High rate of delirium in senior citizens after
surgery increases risk of cognitive decline, nursing home
45 percent have
delirium in recovery room; adverse effects on hospital outcomes;
increased nursing home admission
July 24, 2013 – Close to half of senior citizens
undergoing surgery with general anesthesia are found to have delirium in
the post anesthesia care unit (PACU), according to a study in the August
issue of Anesthesia & Analgesia, official journal of the
International Anesthesia Research Society (IARS).
Delirium - sudden severe
confusion and rapid changes in brain function - occurring
early after surgery is linked to decreased cognitive (mental) function
and an increased rate of nursing home admission, according to the study
by Dr. Karin J. Neufeld of Johns Hopkins University and colleagues.
"Recognizing delirium in the PACU may be important
for identifying patients at higher risk of in-hospital harms…as well as
cognitive impairment and institutionalization at hospital discharge,"
Many Older Patients Have Delirium after Surgery
The researchers performed testing for delirium in
the PACU (recovery room) in 91 older adults undergoing major surgery
with general anesthesia. Delirium was defined as "acute change in level
of consciousness, inattention, and disturbed cognitive function." It's a
common medical problem—especially in hospitalized patients.
The patients' average age was 79 years, and nearly
80 percent were living independently before their operation. All
received widely used forms of general anesthesia for surgery.
On analysis by experts using standard diagnostic
criteria, 45 percent of the patients had delirium in the PACU. In many
cases, delirium persisted after the patient was moved to the hospital
wards. Overall, about three-fourths of all cases of delirium occurring
in the hospital after surgery started in the PACU.
Patients with early delirium had decreased mental
function, with significant reduction on a standard cognitive test. The
decline was significant even after adjustment for other factors,
including initial cognitive score and duration of surgery.
Patients with early, persistent delirium were more
likely to be discharged to a nursing home or other institution, rather
than being sent home: 39 percent, compared to three percent of patients
without delirium in the PACU. Of patients who had early delirium but
were normal on the day after surgery, 26 percent were discharged to an
A 'Common But Not Universal' Problem
The results show that delirium is a "common but not
universal" problem for elderly patients undergoing surgery, according to
Dr. Neufeld and coauthors. They point out that 55 percent of patients
did not have delirium in the PACU. Eighty percent of patients who were
free of delirium in the PACU remained normal throughout their hospital
But even brief episodes of postoperative delirium
may have lasting effects in older adults, the study suggests. Dr.
Neufeld and colleagues note that many cases of delirium would have been
missed if monitoring had started the day after surgery, rather than in
the recovery room. They call for further studies of the rate and impact
of early delirium after anesthesia and surgery, including evaluation of
longer-term patient outcomes.
Analgesia was founded in 1922 and is a leading journal
for anesthesia clinicians and researchers and includes more than 500
articles annually in all areas related to anesthesia and analgesia, such
as cardiovascular anesthesiology, patient safety, anesthetic
pharmacology, and pain management. The journal is published on behalf of
the IARS by Lippincott Williams & Wilkins (LWW),
a division of