Postoperative delirium tied to worse surgical outcomes in older adults

In older adults undergoing elective abdominal cancer resection, postoperative delirium (POD) appears to lead to poor surgical outcomes, a recent Taiwan study has found.

The study included 345 patients (aged ≥65 years, 59.7 percent men), in whom POD was measured using the Confusion Assessment Method. Delirium evaluations were conducted daily. Colorectal cancer was the most prevalent indication (51.9 percent), and majority had stage I disease. Participants underwent surgery for a median of 276 minutes and lost a median blood volume of 50 mL.

Overall, 19 patients developed POD, yielding an incidence rate of 5.5 percent. One of the patients had grade I delirium, characterized by an acute confusional state. The remaining 18 patients were scored delirium grade II, which referred to a state of delirium that limited instrumental activities of daily living on top of an acute confusional state.

Logistic regression analysis revealed that patients aged ≥75 years were more than twice as likely to develop POD (adjusted odds ratio [OR], 2.11, 95 percent confidence interval [CI], 1.03–4.27; p=0.045), as were those who had a Charlson comorbidity index score ≥3 (adjusted OR, 2.37, 95 percent CI, 1.01–6.65; p=0.041). An operative time ≥420 minutes likewise increased the likelihood of POD (adjusted OR, 3.85, 95 percent CI, 1.06–13.9; p=0.04).

In turn, those with POD were at a higher risk of adverse surgical outcomes, such as 90-day death (adjusted OR, 4.2, 95 percent CI, 1.0–17.9; p=0.041), intensive care unit stay (adjusted OR, 3.9, 1.5–10.5; p=0.008), 30-day readmission (adjusted OR, 2.7, 95 percent CI, 1.1–9.7; p=0.039), and prolonged hospital stay (>14 days: adjusted OR, 2.8, 95 percent CI, 1.0–8.1; p=0.037).