Delirium common in older patients after gastrointestinal surgery
Postoperative delirium (POD) may be a common occurrence in older patients following gastrointestinal (GI) surgery, according to a systematic review and meta-analysis, highlighting the need for physicians to identify those at risk for POD and to come up with tailored interventions.
“Delirium is not exclusive to medical healthcare settings,” said lead investigator Dr. Anna Scholz from the Cardiff University in Cardiff, Wales, UK. POD was tied up to longer hospital stay (mean difference [MD], 4.56 days) and higher risk of dying in older patients (odds ratio [OR], 4.03) compared to patients without delirium. [Br J Surg 2016;103:e21-28]
Using five databases, Scholz and her team searched the available evidence in general surgery and analysed data on 1,427 patients (318 with delirium and 1,109 without) from 11 studies. Patients’ age ranged from 68 to 81 years and most underwent elective colorectal surgery.
POD incidence ranged from 8.2 to 54.4 percent in these patients following GI surgery. After assessing all risk factors, advanced age, poor physical status (ASA grade ≥3), low body mass index, low serum albumin levels, intraoperative hypotension, perioperative blood transfusion, and history of alcohol excess appeared to demonstrate significantly higher risks for POD in a pooled analysis.
“The risk factors identified in this review will aid the planning of future studies to explore the extent of their effect, as well as the impact of tailored interventions,” Scholz and team said. “By stratifying patients, intervention studies can be planned, which should result in improvements in patient care.”
Delirium is common but often undiagnosed in geriatric post operative patients and can result in falls, aspiration pneumonia, and pulling of tubes or lines in some patients. Thus, recognition and treatment of POB is critically important.