BACKGROUND: Perioperative delirium is common in high-risk surgery and is associated with age, education, preoperative cognitive functioning, pre-existing medical conditions, and postoperative complications. We investigated these factors as well as lifestyle and demographic variables by using cognitive measures that were more sensitive than those used in previous studies. METHODS: Extensive medical and demographic data were collected on 102 patients between 41 and 88 years of age to identify comorbidities and lifestyle considerations preoperatively. Elective abdominal aortic aneurysm surgery was performed under combined general/epidural anesthesia with postoperative epidural analgesia. A battery of sensitive, cognitive measures was administered preoperatively, at the time of discharge from hospital, and 3 months postoperatively. Symptoms of delirium were assessed during the first 6 postoperative days using Diagnostic and Statistical Manual of Mental Disorders-4th Edition criteria. Intraoperative and postoperative data, including medications, vital signs, conduct of the surgery and anesthesia, complications, and details of pain control, were collected. RESULTS: Delirium occurred in 33% of the patients during the first 6 days after surgery. Longer duration of delirium was related to lower education, preoperative depression, and greater preoperative psychoactive medication use. Characteristics of the surgery and hospital stay were unrelated to the development of delirium. Patients who were diagnosed with delirium had lower cognitive scores during each of the three assessment periods, even when controlling for age and education. Logistic regression analysis indicated that the most powerful preoperative predictors of delirium were number of pack years smoked (P = .001), mental status scores (P = .003), and number of psychoactive medications (P = .005). CONCLUSION: A significant proportion of patients undergoing elective abdominal aortic aneurysm repair are susceptible to the development of delirium and are at risk for cognitive dysfunction after surgery. Our findings have implications for promoting long-term lifestyle changes, including smoking cessation and improved management of mental health as risk-reduction strategies.
BACKGROUND: Perioperative delirium is common in high-risk surgery and is associated with age, education, preoperative cognitive functioning, pre-existing medical conditions, and postoperative complications. We investigated these factors as well as lifestyle and demographic variables by using cognitive measures that were more sensitive than those used in previous studies. METHODS: Extensive medical and demographic data were collected on 102 patients between 41 and 88 years of age to identify comorbidities and lifestyle considerations preoperatively. Elective abdominal aortic aneurysm surgery was performed under combined general/epidural anesthesia with postoperative epidural analgesia. A battery of sensitive, cognitive measures was administered preoperatively, at the time of discharge from hospital, and 3 months postoperatively. Symptoms of delirium were assessed during the first 6 postoperative days using Diagnostic and Statistical Manual of Mental Disorders-4th Edition criteria. Intraoperative and postoperative data, including medications, vital signs, conduct of the surgery and anesthesia, complications, and details of pain control, were collected. RESULTS:Delirium occurred in 33% of the patients during the first 6 days after surgery. Longer duration of delirium was related to lower education, preoperative depression, and greater preoperative psychoactive medication use. Characteristics of the surgery and hospital stay were unrelated to the development of delirium. Patients who were diagnosed with delirium had lower cognitive scores during each of the three assessment periods, even when controlling for age and education. Logistic regression analysis indicated that the most powerful preoperative predictors of delirium were number of pack years smoked (P = .001), mental status scores (P = .003), and number of psychoactive medications (P = .005). CONCLUSION: A significant proportion of patients undergoing elective abdominal aortic aneurysm repair are susceptible to the development of delirium and are at risk for cognitive dysfunction after surgery. Our findings have implications for promoting long-term lifestyle changes, including smoking cessation and improved management of mental health as risk-reduction strategies.
Authors: Lori A Daiello; Annie M Racine; Ray Yun Gou; Edward R Marcantonio; Zhongcong Xie; Lisa J Kunze; Kamen V Vlassakov; Sharon K Inouye; Richard N Jones; David Alsop; Thomas Travison; Steven Arnold; Zara Cooper; Bradford Dickerson; Tamara Fong; Eran Metzger; Alvaro Pascual-Leone; Eva M Schmitt; Mouhsin Shafi; Michele Cavallari; Weiying Dai; Simon T Dillon; Janet McElhaney; Charles Guttmann; Tammy Hshieh; George Kuchel; Towia Libermann; Long Ngo; Daniel Press; Jane Saczynski; Sarinnapha Vasunilashorn; Margaret O'Connor; Eyal Kimchi; Jason Strauss; Bonnie Wong; Michael Belkin; Douglas Ayres; Mark Callery; Frank Pomposelli; John Wright; Marc Schermerhorn; Tatiana Abrantes; Asha Albuquerque; Sylvie Bertrand; Amanda Brown; Amy Callahan; Madeline D'Aquila; Sarah Dowal; Meaghan Fox; Jacqueline Gallagher; Rebecca Anna Gersten; Ariel Hodara; Ben Helfand; Jennifer Inloes; Jennifer Kettell; Aleksandra Kuczmarska; Jacqueline Nee; Emese Nemeth; Lisa Ochsner; Kerry Palihnich; Katelyn Parisi; Margaret Puelle; Sarah Rastegar; Margaret Vella; Guoquan Xu; Margaret Bryan; Jamey Guess; Dee Enghorn; Alden Gross; Yun Gou; Daniel Habtemariam; Ilean Isaza; Cyrus Kosar; Christopher Rockett; Douglas Tommet; Ted Gruen; Meg Ross; Katherine Tasker; James Gee; Ann Kolanowski; Margaret Pisani; Sophia de Rooij; Selwyn Rogers; Stephanie Studenski; Yaakov Stern; Anthony Whittemore; Gary Gottlieb; John Orav; Reisa Sperling Journal: Anesthesiology Date: 2019-09 Impact factor: 7.892
Authors: Gizat M Kassie; Tuan A Nguyen; Lisa M Kalisch Ellett; Nicole L Pratt; Elizabeth E Roughead Journal: Drugs Aging Date: 2018-03 Impact factor: 3.923
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