Handover of anesthesia care is associated with an increased risk of delirium in elderly after major noncardiac surgery: results of a secondary analysis

Guang-Yu Liu, Xian Su, Zhao-Ting Meng, Fan Cui, Hong-Liang Li, Sai-Nan Zhu, Dong-Xin Wang, Guang-Yu Liu, Xian Su, Zhao-Ting Meng, Fan Cui, Hong-Liang Li, Sai-Nan Zhu, Dong-Xin Wang

Abstract

In patients undergoing major surgery, complete handover of intraoperative anesthesia care is associated with adverse postoperative outcomes including high mortality and more major complications. The purpose of this study was to explore the association between the intraoperative complete handover between anesthesiologists and the occurrence of postoperative delirium. This was a secondary analysis of the database of a previously published clinical trial. Seven hundred patients aged 65 years or older, who were admitted to the intensive care unit after noncardiac surgery, were included. Delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit twice daily during the first 7 postoperative days. Other postoperative outcomes were also monitored. The association between the intraoperative complete handover of anesthesia care and the development of postoperative delirium was analyzed with a logistic regression model. Of the 700 enrolled patients, 111 (15.9%) developed postoperative delirium within 7 days. After correction for confounding factors, intraoperative complete handover between anesthesiologists was associated with an increased risk of postoperative delirium (OR 1.787, 95% CI 1.012-3.155, P = 0.046). Patients with intraoperative complete handover also had higher incidence of non-delirium complications (P = 0.003) and stayed longer in hospital after surgery (P = 0.002). For elderly patients admitted to the intensive care unit after noncardiac surgery, intraoperative complete handover of anesthesia care was associated with an increased risk of postoperative delirium. Chinese Clinical Trial Registry ( http://www.chictr.org.cn ): ChiCTR-TRC-10000802.

Keywords: Delirium; Elderly; Handover; Noncardiac surgery; Postoperative outcome.

Conflict of interest statement

Dong-Xin Wang reports lecture fees and travel expenses for lectures given at domestic academic meetings from Jiangsu Hengrui Medicine Co Ltd, China, and Yichang Humanwell Pharmaceutical Co Ltd, China. The other authors report no conflicting interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study
Fig. 2
Fig. 2
Daily prevalence of postoperative delirium in patients with or without complete handover of intraoperative anesthesia care. Some patients died or discharged from hospital within 7 days after surgery, leading to different sample sizes during this period
Fig. 3
Fig. 3
The occurrence of non-delirium complications (a) and the length of stay in hospital after surgery (b) in patients with or without complete handover of intraoperative anesthesia care

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