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Research

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 and Rachel G. Khadaroo
CAN J SURG February 01, 2019 62 (1) 33-38; DOI: https://doi.org/10.1503/cjs.016817
Bianka Saravana-Bawan
From the Department of Surgery, University of Alberta, Edmonton, Alta. (Saravana-Bawan, Warkentin, Churchill, Khadaroo); the Division of Geriatrics, Department of Medicine, University of Alberta, Edmonton, Alta. (Rucker, Carr); and the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Khadaroo)
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Lindsey M. Warkentin
From the Department of Surgery, University of Alberta, Edmonton, Alta. (Saravana-Bawan, Warkentin, Churchill, Khadaroo); the Division of Geriatrics, Department of Medicine, University of Alberta, Edmonton, Alta. (Rucker, Carr); and the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Khadaroo)
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Diana Rucker
From the Department of Surgery, University of Alberta, Edmonton, Alta. (Saravana-Bawan, Warkentin, Churchill, Khadaroo); the Division of Geriatrics, Department of Medicine, University of Alberta, Edmonton, Alta. (Rucker, Carr); and the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Khadaroo)
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Frances Carr
From the Department of Surgery, University of Alberta, Edmonton, Alta. (Saravana-Bawan, Warkentin, Churchill, Khadaroo); the Division of Geriatrics, Department of Medicine, University of Alberta, Edmonton, Alta. (Rucker, Carr); and the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Khadaroo)
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Thomas A. Churchill
From the Department of Surgery, University of Alberta, Edmonton, Alta. (Saravana-Bawan, Warkentin, Churchill, Khadaroo); the Division of Geriatrics, Department of Medicine, University of Alberta, Edmonton, Alta. (Rucker, Carr); and the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Khadaroo)
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Rachel G. Khadaroo
From the Department of Surgery, University of Alberta, Edmonton, Alta. (Saravana-Bawan, Warkentin, Churchill, Khadaroo); the Division of Geriatrics, Department of Medicine, University of Alberta, Edmonton, Alta. (Rucker, Carr); and the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Khadaroo)
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    Table 1

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

    CharacteristicNo delirium, no. (%) of patients*
    n = 249
    Delirium, no. (%) of patients*
    n = 73
    All episodesLonger episodes†
    n = 49
    Age, yr, mean ± SD75.7 ± 7.777.5 ± 7.477.8 ± 7.6
    Female sex113 (45.4)33 (45.2)24 (49.0)
    White176 (70.7)62 (84.9)38 (77.6)
    Body mass index, mean ± SD27.3 ± 6.026.4 ± 6.426.2 ± 7.0
    Smoker29 (11.6)11 (15.1)8 (16.3)
    Living situation
     Home without support189 (75.9)43 (58.9)‡28 (57.1)‡
     Home with informal caregiver48 (19.3)23 (31.5)‡15 (30.6)‡
     Supportive living/long-term care11 (4.4)6 (8.2)‡5 (10.2)‡
     Missing1 (0.4)1 (1.4)‡1 (2.0)‡
    Clinical Frailty Scale
     Very fit/well63 (25.3)9 (12.3)‡3 (6.1)‡
     Managing well/vulnerable141 (56.6)31 (42.5)‡24 (49.0)‡
     Mildly or moderately frail45 (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 disease65 (26.1)28 (38.4)‡19 (38.8)‡
     Diabetes50 (20.0)14 (19.2)12 (24.5)
     Dyslipidemia57 (22.9)27 (37.0)‡17 (34.7)‡
     Cognitive decline4 (1.6)6 (8.2)‡4 (8.2)‡
     Sensory impairment9 (3.6)7 (9.6)‡5 (10.2)‡
     Respiratory problem56 (22.5)25 (34.2)‡15 (30.6)‡
    American Society of Anesthesiologists classification score, mean ± SD2.6 ± 0.743.1 ± 0.78‡3.1 ± 0.73
    Total no. of medications, mean ± SD4.57 ± 3.445.85 ± 3.80‡5.73 ± 3.93‡
    Surgery area
     Intestinal94 (37.8)48 (5.8.)‡33 (67.3)‡
     Appendix29 (11.6)6 (8.2)‡3 (6.1)‡
     Gallbladder63 (25.3)12 (16.4)‡8 (16.3)‡
     Hernia repair40 (16.1)3 (4.1)‡2 (4.1)‡
     Other23 (9.2)4 (5.5)‡3 (6.1)‡
    Time in operating room, min, mean ± SD106 ± 55127 ± 61‡126 ± 65‡
    Intensive care unit admission21 (8.4)22 (30.1)‡14 (28.6)‡
    Foley catheter use153 (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.

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    Table 2

    Multivariable logistic regression analysis for overall delirium and longer delirium episodes

    VariableOR (95% CI)
    Overall deliriumLonger delirium episodes
    Appendix surgery5.26 (1.40–19.75)—
    Intestinal surgery4.74 (1.86–12.08)—
    Mild to moderate frailty4.50 (1.76–11.50)7.77 (2.18–27.65)
    Gallbladder surgery4.48 (1.41–14.17)—
    Foley catheter use3.37 91.36–8.35)4.48 (1.76–11.50)
    Intensive care unit admission1.37 (1.06–1.78)—
    • CI = confidence interval; OR = odds ratio.

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Canadian Journal of Surgery: 62 (1)
CAN J SURG
Vol. 62, Issue 1
1 Feb 2019
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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
CAN J SURG Feb 2019, 62 (1) 33-38; DOI: 10.1503/cjs.016817

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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
CAN J SURG Feb 2019, 62 (1) 33-38; DOI: 10.1503/cjs.016817
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