Postoperative delirium in older adults: A retrospective cohort study.

Abstract

Introduction and objectives: Postoperative delirium (POD) is an adverse outcome that has garnered significant interest in perioperative medicine, particularly in older adults, due to its association with increased morbidity, mortality, and health care costs. In Colombia, this disease is under-reported due to the lack of POD diagnosis and prevention protocols. The aim of this study was to determine the incidence and potential risk factors of POD, and its association with other postoperative complications.

Materials and methods: This retrospective cohort study was performed at a tertiary care hospital. Patients over 60 years of age who underwent surgery between 2012 and 2019 were included. Random sampling was used to analyse electronic medical records to estimate the incidence of POD, risk factors, and postoperative complications within 7 days of surgery.

Results: A total of 2535 patients were evaluated. The cumulative incidence of POD was 6.0% (95% confidence interval [CI]: 5.1%-6.9%), with most cases (67%) occurring within the first 3 postoperative days. Risk factors associated with POD included a history of psychiatric disorders, preoperative opioid use, ASA (American Society of Anesthesiologists) class III/IV, vascular surgery, urgent or emergency surgery, and functional dependency. POD was also associated with higher in-hospital mortality (OR 2.9 [95% CI 1.66-5.07]).

Conclusion: POD is common in patients aged over 60 undergoing surgery, particularly those that undergo urgent or emergency procedures and vascular surgery, who are ASA class > III, functionally dependent, and present psychiatric disorders. POD is also associated with increased postoperative morbidity and mortality.