Postoperative delirium in elderly patients is associated with subsequent cognitive impairment

J. Sprung, Rosebud O Roberts, T. N. Weingarten, A. Nunes Cavalcante, David S Knopman, Ronald Carl Petersen, A. C. Hanson, D. R. Schroeder, David Oman Warner

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

We examined the risk for postoperative delirium (POD) in patients with mild cognitive impairment (MCI) or dementia, and the association between POD and subsequent development of MCI or dementia in cognitively normal elderly patients. Methods. Patients 65 yr of age enrolled in the Mayo Clinic Study of Aging who were exposed to any type of anaesthesia from 2004 to 2014 were included. Cognitive status was evaluated before and after surgery by neuropsychological testing and clinical assessment, and was defined as normal or MCI/dementia. Postoperative delirium was detected with the Confusion Assessment Method for the intensive care unit. Logistic regression analyses were performed. Results. Among 2014 surgical patients, 74 (3.7%) developed POD. Before surgery, 1667 participants were cognitively normal, and 347 met MCI/dementia criteria. The frequency of POD was higher in patients with pre-existing MCI/dementia compared with no MCI/dementia {8.7 vs 2.6%; odds ratio (OR) 2.53, [95% confidence interval (CI) 1.52-4.21]; P<0.001}. Postoperative delirium was associated with lower education [OR, 3.40 (95% CI, 1.60-7.40); P0.002 for those with <12 vs 16 yr of schooling]. Of the 1667 patients cognitively normal at their most recent assessment, 1152 returned for postoperative evaluation, and 109 (9.5%) met MCI/dementia criteria. The frequency of MCI/dementia at the first postoperative evaluation was higher in patients who experienced POD compared with those who did not [33.3 vs 9.0%; adjusted OR, 3.00 (95% CI, 1.12-8.05); P0.029].

Original languageEnglish (US)
Pages (from-to)316-323
Number of pages8
JournalBritish Journal of Anaesthesia
Volume119
Issue number2
DOIs
StatePublished - Aug 1 2017

Fingerprint

Delirium
Dementia
Odds Ratio
Confidence Intervals
Confusion
Cognitive Dysfunction
Intensive Care Units
Anesthesia
Logistic Models
Regression Analysis
Education

Keywords

  • aged
  • anaesthesia
  • delirium
  • dementia
  • female
  • general
  • humans
  • male
  • mild cognitive impairment
  • surgery

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Postoperative delirium in elderly patients is associated with subsequent cognitive impairment. / Sprung, J.; Roberts, Rosebud O; Weingarten, T. N.; Nunes Cavalcante, A.; Knopman, David S; Petersen, Ronald Carl; Hanson, A. C.; Schroeder, D. R.; Warner, David Oman.

In: British Journal of Anaesthesia, Vol. 119, No. 2, 01.08.2017, p. 316-323.

Research output: Contribution to journalArticle

Sprung, J. ; Roberts, Rosebud O ; Weingarten, T. N. ; Nunes Cavalcante, A. ; Knopman, David S ; Petersen, Ronald Carl ; Hanson, A. C. ; Schroeder, D. R. ; Warner, David Oman. / Postoperative delirium in elderly patients is associated with subsequent cognitive impairment. In: British Journal of Anaesthesia. 2017 ; Vol. 119, No. 2. pp. 316-323.
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abstract = "We examined the risk for postoperative delirium (POD) in patients with mild cognitive impairment (MCI) or dementia, and the association between POD and subsequent development of MCI or dementia in cognitively normal elderly patients. Methods. Patients 65 yr of age enrolled in the Mayo Clinic Study of Aging who were exposed to any type of anaesthesia from 2004 to 2014 were included. Cognitive status was evaluated before and after surgery by neuropsychological testing and clinical assessment, and was defined as normal or MCI/dementia. Postoperative delirium was detected with the Confusion Assessment Method for the intensive care unit. Logistic regression analyses were performed. Results. Among 2014 surgical patients, 74 (3.7{\%}) developed POD. Before surgery, 1667 participants were cognitively normal, and 347 met MCI/dementia criteria. The frequency of POD was higher in patients with pre-existing MCI/dementia compared with no MCI/dementia {8.7 vs 2.6{\%}; odds ratio (OR) 2.53, [95{\%} confidence interval (CI) 1.52-4.21]; P<0.001}. Postoperative delirium was associated with lower education [OR, 3.40 (95{\%} CI, 1.60-7.40); P0.002 for those with <12 vs 16 yr of schooling]. Of the 1667 patients cognitively normal at their most recent assessment, 1152 returned for postoperative evaluation, and 109 (9.5{\%}) met MCI/dementia criteria. The frequency of MCI/dementia at the first postoperative evaluation was higher in patients who experienced POD compared with those who did not [33.3 vs 9.0{\%}; adjusted OR, 3.00 (95{\%} CI, 1.12-8.05); P0.029].",
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