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Postop delirium heightens risk of other dangerous complications

Key clinical point: Delirium is the most common and among the most harmful of complications of elective surgery in older adults.

Major finding: Elderly patients who developed delirium had a twofold higher risk of prolonged length of stay, a 50% higher risk of discharge to an institution, and more than double the risk of 30-day readmission.

Data source: A prospective cohort study involving 566 older adults undergoing elective surgery at two hospitals in a 3-year period.

Disclosures: This study was supported by the National Institute on Aging, the Health and Resources Services Administration, and the John A. Hartford Foundation.


 

FROM JAMA SURGERY

References

Delirium is not only the most common major complication of elective surgery in older adults, it also markedly raises the risk of all adverse outcomes, including prolonged length of stay, discharge to an institution rather than home, and readmission within 30 days, according to a report published online Sept. 9 in JAMA Surgery.

“Given its high prevalence and negative effect, delirium should be considered as the leading postoperative complication contributing to adverse outcomes” in this patient population, wrote Dr. Lauren J. Gleason of the department of medicine at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, and her associates.

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Delirium is typically considered a less serious event than other major postoperative complications, even though its association with higher in-hospital mortality, 6-month mortality, functional decline, and higher health care costs has been well documented. To assess whether delirium should be considered equivalent to other major life-altering or life-threatening complications, the investigators studied 566 patients aged 70 years and older who underwent elective orthopedic, general, or vascular procedures at Beth Israel Deaconess or Brigham and Women’s Hospital in a 3-year period. The data were collected for the Successful Aging after Elective Surgery (SAGES) study.

Operations included total hip or knee replacement, lumbar or cervical laminectomy, lower-extremity bypass, open abdominal aortic aneurysm repair, open colectomyt, and laparoscopic colectomy. In general, these patients were highly functional and highly educated. The mean age was 76.7 years, and 93% of the study participants were white.

Delirium developed in 135 patients (24%) – much more frequently than all other major complications combined (47 patients, or 8%). This is comparable with rates of delirium reported in other studies of elective noncardiac surgeries, Dr. Gleason and her associates noted. Other major complications included unstable arrhythmias, respiratory failure, abscess requiring incision and drainage, abdominal compartment syndrome, anastomotic leak, deep surgical site infection, and hernia repair.

Compared with patients who didn’t develop delirium, those who did had a twofold higher risk of prolonged length of stay, a 50% higher risk of discharge to an institution, and more than double the risk of 30-day readmission, the investigators reported (JAMA Surg. 2015 Sept 9. doi: 10.1001/jamasurg.2015.2606).

Since delirium is often preventable, clinicians should try harder to implement preventive strategies before surgery and continue them afterward. The Hospital Elder Life Program, proactive geriatric consultation, and comanagement services all have proved effective in this regard, they added.

This study was supported by the National Institute on Aging, the Health and Resources Services Administration, and the John A. Hartford Foundation. The authors reported no relevant disclosures.

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