Severe preoperative resting pain increased the risk of postoperative delirium (OR 3.7; 95% CI 1.5-9.0), while using oral opioids instead of IV PCA decreased the risk (OR 0.4; 95% CI 0.2-0.7).
Cohort (n=333)
Are postoperative pain and pain management strategies associated with postoperative delirium in elderly patients undergoing major noncardiac surgery?
Preoperative pain and the method of postoperative pain management are significant independent predictors of postoperative delirium in elderly patients undergoing major noncardiac surgery.
Odds Ratio: 0.4 (95% CI 0.2–0.7)
In Brief Postoperative delirium is common in geriatric patients. Few studies have examined events in the postoperative period that may contribute to the occurrence of postoperative delirium. We hypothesized that postoperative delirium is related to postoperative pain and/or pain management strategy. Patients aged ≥65 years who were scheduled for major noncardiac surgery were studied. A structured interview was conducted preoperatively and for the first 3 postoperative days to determine the presence of delirium using the Confusion Assessment Method. The method of postoperative pain management, as well as pre- and postoperative medications for the first 3 days, was collected. Pre- and postoperative pain at rest and with movement was recorded using the Visual Analog Scale. Three hundred thirty-three patients, with a mean age of 74 ± 6 years, were studied. After surgery, 46% of patients developed postoperative delirium. By multivariate logistic regression, age (odds ratio OR, 2.5; 95% confidence interval CI 1.5 to 4.2), moderate (OR, 2.2; 95% CI 1.2 to 4.0) and severe (OR, 3.7; 95% CI 1.5 to 9.0) preoperative resting pain, and increase in level of pain from baseline to postoperative day one (OR, 1.1; 95% CI 1.01 to 1.2) were independently associated with a greater risk for the development of postoperative delirium. In contrast, patients who used oral opioid analgesics as their sole means of postoperative pain control were at decreased risk of developing delirium in comparison with those who used opioid analgesics via IV patient-controlled analgesia technique (OR, 0.4; 95% CI 0.2 to 0.7). These results validate our hypothesis that pain and pain management strategies are important factors related to the development of postoperative delirium in elderly patients. IMPLICATIONS: Our study demonstrates that pain and pain management strategies are important factors related to the development of postoperative delirium in elderly patients. These results suggest that elderly surgical patients with substantial preoperative baseline pain should be targeted for more intensive pain control or addition of adjuvant analgesia postoperatively.
Vaurio et al. (2006) conducted a cohort in Postoperative delirium (n=333). Oral opioid analgesics vs. Opioid analgesics via IV patient-controlled analgesia was evaluated on Development of postoperative delirium (OR 0.4, 95% CI 0.2-0.7). Severe preoperative resting pain increased the risk of postoperative delirium (OR 3.7; 95% CI 1.5-9.0), while using oral opioids instead of IV PCA decreased the risk (OR 0.4; 95% CI 0.2-0.7).