Key result
Postoperative delirium occurred in 35% of elderly patients undergoing urgent abdominal surgery, with narcotic analgesics identified as an independent risk factor (OR 5.3; 95% CI 1.2-23.8).
Why the study?
Elderly patients have an increased risk of postoperative delirium, prompting an evaluation of its incidence and risk factors following urgent surgery.
Cohort (n=46)
No
Odds Ratio: 5.3 (95% CI 1.2–23.8)
In elderly patients undergoing urgent abdominal surgery, postoperative delirium occurred in 35% of cases, with age ≥78, dementia, fragility, and narcotic analgesics identified as independent risk factors.
Narcotics were associated with higher delirium risk in elderly urgent surgery; leaves open whether minimization reduces incidence.
Postoperative delirium (POD) is an acute complication after surgery that can occur in patients of any age, from children to the elderly. It is believed that the elderly have an increased risk of developing POD, due to a combination of cognitive deficits, comorbidities, fragility, polymedicine, malnutrition and aging. The aim of the study was to assess the incidence of POD and determine the impact of risk factors on the development of POD. Object and methods. After passing the Commission on Bioethics at Zaporizhzhya State Medical University and obtaining informed consent, 46 elderly patients who underwent surgery on the abdominal organs in an urgent manner were consistently included in the one-center prospective study. Results. According to the results of our study, POD was detected in 35% of cases (n = 16) among patients who underwent emergency surgery. In our study, the analysis of the ROC curve showed that the age of ≥78 years is the optimal threshold age for the development of POD with a sensitivity of 56.2% and a specificity of 82.1%. The score on the Mini-Cog scale of 3 points is the optimal threshold level for the development of POD with a sensitivity of 87.5% and a specificity of 53.5%. To determine the risk of POD using the Delphi scale, analysis of the ROC curve showed that a score of 7 points is the optimal threshold level for the development of POD with a sensitivity of 81.25% and a specificity of 78.57%. In our study, the analysis of the ROC curve showed that the assessment on the scale of wear ≥3 points is the optimal threshold level for the development of POD with a sensitivity of 68.7% and a specificity of 53.5%. According to the results of the analysis of the ROC-curve of leukocytosis, 13.4 *109 /l is the optimal threshold level of leukocytes for the development of POD with a sensitivity of 57.1% and a specificity of 85.2%. The use of narcotic analgesics for postoperative analgesia (odds ratio 5.3, 95%, confidence interval 1.2-23.8) was one of the independent risk factors for POD. Conclusions. POD was recorded in 35% of cases among patients who underwent non-cardiac surgery in an urgent manner. Dementia, age 78 years and older, fragility greater than 3 points, and postoperative analgesia with narcotic analgesics were independent risk factors for POD.
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Demiter et al. (2020) conducted a cohort in Postoperative delirium (POD) (n=46). Risk factors (including narcotic analgesics, age ≥78 years, dementia, fragility) was evaluated on Development of postoperative delirium (POD) (OR 5.3, 95% CI 1.2-23.8). Postoperative delirium occurred in 35% of elderly patients undergoing urgent abdominal surgery, with narcotic analgesics identified as an independent risk factor (OR 5.3; 95% CI 1.2-23.8).
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