Zhimin Pan1,2, Kai Huang3, Wei Huang4, Ki Hoon Kim5, Hao Wu2, Yanghong Yu6, Keung Nyun Kim1, Seong Yi1, Dong Ah Shin1, Darshan Vora7, Cristian Gragnaniello7, Kevin Phan8, Anastasia Tasiou9, Mark J Winder10, Hisashi Koga11, Parisa Azimi12, Suk Yun Kang13, Yoon Ha1. 1. Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea. 2. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China. 3. Department of Orthopedics, Zhabei Central Hospital of Jing'an District, Shanghai 200070, China. 4. Department of Clinical Laboratory, Jiangxi Province Children's Hospital, Nanchang 330006, China. 5. Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea. 6. Department of Radiology, Jiangxi Province Children's Hospital, Nanchang 330006, China. 7. Department of Neurosurgery, George Washington University, Washington, DC 20037, USA. 8. NeuroSpine Surgery Research Group (NSURG), Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Randwick, NSW 2031, Australia. 9. Department of Neurosurgery, University Hospital of Larissa, Larissa 41110, Greece. 10. Department of Neurosurgery, St Vincent's Public and Private Hospitals, Darlinghurst 2010, NSW, Australia. 11. PELD Center, Iwai Orthopaedic Medical Hospital, Tokyo 133-0056, Japan. 12. Functional Neurosurgery Research Center of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 13. Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, Republic of Korea.
Abstract
BACKGROUND: To prospectively explore the incidence and risk factors for postoperative delirium in elderly patients following lumbar spine surgery. METHODS: This prospective study enrolled 148 consecutive patients over the age of 65 who were scheduled to undergo spine surgery. Patients were screened for delirium using the short Confusion Assessment Method (CAM) postoperatively. Patient demographics and relevant medical information were collected. Logistic regression analysis was used to identify the risk factors associated with postoperative delirium. RESULTS: Eighty-three patients (56.1%) who underwent lumbar spine surgery (not coexisting with cervical or thoracic spine surgery) were enrolled in our study. Post-operative delirium was noted in 14.5% of patients over 65 years old. The presence of preoperative Parkinsonism was significantly higher in the delirium group (41.7% vs. 8.5%, P=0.002), as was a higher preoperative C-reactive protein (CRP) (7.0±15.2 vs. 1.3±2.3 mg/L, P=0.017) when compared with the non-delirium group. Of the risk factors, male sex [odds ratio (OR) =0.10, 95% confidence interval (CI): 0.01-0.66, P=0.017], Parkinsonism (OR =5.83, 95% CI: 1.03-32.89, P=0.046), and lower baseline MMSE score (OR =0.71, 95% CI: 0.52-0.97, P=0.032) were independently associated with postoperative delirium in elderly patients undergoing lumbar spine surgery. CONCLUSIONS: Post-operative delirium occurred in 14.5% of elderly patients who underwent lumbar spine surgery. Male sex, Parkinsonism, and lower baseline MMSE score were identified as independent risk factors for postoperative delirium in elderly patients following lumbar surgery.
BACKGROUND: To prospectively explore the incidence and risk factors for postoperative delirium in elderly patients following lumbar spine surgery. METHODS: This prospective study enrolled 148 consecutive patients over the age of 65 who were scheduled to undergo spine surgery. Patients were screened for delirium using the short Confusion Assessment Method (CAM) postoperatively. Patient demographics and relevant medical information were collected. Logistic regression analysis was used to identify the risk factors associated with postoperative delirium. RESULTS: Eighty-three patients (56.1%) who underwent lumbar spine surgery (not coexisting with cervical or thoracic spine surgery) were enrolled in our study. Post-operative delirium was noted in 14.5% of patients over 65 years old. The presence of preoperative Parkinsonism was significantly higher in the delirium group (41.7% vs. 8.5%, P=0.002), as was a higher preoperative C-reactive protein (CRP) (7.0±15.2 vs. 1.3±2.3 mg/L, P=0.017) when compared with the non-delirium group. Of the risk factors, male sex [odds ratio (OR) =0.10, 95% confidence interval (CI): 0.01-0.66, P=0.017], Parkinsonism (OR =5.83, 95% CI: 1.03-32.89, P=0.046), and lower baseline MMSE score (OR =0.71, 95% CI: 0.52-0.97, P=0.032) were independently associated with postoperative delirium in elderly patients undergoing lumbar spine surgery. CONCLUSIONS: Post-operative delirium occurred in 14.5% of elderly patients who underwent lumbar spine surgery. Male sex, Parkinsonism, and lower baseline MMSE score were identified as independent risk factors for postoperative delirium in elderly patients following lumbar surgery.
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Authors: Shane Shahrestani; Joshua Bakhsheshian; Xiao T Chen; Andy Ton; Alexander M Ballatori; Ben A Strickland; Djani M Robertson; Zorica Buser; Raymond Hah; Patrick C Hsieh; John C Liu; Jeffrey C Wang Journal: EClinicalMedicine Date: 2021-05-15