Impact of postanesthesia care unit delirium on self-reported cognitive function and perceived health status: a prospective observational cohort study

Elena Kainz, Karin Stuff, Ursula Kahl, Christian Wiessner, Yuanyuan Yu, Franziska von Breunig, Rainer Nitzschke, Alexander Haese, Markus Graefen, Marlene Fischer, Elena Kainz, Karin Stuff, Ursula Kahl, Christian Wiessner, Yuanyuan Yu, Franziska von Breunig, Rainer Nitzschke, Alexander Haese, Markus Graefen, Marlene Fischer

Abstract

Purpose: The objective of this study was to determine the influence of postanesthesia care unit (PACU) delirium on self-reported cognitive function and perceived health status 3 months after surgery.

Methods: This prospective observational cohort study was performed in a PACU at a high-volume prostate cancer center. We used a convenience sample of patients > 60 years undergoing elective radical prostatectomy. Patients with a history of cerebrovascular or neurodegenerative disease were excluded. Fifteen, 30, 45, and 60 following extubation, patients were screened for signs of delirium with the Confusion Assessment Method for the Intensive Care Unit. Three months after surgery self-reported cognitive function was assessed with the Cognitive Failures Questionnaire, and health status was evaluated with the 36-item Short-Form Health Survey (SF-36).

Results: Signs of PACU delirium were present in 32.4% (n = 72/222) of patients, and 80.2% (n = 178/222) completed the 3-month follow-up. The presence of PACU delirium signs was not significantly associated with self-reported cognitive failures (B = 0.60, 95% CI: -1.72; 2.92, p = 0.61) or SF-36 physical component scores (B = 0.19, 95% CI: 0.02; 0.36, p = 0.03) or SF-36 mental component scores (B = -0.03, 95% CI: -0.18, 0.11, p = 0.66) 3 months after radical prostatectomy.

Conclusions: In a cohort of educated, highly functioning, elderly male patients who were assessed immediately after surgery and at a 3-month follow-up, we found no association between PACU delirium and self-reported cognitive failures or perceived health status, which implies that PACU delirium may be an event of limited duration and impact.

Trial registration: The study was registered at ClinicalTrials.gov (Identifier: NCT04168268, Date of registration: November 19, 2019).

Keywords: Anesthesia recovery period; Cognitive dysfunction; Delirium; Perceived health status; Postoperative cognitive complications; Prostatectomy; Quality of life.

Conflict of interest statement

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flow of participants. PACU Postanesthesia care unit, CFQ Cognitive Failures Questionnaire, SF-36 36-item Short Form Health Survey. aRefractory cardiogenic shock after myocardial infarction
Fig. 2
Fig. 2
Incidence of PACU delirium during the first hour after extubation. PACU Postanesthesia care unit, CAM-ICU Confusion Assessment Method for the Intensive Care Unit. Data are presented as relative numbers. Assessment not possible: application of the CAM-ICU was not possible due to agitation or lethargy/no response. Assessment missing refers to patients with a score < −3 on the Richmond Assessment Agitation Scale or patients, who had urological physical and/or sonographic examination at the time of delirium screening: 15 min: n = 2; 30 min: n = 6; 45 min: n = 10; 60 min: = 14
Fig. 3
Fig. 3
Path diagrams for cognitive failures (a), SF-36 physical component score (b), and SF-36 mental component score (c). Postanesthesia care unit (PACU) delirium was included as an endogenous variable to assess a potential mediation effect on patient-reported outcomes. ASA American Society of Anesthesiologists, CFQ Cognitive Failures Questionnaire, PHQ-9 Patient Health Questionnaire, SF-36 Short Form Health Survey

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