ABSTRACT
Background
Delirium is among the most common complications following major surgery. Delirium
following medical illness is associated with the development of chronic cognitive
decline. The objective of this study was to determine the association of postoperative
delirium with dementia in the year following surgery.
Materials and methods
This was a retrospective cohort study in a large health network (January 2013 to December
2019). All patients over age 50 undergoing surgery requiring an inpatient stay were
included. Our main exposure was an episode of delirium. The primary outcome was a
new dementia diagnosis in the 1 y following discharge. Secondary outcomes included
hospital length of stay, non-home discharge destination, mortality and rehospitalizations
in 1 y.
Results
There were 39,665 patients included, with a median age of 66. There were 4156 of 39,665
emergencies (10.5%). Specialties were general surgery (12,285/39,665, 31%) and orthopedics
(11,503/39,665, 29%). There were 3327 (8.4%) patients with delirium. Delirious patients
were older and were more likely to have comorbid conditions and undergone complex
procedures. There were 1353 of 39,665 (3.5%) patients who developed dementia in the
year following their surgery; 4930 of 39,665 (12.4%) who died; and 8200 of 39,665
(20.7%) who were readmitted. Delirium was associated with a new dementia diagnosis
after adjusting for baseline characteristics (Odds ratio [OR] 13.9; 95% CI, 12.2-15.7).
Similarly, delirium was also associated with 1 y mortality (OR 3.1; 95% CI 2.9-3.4)
and readmission (OR 1.9, 95% CI 1.7-2.0).
Conclusions
Postoperative delirium is the strongest factor associated with development of dementia
in the year following a major operation. Strategies to prevent, identify, and treat
delirium in the postoperative setting may improve long-term cognitive recovery.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Surgical ResearchAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Delirium in elderly people.Lancet. 2014; 383: 911-922https://doi.org/10.1016/S0140-6736(13)60688-1
- American geriatrics society clinical practice guideline for postoperative delirium in older adults.J Am Geriatr Soc. 2015; 63: 142-150https://doi.org/10.1111/jgs.13281
- The association between delirium and cognitive decline: a review of the empirical literature.Neuropsychol Rev. 2004; 14: 87-98https://doi.org/10.1023/B:NERV.0000028080.39602.17
- Delirium and long-term cognitive impairment.Int Rev Psychiatry. 2009; 21: 30-42https://doi.org/10.1080/09540260802675031
- Long-term cognitive impairment after critical illness.N Engl J Med. 2013; 369: 1306-1316https://doi.org/10.1056/NEJMoa1301372
- Delirium as a predictor of long-term cognitive impairment in survivors of critical illness.Crit Care Med. 2010; 38: 1513-1520https://doi.org/10.1097/CCM.0b013e3181e47be1
- The short-term and long-term relationship between delirium and cognitive trajectory in older surgical patients.Alzheimers Dement. 2016; 12: 766-775https://doi.org/10.1016/j.jalz.2016.03.005
- Postoperative delirium in elderly patients is associated with subsequent cognitive impairment.Br J Anaesth. 2017; 119: 316-323https://doi.org/10.1093/bja/aex130
- Delirium superimposed on dementia strongly predicts worse outcomes in older rehabilitation inpatients.J Am Med Dir Assoc. 2014; 15: 349-354https://doi.org/10.1016/j.jamda.2013.12.084
- Delirium severity post-surgery and its relationship with long-term cognitive decline in a cohort of patients without dementia.J Alzheimers Dis. 2018; 61: 347-358https://doi.org/10.3233/JAD-170288
- One-year medicare costs associated with delirium in older patients undergoing major elective surgery.JAMA Surg. 2021; (Published online February 24)https://doi.org/10.1001/jamasurg.2020.7260
- The Department of Veterans Affairs’ NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program.Ann Surg. 1998; 228: 491-507
- Successful implementation of the Department of Veterans Affairs’ National Surgical Quality Improvement Program in the private sector: the patient safety in surgery study.Ann Surg. 2008; 248: 329-336https://doi.org/10.1097/SLA.0b013e3181823485
- Impact and recognition of cognitive impairment among hospitalized elders.J Hosp Med. 2010; 5: 69-75https://doi.org/10.1002/jhm.589
- Recommendations for optimal ICD codes to study neurologic conditions.Neurology. 2012; 79: 1049-1055https://doi.org/10.1212/WNL.0b013e3182684707
- The Successful Aging after Elective Surgery (SAGES) Study: cohort description and data quality procedures.J Am Geriatr Soc. 2015; 63 (Epub 2015 Dec 14): 2463-2471https://doi.org/10.1111/jgs.13793
- Tryptophan supplementation and postoperative delirium – a randomized controlled trial.J Am Geriatr Soc. 2014; 62: 1764-1771https://doi.org/10.1111/jgs.12972
- Prospective evaluation of delirium in geriatric patients undergoing emergency general surgery.J Am Coll Surg. 2020; 230 (Epub 2020 Feb 21): 758-765https://doi.org/10.1016/j.jamcollsurg.2020.01.029
- Postoperative delirium as a target for surgical quality improvement.Ann Surg. 2018; 268: 93-99https://doi.org/10.1097/SLA.0000000000002436
- Delirium accelerates cognitive decline in Alzheimer disease.Neurology. 2009; 72: 1570-1575https://doi.org/10.1212/WNL.0b013e3181a4129a
- Association between delirium and cognitive change after cardiac surgery.Br J Anaesth. 2017; 119: 308-315https://doi.org/10.1093/bja/aex053
- Prediction of long-term cognitive decline following postoperative delirium in older adults.J Gerontol A Biol Sci Med Sci. 2017; 72: 1697-1702https://doi.org/10.1093/gerona/glx030
- Cognitive trajectories after postoperative delirium.N Engl J Med. 2012; 367: 30-39https://doi.org/10.1056/NEJMoa1112923
- Trajectory of functional recovery after postoperative delirium in elective surgery.Ann Surg. 2017; 265: 647-653https://doi.org/10.1097/SLA.0000000000001952
Article info
Publication history
Published online: October 29, 2021
Accepted:
August 27,
2021
Received in revised form:
July 22,
2021
Received:
April 13,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
