INTRODUCTION: Postoperative delirium (POD) is a subtype of delirium that commonly occurs within the first three days after a surgical procedure. Common risk factors for POD include advanced age, dementia, visual and hearing impairment, alcohol abuse, illicit drug use, and previous history of delirium.This study aimed to investigate the risk factors associated with POD in elderly surgical patients following elective surgical procedures.
METHODS: This is a prospective observational study. Demographic information and clinical data were collected for adult patients over 65 years old who underwent elective surgical procedures that required general anesthesia at Boston Medical Center (BMC) between May 2021 and November 2022. POD was assessed using the Confusion Assessment Method, which was administered by the nursing staff as part of usual care protocols at BMC. Univariate analysis was utilized to assess potential risk factors. A multivariate logistic regression with odds ratio (OR) and 95% confidence interval (CI) was conducted in order to identify independent risk factors.
RESULTS: A total of 89 patients were enrolled in this study, including 43 male and 46 female patients. Four patients presented with POD following their surgical procedure, making the incidence of POD in this study 4.5%. There was a statistically significant difference regarding frequency of alcohol use, with 50% of POD patients classified as having frequent alcohol use compared to 7.1% of patients without POD (p = 0.029). POD patients had significantly lower incidence of increased blood pressure fluctuations during surgery compared to patients without POD (50% versus 95.3%, p = 0.012). Increased blood pressure fluctuation during surgery was also identified as a significant protective factor in elderly patients without POD (OR: 0.002, p = 0.015) POD was also significantly associated with administration of postoperative olanzapine (25% versus 0%, p = 0.027) and quetiapine (25% versus 0%, p = 0.027).
CONCLUSIONS: POD in elderly patients after elective surgery procedures with general anesthesia is significantly associated with frequent alcohol use, postoperative administration of quetiapine, and postoperative administration of olanzapine. Increased blood pressure fluctuations was significantly greater in patients without POD, which suggests it may be an important protective factor against POD. Future study should consider focusing on the effects of hemodynamics in the development of POD.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/48299 |
| Date | 01 March 2024 |
| Creators | Malta, Stephanie Marie |
| Contributors | Canelli, Robert, Nozari, Ala |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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