Nathan Ziman1, Laura P Sands2, Christopher Tang3, Jiafeng Zhu4, Jacqueline M Leung5. 1. School of Medicine, Virginia Tech. 2. Center for Gerontology, Virginia Tech. 3. Department of Anesthesia & Perioperative Care, University of California, San Francisco. 4. Department of Statistics, Virginia Tech. 5. Department of Anesthesia & Perioperative Care, University of California, 500 Parnassus Avenue, Room MUE-415, San Francisco, CA 94143-0648, USA.
Abstract
OBJECTIVE: to determine whether incident postoperative delirium in elective older surgical patient was associated with increased risk for mortality, controlling for covariates of 5-year mortality. DESIGN: secondary analysis of prospective cohort studies. SETTING: academic Medical Center. SUBJECTS: patients ≥65 years of age undergoing elective non-cardiac surgery. OUTCOMES: postoperative assessments of delirium measured using the Confusion Assessment Method (CAM), mortality within 5 years of the index surgery was determined from National Death Index records. RESULTS: postoperative delirium occurred in 332/1,315 patients (25%). Five years after surgery, 175 patients (13.3%) were deceased. Older age was associated with an increased odds of mortality [odds ratio (OR) 1.90, 95% confidence interval (CI) 1.20-2.70] for those aged 70-79 years compared to those aged <70 years, and OR 3.29, 95% CI 2.14-5.06 for those aged >80 years. Other variables associated with 5-year mortality on bi-variate analyses were white race, self-rated functional status, lower preoperative cognitive status, higher risk score as measured by the American Society of Anesthesiologists (ASA) classification, higher surgical risk score, history of congestive heart failure, myocardial infarction, renal disease, cancer, peripheral vascular disease and postoperative delirium. However, postoperative delirium was not associated with 5-year mortality on multi-variate logistic regression (OR 1.18, 95% CI 0.85-1.65). CONCLUSIONS: our results showed that delirium was not associated with 5-year mortality in elective surgical patients after consideration of co-variates of mortality. Our results suggest the importance of accounting for known preoperative risks for mortality when investigating the relationship between delirium and long-term mortality.
OBJECTIVE: to determine whether incident postoperative delirium in elective older surgical patient was associated with increased risk for mortality, controlling for covariates of 5-year mortality. DESIGN: secondary analysis of prospective cohort studies. SETTING: academic Medical Center. SUBJECTS:patients ≥65 years of age undergoing elective non-cardiac surgery. OUTCOMES: postoperative assessments of delirium measured using the Confusion Assessment Method (CAM), mortality within 5 years of the index surgery was determined from National Death Index records. RESULTS:postoperative delirium occurred in 332/1,315 patients (25%). Five years after surgery, 175 patients (13.3%) were deceased. Older age was associated with an increased odds of mortality [odds ratio (OR) 1.90, 95% confidence interval (CI) 1.20-2.70] for those aged 70-79 years compared to those aged <70 years, and OR 3.29, 95% CI 2.14-5.06 for those aged >80 years. Other variables associated with 5-year mortality on bi-variate analyses were white race, self-rated functional status, lower preoperative cognitive status, higher risk score as measured by the American Society of Anesthesiologists (ASA) classification, higher surgical risk score, history of congestive heart failure, myocardial infarction, renal disease, cancer, peripheral vascular disease and postoperative delirium. However, postoperative delirium was not associated with 5-year mortality on multi-variate logistic regression (OR 1.18, 95% CI 0.85-1.65). CONCLUSIONS: our results showed that delirium was not associated with 5-year mortality in elective surgical patients after consideration of co-variates of mortality. Our results suggest the importance of accounting for known preoperative risks for mortality when investigating the relationship between delirium and long-term mortality.
Authors: Jacqueline M Leung; Laura P Sands; Eunjung Lim; Tiffany L Tsai; Sakura Kinjo Journal: Am J Geriatr Psychiatry Date: 2013-05-06 Impact factor: 4.105
Authors: Andres D Pelavski; Marcos De Miguel; Gabriela Alcaraz Garcia-Tejedor; Laura Villarino; Albert Lacasta; Lucía Señas; María I Rochera Journal: Anesth Analg Date: 2017-10 Impact factor: 5.108
Authors: Curtis N Sessler; Mark S Gosnell; Mary Jo Grap; Gretchen M Brophy; Pam V O'Neal; Kimberly A Keane; Eljim P Tesoro; R K Elswick Journal: Am J Respir Crit Care Med Date: 2002-11-15 Impact factor: 21.405
Authors: Allan Gottschalk; Jessica Hubbs; Ami R Vikani; Lindsey B Gottschalk; Frederick E Sieber Journal: Anesth Analg Date: 2015-11 Impact factor: 5.108
Authors: Jacqueline M Leung; Laura P Sands; Ningning Chen; Christopher Ames; Sigurd Berven; Kevin Bozic; Shane Burch; Dean Chou; Kenneth Covinsky; Vedat Deviren; Sakura Kinjo; Joel H Kramer; Michael Ries; Bobby Tay; Thomas Vail; Philip Weinstein; Stacey Chang; Gabriela Meckler; Stacey Newman; Tiffany Tsai; Vanessa Voss; Emily Youngblom Journal: Anesthesiology Date: 2017-10 Impact factor: 7.892
Authors: Jacqueline M Leung; Laura P Sands; Yun Wang; Annie Poon; Pui-yan Kwok; John P Kane; Clive R Pullinger Journal: Anesthesiology Date: 2007-09 Impact factor: 7.892