psychiatric illness, and preoperative hemoglobin ≤ 10 g/dl. PRACTICE IMPLICATIONS The correction of modifiable risk factors, the use of preventive strategies, and the monitoring of POD are advisable to improve the quality of perioperative care.
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Affiliation(s)
- Tanyong Pipanmekaporn
- Department of Anesthesiology, Chiang Mai University, Chiang Mai, Thailand.,Clinical Epidemiology and Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | | | | | | | | | - Sirirat Mueankwan
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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25
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Ní Chróinín D, Francis N, Wong P, Kim YD, Nham S, D'Amours S. Older trauma patients are at high risk of delirium, especially those with underlying dementia or baseline frailty. Trauma Surg Acute Care Open 2021; 6:e000639. [PMID: 33997291 PMCID: PMC8088250 DOI: 10.1136/tsaco-2020-000639] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/07/2021] [Accepted: 03/08/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Given the increasing numbers of older patients presenting with trauma, and the potential influence of delirium on outcomes, we sought to investigate the proportion of such patients who were diagnosed with delirium during their stay-and patient factors associated therewith-and the potential associations between delirium and hospital length of stay (LOS). We hypothesized that delirium would be common, associated with certain patient characteristics, and associated with long hospital LOS (highest quartile). METHODS We conducted a retrospective observational cohort study of all trauma patients aged ≥65 years presenting in September to October 2019, interrogating medical records and the institutional trauma database. The primary outcome measure was occurrence of delirium. RESULTS Among 99 eligible patients, delirium was common, documented in 23% (23 of 99). On multivariable analysis, adjusting for age, frailty and history of dementia, frailty (OR 4.09, 95% CI 1.08 to 15.53, p=0.04) and dementia (OR 5.23, 95% CI 1.38 to 19.90, p=0.02) were independently associated with likelihood of delirium. Standardized assessment tools were underused, with only 34% (34 of 99) screened within 4 hours of arrival. On univariate logistic regression analysis, having an episode of delirium was associated with long LOS (highest quartile), OR of 5.29 (95% CI 1.92 to 14.56, p<0.001). In the final multivariable model, adjusting for any (non-delirium) in-hospital complication, delirium was independently associated with long LOS (≥16 days; OR 4.81, p=0.005). DISCUSSION In this study, delirium was common. History of dementia and baseline frailty were associated with increased risk. Delirium was independently associated with long LOS. However, many patients did not undergo standardized screening at admission. Early identification and targeted management of older patients at risk of delirium may reduce incidence and improve care of this vulnerable cohort. These data are hypothesis generating, but support the need for initiatives which improve delirium care, acknowledging the complex interplay between frailty and other geriatric syndromes in the older trauma patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Danielle Ní Chróinín
- Department of Geriatric Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia
| | - Nevenka Francis
- South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia
- Acute Care Surgery Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Pearl Wong
- Department of Head and Neck Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Yewon David Kim
- Department of Plastic Surgery, Liverpool Hospital, Liverpool, UK
| | - Susan Nham
- South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia
- Department of Haematology, Liverpool Hospital, Liverpool, UK
| | - Scott D'Amours
- South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia
- Acute Care Surgery Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
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26
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Chuan A, Sanders RD. The use of dexmedetomidine to prevent delirium after major cardiac and non-cardiac surgery. Anaesthesia 2021; 76:1296-1299. [PMID: 33899223 DOI: 10.1111/anae.15494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 11/25/2022]
Affiliation(s)
- A Chuan
- Department of Anaesthesia, Liverpool Hospital, Sydney, NSW, Australia.,South West Sydney Clinical School and Ingham Institute of Applied Medical Research, UNSW Sydney, Sydney, NSW, Australia
| | - R D Sanders
- Department of Anaesthesia, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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27
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Gosch M, Kammerlander C, Fantin E, Jensen TG, Salazar AML, Olarte C, Bavatonavarech S, Medina C, Link BC, Cunningham M. Design and Evaluation of a Hospital-Based Educational Event on Fracture Care for Older Adult. Geriatr Orthop Surg Rehabil 2021; 12:21514593211003857. [PMID: 33868767 PMCID: PMC8020218 DOI: 10.1177/21514593211003857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 02/17/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Surgeons, internal medicine physicians, nurses, and other members of the
healthcare team managing older adults with a fracture all have barriers to
attending educational courses, including time away from practice and cost.
Our planning group decided to create and evaluate a hospital-based
educational event to address, meet, and improve the care of older adults
with a fracture. Materials and Methods: A committee of surgeons and geriatricians defined 3 learning objectives to
improve knowledge and attitudes in co-managed care. They designed a 1-day
educational event consisting of a departmental visit, a review of cases, a
planning session to identify gaps and plan changes, and presentations on
selected topics. Thirteen hospitals worldwide completed an 8-question online
application form, and 7 sites were selected for delivery over 3 years in
Denmark, Colombia, Thailand, Paraguay, Switzerland, and the Dominican
Republic. Results: Each event was conducted by 1 or more visiting surgeons and geriatricians,
and the local team leaders. The most common challenges reported in the
applications were preoperative assessment or optimization, delayed surgery,
lack of protocols, access to a geriatrician, teamwork, and specific aspects
of perioperative and postoperative care. In each department, 4 or 5 goals
and targets for implementation were agreed. The presentations section was
customized and attended by 20 to 50 team members. Discussion: Topics selected by a majority of departments were principles of co-managed
care (7), preoperative optimization (7), and management of delirium (4).
Follow up was conducted after 3 and 12 months to review the degree of
achievement of each planned change and to identify any barriers to complete
implementation. Conclusions: Hospital-based events with visiting and local faculty were effective to
engage a broader audience that might not attend external courses. A
performance improvement component with goal setting and follow up was
acceptable to all host departments.
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Affiliation(s)
| | | | - Emilio Fantin
- IMC Instituto Modelo de Cardiologia Cordoba, Argentina
| | | | | | | | | | - Claudia Medina
- IPS Universitaria Clínica León XIII, Envigado, Antioquia, Colombia
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28
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White LB, Coyne E, Grealish L. Management of delirium within intraoperative settings for older adults with hip fracture: a scoping review. J Clin Nurs 2021; 30:2169-2178. [PMID: 33616299 DOI: 10.1111/jocn.15720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/20/2021] [Accepted: 02/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Delirium is a common adverse event in older patients undergoing hip fracture repair surgery. The impact of hospital-acquired delirium during intraoperative phase of their treatment can have a significant impact on post-operative outcomes. While non-pharmacological, multicomponent delirium prevention interventions are considered standard practice in acute medical units, delirium management in the intraoperative setting is less clear. OBJECTIVES The aim was to identify evidence-based delirium management interventions which are, and could be, undertaken within the intraoperative setting for older patients undergoing hip fracture repair surgery. DESIGN A scoping review following the principles developed by Arksey and O'Malley (2005). DATA SOURCES Seven databases including Cochrane, CINAHL, Embase, MEDLINE, PsychINFO, PubMed and SCOPUS were systematically searched. The search was limited to the last 11 years (2009-2020). Research studies included both primary and secondary sources of evidence. RESULTS A total of 2464 articles were initially identified. These articles were further refined using keyword searches and exclusion criteria, with a final set of 16 articles meeting the inclusion criteria. Three main themes were as follows: anaesthetic-related interventions used to prevent delirium; recognising non-modifiable and potentially modifiable risk factors; and screening and diagnosis of delirium. CONCLUSIONS While there is a strong focus on anaesthetist-led interventions in the intraoperative setting, there are opportunities for more nurse-led interventions through adequate pain management and haemodynamic monitoring that require further research. Identifying the best test for screening and diagnosing delirium in the intraoperative setting requires further research.
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Affiliation(s)
- Laura Beth White
- School of Nursing & Midwifery & Menzies Health Institute, Griffith University
| | - Elisabeth Coyne
- School of Nursing & Midwifery & Menzies Health Institute, Griffith University
| | - Laurie Grealish
- School of Nursing & Midwifery & Menzies Health Institute, Griffith University.,Gold Coast Health
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29
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Abstract
PURPOSE OF REVIEW Postoperative delirium (POD) is one of the most severe complications after surgery.The consequences are dramatic: longer hospitalization, a doubling of mortality and almost all cases develop permanent, yet subtle, cognitive deficits specific to everyday life. Actually, no global guideline with standardized concepts of management exists. Advances in prevention, diagnosis and treatment can improve recognition and risk stratification of delirium and its consequences. RECENT FINDINGS Management of POD is a multiprofessional approach and consists of different parts: First, the detection of high-risk patients with a validated tool, preventive nonpharmacological concepts and an intraoperative anesthetic management plan that is individualized to the older patient (e.g. avoiding large swings in blood pressure, vigilance in maintaining normothermia, ensuring adequate analgesia and monitoring of anesthetic depth). In addition to preventive standards, treatment and diagnostic concepts must also be available, both pharmaceutical and nonpharmacological. SUMMARY Not every POD can be prevented. It is important to detect patients with high risk for POD and have standardized concepts of management. The most important predisposing risk factors are a higher age, preexisting cognitive deficits, multimorbidity and an associated prodelirious polypharmacy. In view of demographic change, the implementation of multidisciplinary approaches to pharmacological and nonpharmacological POD management is highly recommended.
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30
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Uzoigwe CE, O'Leary L, Nduka J, Sharma D, Melling D, Simmons D, Barton S. Factors associated with delirium and cognitive decline following hip fracture surgery. Bone Joint J 2020; 102-B:1675-1681. [PMID: 33249907 DOI: 10.1302/0301-620x.102b12.bjj-2019-1537.r3] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIMS Postoperative delirium (POD) and postoperative cognitive decline (POCD) are common surgical complications. In the UK, the Best Practice Tariff incentivizes the screening of delirium in patients with hip fracture. Further, a National Hip Fracture Database (NHFD) performance indicator is the reduction in the incidence of POD. To aid in its recognition, we sought to determine factors associated with POD and POCD in patients with hip fractures. METHODS We interrogated the NHFD data on patients presenting with hip fractures to our institution from 2016 to 2018. POD was determined using the 4AT score, as recommended by the NHFD and UK Department of Health. POCD was defined as a decline in Abbreviated Mental Test Score (AMTS) of two or greater. Using logistic regression, we adjusted for covariates to identify factors associated with POD and POCD. RESULTS Of the 1,224 patients presenting in the study period, 1,023 had complete datasets for final analysis. POD was observed in 242 patients (25%). On multivariate analysis only preoperative AMTS and American Society of Anesthesiologists grade (ASA) were independent predictors of POD. Every point increase in AMTS was associated with a fall in the odds of POD by a factor of 0.60 (95% confidence interval (CI) 0.56 to 0.63, p < 0.001). Every grade increase in ASA led to a 1.7-fold increase in the odds of POD (95% CI 1.13 to 2.50, p = 0.009). A preoperative AMTS of less than 8 was strongly predictive of POD with area under the receiver operating characteristic of 0.86 (95% CI 0.84 to 0.89). Only ASA was predictive of POCD-every grade increase in ASA led to a 2.6-fold increase in the odds of POCD (95% CI 1.7 to 4.0, p < 0.001). CONCLUSION POD and POCD are common in the hip fracture patients. Preoperative AMTS and ASA are strong predictors of POD, and ASA predictive of POCD. This may aid in the earlier identification of those most at risk and suited for the patient consent and decision-making process. Cite this article: Bone Joint J 2020;102-B(12):1675-1681.
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Affiliation(s)
| | - Lawrence O'Leary
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jude Nduka
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Daman Sharma
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - David Melling
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Damon Simmons
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Simon Barton
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
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31
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Griffiths R, Babu S, Dixon P, Freeman N, Hurford D, Kelleher E, Moppett I, Ray D, Sahota O, Shields M, White S. Guideline for the management of hip fractures 2020: Guideline by the Association of Anaesthetists. Anaesthesia 2020; 76:225-237. [PMID: 33289066 DOI: 10.1111/anae.15291] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2020] [Indexed: 12/26/2022]
Abstract
We convened a multidisciplinary Working Party on behalf of the Association of Anaesthetists to update the 2011 guidance on the peri-operative management of people with hip fracture. Importantly, these guidelines describe the core aims and principles of peri-operative management, recommending greater standardisation of anaesthetic practice as a component of multidisciplinary care. Although much of the 2011 guidance remains applicable to contemporary practice, new evidence and consensus inform the additional recommendations made in this document. Specific changes to the 2011 guidance relate to analgesia, medicolegal practice, risk assessment, bone cement implantation syndrome and regional review networks. Areas of controversy remain, and we discuss these in further detail, relating to the mode of anaesthesia, surgical delay, blood management and transfusion thresholds, echocardiography, anticoagulant and antiplatelet management and postoperative discharge destination. Finally, these guidelines provide links to supplemental online material that can be used at readers' institutions, key references and UK national guidance about the peri-operative care of people with hip and periprosthetic fractures during the COVID-19 pandemic.
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Affiliation(s)
- R Griffiths
- Department of Anaesthesia, Peterborough and Stamford Hospitals NHS Trust Peterborough, UK and Chair, Working Party, Association of Anaesthetists, UK
| | - S Babu
- Department of Anaesthesia, Warrington and Halton Hospitals NHS Trust, Warrington, UK
| | - P Dixon
- Department of Trauma and Orthopaedics, South Tyneside and Sunderland NHS Trust, Sunderland, UK and British Orthopaedic Association, Orthopaedic Trauma Society, UK
| | - N Freeman
- Department of Anaesthesia, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D Hurford
- Department of Anaesthesia, Cwm Taf Morgannwg University Health Board and Chair, Welsh Frailty Fracture Network, UK, UK
| | - E Kelleher
- Department of Anaesthesia, University of Galway, Galway, Ireland
| | - I Moppett
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, UK.,Department of Anaesthesia, Nottingham University Hospitals, Nottingham, UK
| | - D Ray
- Department of Anaesthesia, Royal Infirmary Edinburgh and Honorary Clinical Senior Lecturer, University of Edinburgh, Edinburgh, UK
| | - O Sahota
- Department of Healthcare of Older People, Nottingham University Hospitals, Nottingham, UK and British Geriatrics Society, UK
| | - M Shields
- Department of Anaesthesia, Royal Hospitals, Belfast, UK
| | - S White
- Department of Anaesthesia, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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32
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Pysyk CL. Accelerated surgery for hip fractures-the HIP ATTACK results discussed. Lancet 2020; 396:1331. [PMID: 34338207 DOI: 10.1016/s0140-6736(20)31373-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/08/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Christopher L Pysyk
- Department of Anesthesiology and Pain Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON K1H 8M5, Canada.
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33
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Jin Z, Hu J, Ma D. Postoperative delirium: perioperative assessment, risk reduction, and management. Br J Anaesth 2020; 125:492-504. [DOI: 10.1016/j.bja.2020.06.063] [Citation(s) in RCA: 231] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/22/2020] [Accepted: 06/20/2020] [Indexed: 12/20/2022] Open
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34
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Bilotta F, Pugliese F. The evolving clinical use of dexmedetomidine. Lancet 2020; 396:145-147. [PMID: 32682463 DOI: 10.1016/s0140-6736(20)30902-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/07/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Federico Bilotta
- Department of Anaesthesiology, Critical Care and Pain Medicine, "Sapienza" University of Rome, Rome 00199, Italy.
| | - Francesco Pugliese
- Department of Anaesthesiology, Critical Care and Pain Medicine, "Sapienza" University of Rome, Rome 00199, Italy
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35
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Shelton C, White S. Anaesthesia for hip fracture repair. BJA Educ 2020; 20:142-149. [PMID: 33456943 PMCID: PMC7808106 DOI: 10.1016/j.bjae.2020.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/24/2020] [Accepted: 02/04/2020] [Indexed: 01/13/2023] Open
Affiliation(s)
- C. Shelton
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - S. White
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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