Older patients undergoing gastrointestinal surgery often experience postoperative delirium. In an analysis of 11 studies, incidence of postoperative delirium ranged from 8.2% to 54.4%. The findings from this systematic review and meta-analysis were published in the British Journal of Surgery (doi:10.1002/bjs.10062).
Delirium is an acute clouding of consciousness linked to an underlying physiologic disturbance, according to background information in the article. Preventive strategies and early recognition can reduce postoperative delirium by one-third.
Pooling the data from the 11 studies, which included 1427 patients, 318 with delirium, the research team identified 7 risk factors that were significantly associated with delirium: old age, American Society of Anesthesiologists (ASA) physical status grade at least III, body mass index, lower serum level of albumin, intraoperative hypotension, perioperative blood transfusion, and history of alcohol excess.
Those patients who experience postoperative delirium tended to stay in the hospital longer and die earlier than patients without delirium.
“The importance of delirium in critical care and older adult patients is well recognized. We have demonstrated that delirium is not exclusive to ‘medical’ health care settings; our review summarizes the available evidence in general surgery and highlights a number of areas where more research is urgently needed,” said Anna Scholz, MD, of Cardiff University, Glasgow Royal Infirmary, and North Bristol NHS Trust in the United Kingdom, and lead author of the study.
The authors stated that better understanding of the risk factors for delirium may allow better stratification of patients before surgery. This will enable interventions and health care resources to be better targeted.