Postoperative Delirium Risk Assessment, Prevention, Detection, and Management
Main Article Content
Keywords
perioperative medicine, delerium
Abstract
There is strong evidence to support prevention of postoperative delirium through comprehensive geriatric assessment and multicomponent nonpharmacologic interventions. Risk assessment must be accompanied by communication of the risk to the patient, caregivers, and perioperative interdisciplinary team to engage all in evidence-based prevention interventions. However, once postoperative delirium has developed, efforts should be focused on prevention of short- and long-term adverse effects.
RÉSUMÉ
Des données probantes solides appuient la prévention du délire postopératoire en recourant à une évaluation gériatrique complète et à des interventions non pharmacologiques à plusieurs composantes. L’évaluation des risques doit s’accompagner d’une communication du risque au patient, aux soignants et à l’équipe interdisciplinaire périopératoire afin que tous participent aux interventions de prévention fondées sur des données probantes. Toutefois, une fois que le délire postopératoire s’est installé, les efforts doivent être axés sur la prévention des effets indésirables à court et à long terme.
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4. Robinson TN, Raeburn CD, Tran ZV, Angles EM, Brenner LA, Moss M. Postoperative delirium in the elderly: Risk factors and outcomes. Ann Surg. 2009;249(1):173–8. http://dx.doi.org/10.1097/SLA.0b013e31818e4776
5. Partridge JSL, Crichton S, Biswell E, Harari D, Martin FC, Dhesi JK. Measuring the distress related to delirium in older surgical patients and their relatives. Int J Geriatr Psychiatry. 2019;34(7):1070–7. http://dx.doi.org/10.1002/gps.5110
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7. Hshieh TT, Saczynski J, Gou RY, et al. Trajectory of functional recovery after postoperative delirium in elective surgery. Ann Surg. 2017. http://dx.doi.org/10.1097/SLA.0000000000001952
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11. American College of Surgeons. Optimal resources for geriatric surgery: 2019 standards. 2019.
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13. Inouye SK, Marcantonio ER, Kosar CM, et al. The short-term and long-term relationship between delirium and cognitive trajectory in older surgical patients. Alzheimers Dement. 2016;12(7):766–75. http://dx.doi.org/10.1016/j.jalz.2016.03.005
14. Arias F, Wiggins M, Urman RD, et al. Rapid in-person cognitive screening in the preoperative setting: Test considerations and recommendations from the Society for Perioperative Assessment and Quality Improvement (SPAQI). Perioper Care Oper Room Manag. 2020;19:100089. http://dx.doi.org/10.1016/j.pcorm.2020.100089
15. Heng M, Eagen CE, Javedan H, Kodela J, Weaver MJ, Harris MB. Abnormal Mini-Cog is associated with higher risk of complications and delirium in geriatric patients with fracture. J Bone Jt Surg Am Vol. 2016;98(9):742–50. http://dx.doi.org/10.2106/JBJS.15.00859
16. Standardized Mini-Cog© Instrument—Mini-Cog© [Internet]. [cited 2020 Oct 3]. Available from: https://mini-cog.com/mini-cog-instrument/standardized-mini-cog-instrument/
17. Inouye SK, Westendorp RGJ, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–22. http://dx.doi.org/10.1016/S0140-6736(13)60688-1
18. Watt J, Tricco AC, Talbot-Hamon C, et al. Identifying older adults at risk of delirium following elective surgery: A systematic review and meta-analysis. J Gen Intern Med. 2018;33(4):500–9. http://dx.doi.org/10.1007/s11606-017-4204-x
19. Postoperative delirium in older adults: Best practice statement from the American geriatrics society. J Am Coll Surg. 2015;220(2):136–48.e1. http://dx.doi.org/10.1016/j.jamcollsurg.2014.10.019
20. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381:752–62. http://dx.doi.org/10.1016/S0140-6736(12)62167-9
21. Aucoin SD, Aucoin SD, Aucoin SD, et al. Accuracy and feasibility of clinically applied frailty instruments before surgery: A systematic review and meta-analysis. Anesthesiology. 2020;133(1):78–95. http://dx.doi.org/10.1097/ALN.0000000000003257
22. Lawton MP, Brody EM. Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3 Part 1):179–86. http://dx.doi.org/10.1093/geront/9.3_Part_1.179
23. Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of ADL. Gerontologist. 1970;10(1):20–30. http://dx.doi.org/10.1093/geront/10.1_Part_1.20
24. Dasgupta M, Dumbrell AC. Preoperative risk assessment for delirium after noncardiac surgery: A systematic review. J Am Geriatr Soc. 2006;54:1578–89. http://dx.doi.org/10.1111/j.1532-5415.2006.00893.x
25. Marcantonio ER, Goldman L, Mangione CM, et al. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA J Am Med Assoc. 1994;271(2):134–9. http://dx.doi.org/10.1001/jama.1994.03510260066030
26. Rudolph JL, Jones RN, Levkoff SE, et al. Derivation and validation of a preoperative prediction rule for delirium after cardiac surgery. Circulation. 2009;119(2):229–36. http://dx.doi.org/10.1161/CIRCULATIONAHA.108.795260
27. Rubenstein LZ, Stuck AE, Siu AL, Wieland D. Impacts of geriatric evaluation and management programs on defined outcomes: Overview of the evidence. J Am Geriatr Soc. 1991. http://dx.doi.org/10.1111/j.1532-5415.1991.tb05927.x
28. Eamer G, Taheri A, Chen SS, et al. Comprehensive geriatric assessment for older people admitted to a surgical service. Cochrane Database Syst Rev. 2018. http://dx.doi.org/10.1002/14651858.CD012485.pub2
29. Ludolph P, Stoffers-Winterling J, Kunzler AM, et al. Non-pharmacologic multicomponent interventions preventing delirium in hospitalized people. J Am Geriatr Soc. 2020. http://dx.doi.org/10.1111/jgs.16565
30. Hshieh TT, Yang T, Gartaganis SL, Yue J, Inouye SK. Hospital elder life program: Systematic review and meta-analysis of effectiveness. Am J Geriatr Psychiatry. 2018. http://dx.doi.org/10.1016/j.jagp.2018.06.007
31. Rudolph JL, Marcantonio ER. Postoperative delirium: Acute change with long-term implications. Anesth Analg. 2011. http://dx.doi.org/10.1213/ANE.0b013e3182147f6d
32. Marcantonio ER, Juarez G, Goldman L, et al. The relationship of postoperative delirium with psychoactive medications. JAMA J Am Med Assoc. 1994. http://dx.doi.org/10.1001/jama.1994.03520190064036
33. Remy C, Marret E, Bonnet F. Effects of acetaminophen on morphine side-effects and consumption after major surgery: Meta-analysis of randomized controlled trials. Br J Anaesth. 2005. http://dx.doi.org/10.1093/bja/aei085
34. Wang YY, Yue JR, Xie DM, et al. Effect of the tailored, family-involved hospital elder life program on postoperative delirium and function in older adults: A randomized clinical trial. JAMA Intern Med. 2020. http://dx.doi.org/10.1001/jamainternmed.2019.4446
35. Radtke FM, Franck M, MacGuill M, et al. Duration of fluid fasting and choice of analgesic are modifiable factors for early postoperative delirium. Eur J Anaesthesiol. 2010;27(5):411–16. http://dx.doi.org/10.1097/EJA.0b013e3283335cee
36. Tow A, Holtzer R, Wang C, et al. Cognitive reserve and postoperative delirium in older adults. J Am Geriatr Soc. 2016;64(6):1341–6. http://dx.doi.org/10.1111/jgs.14130
37. Humeidan ML, Reyes JPC, Mavarez-Martinez A, et al. Effect of cognitive prehabilitation on the incidence of postoperative delirium among older adults undergoing major noncardiac surgery: The neurobics randomized clinical trial. JAMA Surg. 2020. http://dx.doi.org/10.1001/jamasurg.2020.4371
38. Oh ES, Needham DM, Nikooie R, et al. Antipsychotics for preventing delirium in hospitalized adults a systematic review. Ann Intern Med. 2019. http://dx.doi.org/10.7326/M19-1859
39. Larsen KA, Kelly SE, Stern TA, et al. Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: A randomized, controlled trial. Psychosomatics. 2010. http://dx.doi.org/10.1016/s0033-3182(10)70723-4
40. Campbell AM, Axon DR, Martin JR, Slack MK, Mollon L, Lee JK. Melatonin for the prevention of postoperative delirium in older adults: A systematic review and meta-analysis. BMC Geriatr. 2019;19(1). http://dx.doi.org/10.1186/s12877-019-1297-6
41. Hovaguimian F, Tschopp C, Beck-Schimmer B, Puhan M. Intraoperative ketamine administration to prevent delirium or postoperative cognitive dysfunction: A systematic review and meta-analysis. Acta Anaesthesiol Scand. 2018. http://dx.doi.org/10.1111/aas.13168
42. Liptzin B. Donepezil in the prevention and treatment of post-surgical delirium. Am J Geriatr Psychiatry. 2005. http://dx.doi.org/10.1176/appi.ajgp.13.12.1100
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Mar 16, 2021
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Wong CL, von Maltzahn M. Postoperative Delirium: Risk Assessment, Prevention, Detection, and Management. Can Journ Gen Int Med [Internet]. 2021 Mar. 16 [cited 2023 Nov. 28];16(SP1):37-42. Available from: https://www.cjgim.ca/index.php/csim/article/view/532
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Author Biographies
Camilla L. Wong, University of Toronto, Toronto, ON, Canada
Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto
Maia von Maltzahn, Dalhousie University
Dalhousie University, Halifax, Nova Scotia