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Delirium in fast-track colonic surgery
Sorel Kurbegovic1, Jens Andersen, Lene Krenk
1Section of Surgical Pathophysiology, Rigshospitalet Copenhagen University, 4074, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Langenbeck'S Archives of Surgery
|March 17, 2015
Summary
Enhanced recovery programs may reduce the risk of postoperative delirium (PD) after colonic surgery. This study found a low incidence of PD, suggesting improved patient outcomes with these enhanced recovery protocols.
Area of Science:
- Colorectal Surgery
- Anesthesiology
- Geriatric Medicine
Background:
- Postoperative delirium (PD) is a frequent complication following major surgery.
- Its multifactorial causes include age, pain, opioids, and surgical stress.
- Enhanced recovery after surgery (ERAS) protocols, or fast-track methodology, aim to mitigate these factors.
Purpose of the Study:
- To evaluate the incidence and duration of PD in patients undergoing colonic surgery within an enhanced recovery program.
- To assess the impact of the enhanced recovery program on PD development and patient outcomes.
Main Methods:
- A prospective study of 247 consecutive patients undergoing colonic surgery within a defined enhanced recovery program.
- Clinical symptoms of PD were monitored thrice daily from pre-operation to discharge.
- Data on patient demographics, surgical approach (open vs. laparoscopic), and length of stay were collected.
Main Results:
- The overall incidence of PD was low at 2.8% (7 patients), with most cases occurring within 72 hours post-operation.
- PD patients were significantly older (83 vs. 73 years) and had a longer hospital stay (6 vs. 3 days).
- No difference in PD rates was observed between open and laparoscopic surgery. Three PD patients experienced subsequent surgical complications, including strangulated small intestine and anastomotic leakage.
Conclusions:
- Enhanced postoperative recovery programs appear to reduce the incidence and duration of postoperative delirium in colonic surgery patients.
- These findings support the implementation of ERAS protocols to improve patient recovery and minimize PD risk.
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