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Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
Postoperative delirium and 1-year functional decline, institutionalization and mortality
Olga de la Varga-Martínez1, Rosalía Navarro Pérez, Rocío López Herrero
1From the BioCritic Group for Biomedical Research in Critical Care Medicine (OdlVM, RLH, GRC, BMR, RPA, MVD, ET), Valladolid Health Research Institute (IBioVALL), Valladolid (OdlVM, RLH, BMR, RPA, ET), Department of Anaesthesiology, University Hospital Infanta Leonor (OdlVM), Department of Anaesthesiology, University Hospital San Carlos (RNP), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid (RLH, RPA, ET), Department of Anaesthesiology, Clinic University Hospital of Valladolid (RLH, GRC, BMR, RPA, ET), Department of Surgery, University of Valladolid (RLH, BMR, RPA, ET), Biomedical Reengineering Group, University of Valladolid, Valladolid (ESV), Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Instituto de Salud Carlos III, Madrid (ESV), Department of Anaesthesiology, University Hospital of Gran Canaria Doctor Negrin, Las Palmas de Gran Canaria (ABB), Department of Anaesthesiology, Hospital Universitario Fundación Alcorcón, Madrid (AMEM), Department of Anaesthesiology, Parc Taulí Health Corporation University Hospital, Sabadell, Barcelona (MdlRE), Department of Anaesthesiology, Sant Joan d'Alacant University Hospital, Alicante (NB), Department of Anaesthesiology, Hospital de Sant Pau, Barcelona (MGS), Department of Anaesthesiology, University Hospital 12 de Octubre (AML), Department of Anaesthesiology, Móstoles University Hospital, Madrid (DMNC), Department of Anaesthesiology, University Hospital Miguel Servet, Zaragoza (MEIM), Department of Anaesthesiology, University Hospital La Princesa, Madrid (LAGA), Department of Anaesthesiology, University Hospital of Manises, Valencia (ACS), Department of Anaesthesiology, University Hospital of Fuenlabrada, Madrid (JAF), Faculty of Psychology, University of Valencia (RBG), INCLIVA Biomedical Research Institute (RBG, NRG, RB), Department of Anaesthesiology and Surgical-Trauma Intensive Care, Hospital Clínic Universitari de València (NRG, RB), Department of Surgery, School of Medicine, University of Valencia, Valencia (NRG, RB), Department of Anaesthesiology, Complejo Hospitalario Universitario de Canarias, Tenerife (BDD), Cruz Roja San José y Santa Adela University Hospital, Madrid (GPG), Department of Anaesthesiology, University Hospital San Cecilio, Granada (RVdS), Department of Anaesthesiology, University Hospital of Salamanca, Salamanca (MHR, ILY), Department of Anaesthesiology, University Hospital of Burgos, Burgos (CTG), Department of Anaesthesiology, University Hospital of León, León (JMMV), Department of Anaesthesiology, Valencia General Hospital Consortium, Valencia (CFG), Department of Anaesthesiology, Central University Hospital of Asturias, Oviedo (LVR), Department of Anaesthesiology, Critical Care and Pain Clinic, Hospital Universitari de Bellvitge (LCL, LPJ), Department of Clinical Sciences, School of Medicine, Universitat de Barcelona (LCL), Health Group, Neuroscience Program, Perioperative Physiopathology and Pain, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona (LCL), Department of Anaesthesiology, University Hospital Marqués de Valdecilla, Santander (MAF), Department of Anaesthesiology, University Hospital Lucus Augusti, Lugo (RFF), Department of Anaesthesiology, University Hospital Puerta del Hierro, Madrid (CSG), Department of Anaesthesiology, University Hospital of Donostia, San Sebastian (EdVP), Department of Anaesthesiology, Ferrol University Hospital Complex, Ferrol (MARC), Department of Anaesthesiology, University Hospital of A Coruña, A Coruña (AGP), Department of Anaesthesiology, University Hospital of Cabueñes, Gijón (AHS), Department of Anaesthesiology, University Hospital Álvaro Cunqueiro, Vigo (AARA, IdlTR, GIM, CDM), Department of Surgery, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela (MVD), Department of Anaesthesiology, University Hospital of Pontevedra, Pontevedra (MVD) and Institute of Sanitary Research Galicia Sur (IISGS), Spain (MVD).
Background:
Postoperative delirium is a common and serious complication in older surgical patients and has been associated with increased morbidity, healthcare costs, long-term functional decline and mortality.
Objective:
To determine whether postoperative delirium is associated with functional status, quality of life, institutionalisation and mortality at 1 year after surgery in a large multicentre surgical cohort.
Design:
Prospective multicentre observational study.
Setting:
Forty-three hospitals in Spain. Surgical patients were recruited in November 2023 and assessed for delirium 48 h after surgery, with follow-up at 1 year.
Patients, Other Participants:
A total of 2442 adult surgical patients undergoing elective or urgent procedures requiring hospital admission. Postoperative delirium was assessed using the Confusion Assessment Method (CAM), CAM for the Intensive Care Unit (CAM-ICU) or the telephone-administered 4AT according to clinical setting.
Interventions:
None.
Main Outcome Measures:
Functional status and quality of life at 1 year assessed using the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0). Secondary outcomes included institutionalisation and mortality.
Results:
After excluding 81 deaths and 462 nonresponders, the 1-year telephone follow-up was completed for 1899 patients. Postoperative delirium within the first 48 h was independently associated with a 4.6-point higher WHODAS score at 1 year: adjusted mean difference = 4.60 [95% confidence interval (CI), 1.57 to 7.64, P = 0.003]. Delirium was also associated with increased institutionalisation and higher mortality: odds ratio (OR) 2.5 (95% CI, 1.07 to 5.84, P = 0.03), and (16.7 vs. 3.1%; P < 0.001), including 30-day, 60-day, and 365-day mortality (all P < 0.001), respectively.
Conclusions:
Postoperative delirium is independently associated with long-term functional decline, loss of independence, institutionalisation and increased 1-year mortality. These findings highlight delirium as a key perioperative complication and support prevention strategies and structured long-term follow-up after surgery.
Trial Registration:
ClinicalTrials.gov (identifier: NC-T06127901).