Delirium Common in Older Gastrointestinal Surgery Patients

Delirium is a common occurrence among older patients who have undergone gastrointestinal surgery, according to a new study.

A team of investigators searched 5 databases—MEDLINE, Web of Science, Embase, CINAHL^®, and PSYCinfo^®—between January 1987 and November 2014, using the Newcastle-Ottawa Scale to rate study quality. Ultimately, 11 studies met the researchers’ criteria, providing a total of 1,427 patients—318 with delirium and 1,109 without—and predominantly including patients who underwent elective colorectal surgery. The incidence of postoperative delirium (POD) ranged from 8.2% to 54.4%, A total of 95 risk factors were investigated, according to the authors, who say this range illustrates “wide heterogeneity in study design.”
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Overall, 7 statistically significant risk factors were identified in pooled analysis—old age, an American Society of Anesthesiologists (ASA) physical status grade of at least III, body mass index (BMI), lower serum level of albumin, intraoperative hypotension, perioperative blood transfusion, and history of alcohol excess.

Ultimately, the researchers found that patients with POD demonstrated a significantly increased duration of hospital stay, and a higher mortality rate compared to those without delirium, and concluded that delirium is ordinary in older patients undergoing gastrointestinal surgery, with several risk factors consistently associated with postoperative delirium.

Study co-author Jonathan Hewitt, MD, a clinical senior lecturer of geriatric medicine at Cardiff University’s Institute of Primary Care and Public Health, urges primary care practitioners to “consider delirium a potential side effect of surgery, and discuss this with their patients.”

In addition, says Hewitt, primary care practitioners should be mindful that “any patient who becomes delirious can take several weeks or even months to fully recover after leaving the hospital.”

—Mark McGraw

Reference:

Scholz A, Oldroyd C, et al. Systematic review and meta-analysis of risk factors for postoperative delirium among older patients undergoing gastrointestinal surgery. BJS. 2016.