Incidence and predictors of postoperative delirium in the older acute care surgery population: a prospective study

Bianka Saravana-Bawan; Lindsey M. Warkentin; Diana Rucker; Frances Carr; Thomas A. Churchill; Rachel G. Khadaroo

doi:10.1503/cjs.016817

Article Figures & Tables

Tables

View popup

Table 1

Baseline characteristics of older (age ≥ 65 yr) acute care surgical patients according to delirium status

Characteristic	No delirium, no. (%) of patients^* n = 249	Delirium, no. (%) of patients^* n = 73
Characteristic	No delirium, no. (%) of patients^* n = 249	All episodes	Longer episodes^† n = 49
Age, yr, mean ± SD	75.7 ± 7.7	77.5 ± 7.4	77.8 ± 7.6
Female sex	113 (45.4)	33 (45.2)	24 (49.0)
White	176 (70.7)	62 (84.9)	38 (77.6)
Body mass index, mean ± SD	27.3 ± 6.0	26.4 ± 6.4	26.2 ± 7.0
Smoker	29 (11.6)	11 (15.1)	8 (16.3)
Living situation
Home without support	189 (75.9)	43 (58.9)^‡	28 (57.1)^‡
Home with informal caregiver	48 (19.3)	23 (31.5)^‡	15 (30.6)^‡
Supportive living/long-term care	11 (4.4)	6 (8.2)^‡	5 (10.2)^‡
Missing	1 (0.4)	1 (1.4)^‡	1 (2.0)^‡
Clinical Frailty Scale
Very fit/well	63 (25.3)	9 (12.3)^‡	3 (6.1)^‡
Managing well/vulnerable	141 (56.6)	31 (42.5)^‡	24 (49.0)^‡
Mildly or moderately frail	45 (18.1)	33 (45.2)^‡	22 (44.9)^‡
Charlson Comorbidity Index score, median (interquartile range)	0 (0–2)	1 (0–3)^‡	1 (1–2)^‡
Past medical history
Cardiovascular disease	65 (26.1)	28 (38.4)^‡	19 (38.8)^‡
Diabetes	50 (20.0)	14 (19.2)	12 (24.5)
Dyslipidemia	57 (22.9)	27 (37.0)^‡	17 (34.7)^‡
Cognitive decline	4 (1.6)	6 (8.2)^‡	4 (8.2)^‡
Sensory impairment	9 (3.6)	7 (9.6)^‡	5 (10.2)^‡
Respiratory problem	56 (22.5)	25 (34.2)^‡	15 (30.6)^‡
American Society of Anesthesiologists classification score, mean ± SD	2.6 ± 0.74	3.1 ± 0.78^‡	3.1 ± 0.73
Total no. of medications, mean ± SD	4.57 ± 3.44	5.85 ± 3.80^‡	5.73 ± 3.93^‡
Surgery area
Intestinal	94 (37.8)	48 (5.8.)^‡	33 (67.3)^‡
Appendix	29 (11.6)	6 (8.2)^‡	3 (6.1)^‡
Gallbladder	63 (25.3)	12 (16.4)^‡	8 (16.3)^‡
Hernia repair	40 (16.1)	3 (4.1)^‡	2 (4.1)^‡
Other	23 (9.2)	4 (5.5)^‡	3 (6.1)^‡
Time in operating room, min, mean ± SD	106 ± 55	127 ± 61^‡	126 ± 65^‡
Intensive care unit admission	21 (8.4)	22 (30.1)^‡	14 (28.6)^‡
Foley catheter use	153 (61.4)	64 (87.7)^‡	44 (89.8)^‡
Length of stay, d, median (interquartile range)	7 (4–11)	16 (9–29)^‡	16 (10–29)^‡

SD = standard deviation.
↵* Except where noted otherwise.
↵† Acute confusional state for 48 hours or more.
↵‡ p < 0.05 compared to no delirium.

View popup

Table 2

Multivariable logistic regression analysis for overall delirium and longer delirium episodes

Variable	OR (95% CI)
Variable	Overall delirium	Longer delirium episodes
Appendix surgery	5.26 (1.40–19.75)	—
Intestinal surgery	4.74 (1.86–12.08)	—
Mild to moderate frailty	4.50 (1.76–11.50)	7.77 (2.18–27.65)
Gallbladder surgery	4.48 (1.41–14.17)	—
Foley catheter use	3.37 91.36–8.35)	4.48 (1.76–11.50)
Intensive care unit admission	1.37 (1.06–1.78)	—