Retrospective Analysis of Perioperative Variables Associated With Postoperative Delirium and Other Adverse Outcomes in Older Patients After Spine Surgery

Maria J Susano, Seth D Scheetz, Rachel H Grasfield, Dominique Cheung, Xinling Xu, James D Kang, Timothy R Smith, Yi Lu, Michael W Groff, John H Chi, Gregory Crosby, Deborah J Culley, Maria J Susano, Seth D Scheetz, Rachel H Grasfield, Dominique Cheung, Xinling Xu, James D Kang, Timothy R Smith, Yi Lu, Michael W Groff, John H Chi, Gregory Crosby, Deborah J Culley

Abstract

Background: The aim of this retrospective study was to identify perioperative variables predictive of the development of delirium in older surgical patients after spine surgery.

Materials and methods: We collected preoperative, intraoperative, and postoperative data on patients 65 years of age and above having spine surgery between July 1, 2015 and March 15, 2017. The primary outcome was the development of postoperative delirium. Data were analyzed using univariate and multivariable analysis.

Results: Among the 716 patients included in this study 127 (18%) developed postoperative delirium. On multivariable analysis, independent predictors of postoperative delirium included older age (odds ratio [OR]=1.04; 95% confidence interval [CI], 1.00-1.09; P=0.048), American Society of Anesthesiologists physical status >2 (OR=1.89 [95% CI, 1.04-3.59]; P=0.042), metabolic equivalents of task <4 (OR=1.84 [95% CI, 1.10-3.07]; P=0.019), depression (OR=2.01 [95% CI, 1.21-3.32]; P=0.006), nonelective surgery (OR=4.81 [95% CI, 1.75-12.79]; P=0.002), invasive surgical procedures (OR=1.97 [95% CI, 1.10-3.69]; P=0.028) and higher mean pain scores on postoperative day 1 (OR=1.28 [95% CI, 1.11-1.48]; P<0.001).

Conclusions: Postoperative delirium is a common complication in older patients after spine surgery, and there are several perioperative risk factors associated with its development.

Conflict of interest statement

Conflicts of Interest:

MJS: None

SDS: Boston MSTAR (Medical Student Training in Aging Research) supported by a National Institutes of Aging/NIH T35 Research Training Grant

RHG: None

JDK: None

TRS: None

MWG: None

JHC: None

YL: None

MWG: None

JHC: K2M- advisory board/consultant, Medtronic consultant. Neither are related to the topic of the paper.

XX: None

Figures

Figure 1.
Figure 1.
Flow diagram based on primary outcome (Postoperative Delirium)
Figure 2.
Figure 2.
Receiver operating characteristic (ROC) curve of the final model for postoperative delirium.

References

    1. Wan He DG, and Paul Kowal. U.S. Census Bureau, International Population Reports, P95/16–1, An Aging World: 2015. U.S. Government Publishing Office, Washington, DC, 2016
    1. Etzioni DA, Liu JH, Maggard MA, et al.: The aging population and its impact on the surgery workforce. Ann Surg 2003; 238: 170–7
    1. Pfuntner A, Wier LM, Stocks C: Most Frequent Procedures Performed in U.S. Hospitals, 2011: Statistical Brief #165, Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD), 2006
    1. Lagman C, Ugiliweneza B, Boakye M, et al.: Spine Surgery Outcomes in Elderly Patients Versus General Adult Patients in the United States: A MarketScan Analysis. World Neurosurg 2017; 103: 780–788
    1. Marcantonio ER: Postoperative delirium: a 76-year-old woman with delirium following surgery. JAMA 2012; 308: 73–81
    1. Brown CH, LaFlam A, Max L, et al.: Delirium After Spine Surgery in Older Adults: Incidence, Risk Factors, and Outcomes. J Am Geriatr Soc 2016; 64: 2101–2108
    1. Fineberg SJ, Nandyala SV, Marquez-Lara A, et al.: Incidence and risk factors for postoperative delirium after lumbar spine surgery. Spine 2013; 38: 1790–6
    1. Shi C, Yang C, Gao R, et al.: Risk Factors for Delirium After Spinal Surgery: A Meta-Analysis. World Neurosurg 2015; 84: 1466–72
    1. Jiang X, Chen D, Lou Y, et al.: Risk factors for postoperative delirium after spine surgery in middle- and old-aged patients. Aging Clin Exp Res 2016; 29:1039–1044
    1. Elsamadicy AA, Wang TY, Back AG, et al.: Post-operative delirium is an independent predictor of 30-day hospital readmission after spine surgery in the elderly (>/=65years old): A study of 453 consecutive elderly spine surgery patients. J Clin Neurosci 2017; 41: 128–131
    1. Tong HC, Haig AJ, Geisser ME, et al.: Comparing pain severity and functional status of older adults without spinal symptoms, with lumbar spinal stenosis, and with axial low back pain. Gerontology 2007; 53: 111–5
    1. Kuhn E, Du X, McGrath K, et al.: Validation of a consensus method for identifying delirium from hospital records. PLoS One 2014; 9: e111823.
    1. Armaghani SJ, Lee DS, Bible JE, et al.: Preoperative opioid use and its association with perioperative opioid demand and postoperative opioid independence in patients undergoing spine surgery. Spine 2014; 39: E1524–30
    1. SP. K: Opioid (Opiate) Equianalgesia Conversion Calculator, August 22. ClinCalc: . Accessed August 22, 2017.
    1. D M: Narcotic analgesic converter. . Accessed August 22, 2017, 2013
    1. Farrar JT, Young JP Jr., LaMoreaux L, et al.: Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001; 94: 149–58
    1. Harris PA, Taylor R, Thielke R, et al.: Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377–81
    1. Inouye SK: Delirium in older persons. N Engl J Med 2006; 354: 1157–65
    1. Kawaguchi Y, Kanamori M, Ishihara H, et al.: Postoperative delirium in spine surgery. Spine J 2006; 6: 164–9
    1. Inouye SK, Bogardus ST Jr., Charpentier PA, et al.: A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999; 340: 669–76
    1. Raats JW, van Eijsden WA, Crolla RM, et al.: Risk Factors and Outcomes for Postoperative Delirium after Major Surgery in Elderly Patients. PLoS One 2015; 10: e0136071.
    1. Scholz AF, Oldroyd C, McCarthy K, et al.: Systematic review and meta-analysis of risk factors for postoperative delirium among older patients undergoing gastrointestinal surgery. Br J Surg 2016; 103: e21–8
    1. Culley DJ, Flaherty D, Fahey MC, et al.: Poor Performance on a Preoperative Cognitive Screening Test Predicts Postoperative Complications in Older Orthopedic Surgical Patients. Anesthesiology 2017; 127:765–774
    1. Ganai S, Lee KF, Merrill A, et al.: Adverse outcomes of geriatric patients undergoing abdominal surgery who are at high risk for delirium. Arch Surg 2007; 142: 1072–8
    1. Leung JM, Sands LP, Mullen EA, et al.: Are preoperative depressive symptoms associated with postoperative delirium in geriatric surgical patients? J Gerontol A Biol Sci Med Sci 2005; 60: 1563–8
    1. Knaggs JD, Larkin KA, Manini TM: Metabolic cost of daily activities and effect of mobility impairment in older adults. J Am Geriatr Soc 2011; 59: 2118–23
    1. Ansaloni L, Catena F, Chattat R, et al.: Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery. Br J Surg 2010; 97: 273–80
    1. Vaurio LE, Sands LP, Wang Y, et al.: Postoperative delirium: the importance of pain and pain management. Anesth Analg 2006; 102: 1267–73
    1. Radtke FM, Franck M, Lendner J, et al.: Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. Br J Anaesth 2013; 110 Suppl 1: i98–105
    1. Chan MT, Cheng BC, Lee TM, et al.: BIS-guided anesthesia decreases postoperative delirium and cognitive decline. J Neurosurg Anesthesiol 2013; 25: 33–42
    1. Rudolph JL, Inouye SK, Jones RN, et al.: Delirium: an independent predictor of functional decline after cardiac surgery. J Am Geriatr Soc 2010; 58: 643–9
    1. Martin BJ, Buth KJ, Arora RC, et al.: Delirium: a cause for concern beyond the immediate postoperative period. Ann Thorac Surg 2012; 93: 1114–20
    1. American Geriatrics Society Expert Panel on Postoperative Delirium in Older A: Postoperative delirium in older adults: best practice statement from the American Geriatrics Society. J Am Coll Surg 2015; 220: 136–48 e1

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj