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Postoperative Delirium After Intracranial Surgery: A Retrospective Cohort Study.
Pablo R Kappen1, Hilbert J Kappen2, Clemens M F Dirven1
1Department of Neurosurgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
World Neurosurgery
|January 7, 2023
Summary
Postoperative delirium (POD) affects nearly 20% of neurosurgery patients, increasing intensive care unit admissions and residential care discharges. Identifying risk factors like age and modifiable elements can guide future interventions.
Area of Science:
- Neurosurgery
- Geriatric Medicine
- Critical Care Medicine
Background:
- Postoperative delirium (POD) in neurosurgery patients is poorly understood.
- Neurosurgical patients are particularly vulnerable to delirium.
- The clinical relevance and risk factors for POD require investigation.
Purpose of the Study:
- To investigate the incidence of POD in neurosurgery patients.
- To determine the impact of POD on patient health outcomes.
- To identify independent risk factors associated with POD.
Main Methods:
- Retrospective study of adult patients undergoing intracranial surgery (June 2017-September 2020).
- POD incidence defined by Delirium Observation Screening Scale (DOSS) score or antipsychotic treatment.
- Logistic regression analysis used for risk factor and outcome assessment.
Main Results:
- POD incidence was 19.4%, with a mean onset of 2.62 days.
- POD correlated with increased ICU admissions and discharge to residential care.
- Nonmodifiable risk factors included age, prior memory issues, emergency surgery, craniotomy, and blood loss. Modifiable factors included low potassium, opioids, and dexamethasone.
Conclusions:
- POD significantly impacts neurosurgical patients, evidenced by higher ICU admissions and residential care discharges.
- Identified modifiable and nonmodifiable risk factors offer targets for future interventions.
- Further research can elucidate pathophysiologic mechanisms and inform preventative strategies.
