Risk factors for postoperative delirium after colorectal surgery for carcinoma

GERIATRIC SURGERY tinal surgery. In addition, the data regarding colorectal surgery are heterogeneous because they include both benign and malignant disease. The aim of this study was to investigate risk factors for POD in 100 consecutive patients older than 65 years who underwent colorectal surgery for carcinoma.

Risk factors for postoperative institutionalization in the elderly Arek J Wiktor MD, Thomas N Robinson MD, FACS University of Colorado Denver School of Medicine, Aurora, CO INTRODUCTION: Postdischarge institutionalization (PDI) is common in elderly patients following major operation. Specific aims: (1) To determine the incidence of PDI in elderly postoperative patients. (2) To describe the relationship of preoperative and intraoperative clinical markers to PDI. (3) To examine outcomes associated with PDI.

METHODS: Preoperative cognitive function was assessed using the Mini Mental State Examination. The onset of POD was diagnosed by the Confusion Assessment Methods administered to the patients 2 times daily for the first 5 postoperative days. Different parameters preoperatively, intraoperatively, and postoperatively were analyzed. Univariate and multivariate analysis were performed.

METHODS: Prospectively, subjects 50 years or older undergoing an elective operation with an anticipated postoperative intensive care unit (ICU) admission were enrolled. Preoperative baseline assessment included cognitive function (Mini-Cog Test), functional status (Barthel Index), and comorbidities (Charlson Index). The primary outcome variable was discharge to home versus PDI (dichotomous variable). Statistical analysis was performed using analysis of variance. Results are reported as mean ⫾ SD.

RESULTS: POD developed in 18 (18%). Univariate analysis revealed that advanced age (⬎ 75 years old), a history of smoking, a decreased serum albumin concentration (⬍3.8 g/dL), advanced cancer stage, prolonged operation time, large intraoperative blood loss, and cognitive function impairment were possible risk factors for POD. When patients’ perioperative condition and laboratory test results were subjected to multivariate analysis, only advanced age (odd ratio [OR],, 1.201; confidence interval [CI, 1.063–1.357), cognitive function impairment (OR, 1.185; CI, 1.032–1.261), decreased serum albumin concentration (OR, 0.151; CI, 0.025– 0.900), and prolonged operation time (OR, 1.203; CI, 1.068– 1.349) were independent risk factors for POD.

RESULTS: 167 subjects (average age, 64 ⫾ 9 years) were studied. PDI occurred in 17% (29/167). After Discharge Care Home (n ⴝ 138)

Institution (n ⴝ 29)

P-Value

CONCLUSIONS: These findings suggest that POD is a frequent complication after colorectal surgery for carcinoma. A model based on perioperative somatic and psychiatric risk factors allows prediction of the patient’s risk for developing POD.

Preoperative Age (y)

63 ⫾ 8

70 ⫾ 9

⬍0.01

Cognitive function (Mini-Cog)

4.0 ⫾ 1.3

2.6 ⫾ 1.4

⬍0.01

Functional status (Barthel)

97.4 ⫾ 7.2

88.5 ⫾ 10.6

⬍0.01

Comorbidities (Charlson)

2.6 ⫾ 2.0

4.9 ⫾ 2.5

⬍0.01

Albumin (g/dL)

3.7 ⫾ 0.5

2.9 ⫾ 0.7

⬍0.01

Operative time (min)

276 ⫾ 10

298 ⫾ 22

⫽0.37

Blood loss (mL)

603 ⫾ 91

561 ⫾ 134

⫽0.84

Red cell transfusion (units)

1.8 ⫾ 2.6

3.4 ⫾ 3.3

⬍0.01

Length of hospital stay (d)

9⫾7

20 ⫾ 12

⬍0.01

Length of ICU stay (d)

6⫾4

11 ⫾ 10

⬍0.01

Delirium in the critically ill geriatric surgical patient

Intraoperative

Christopher M Freeman BS, Rachael A Calcutt MD, MsPH, Bryce R Robinson MD, Richard D Branson MS, RRT, Blakeman Chris RRT, Krishna P Athota MD, Betty J Tsuei MD The University of Cincinnati, Cincinnati, OH

Outcomes

30-day mortality

2%

3%

⫽0.54

Six-month mortality

5%

24%

⬍0.01

INTRODUCTION: Delirium, an acute disturbance of consciousness, is present in up to 80% of patients in medical intensive care units (ICUs) and is associated with poor outcomes. This study investigates the incidence of, risk factors for, and outcomes associated with delirium in the elderly surgical ICU (SICU) patient.

CONCLUSIONS: PDI occurred in 1 in 5 ICU patients 50 years or older following major operation. Preoperative markers specific to the vulnerable aged patient (cognitive dysfunction, disability, and increased comorbidity) were closely associated with PDI. Outcomes were worse, including 6-month mortality, in elderly patients with PDI.

METHODS: Retrospective review of patients older than 60 years old admitted to the SICU of a tertiary referral hospital was undertaken. Patients with head injury, baseline dementia, or ICU length of stay (LOS) ⬍ 48 hours were excluded. The Confusion Assessment Method for the ICU (CAM-ICU) was part of the established nursing assessment, and delirium was defined as having at least 1 positive CAM-ICU assessment while in the SICU. Age, gender, APACHE II score, ventilator days, ICU and hospital LOS, mortality, and discharge disposition were analyzed using chi-squared, Fisher exact test, and Student t test.

Risk factors for postoperative delirium after colorectal surgery for carcinoma Rosalia K Patti MD, PhD, Giuseppe Caldiero MD, Antonino Tornanbe` MD, Rosaria Faraone Psych, Rosa Lo Baido MD, Gaetano Di Vita MD The University of Palermo, Palermo, Italy

RESULTS: Of the 121 patients analyzed, 42 (35%) were delirious during their SICU stay. Delirious patients had significantly higher APACHE II scores than patients without delirium (20.5 ⫾ 1.4 vs 16.7 ⫾ 0.9; p⫽0.011). Delirious patients had increased ventilator days (7.5 ⫾ 1.8 vs 1.6 ⫾ 0.3; p⫽0.001), ICU LOS (10.7 ⫾ 1.8 vs

INTRODUCTION: There are few studies that assess the incidence and risk factors for postoperative delirium (POD) after gastrointes-

© 2009 by the American College of Surgeons Published by Elsevier Inc.

ISSN 1072-7515/09/$34.00

S54