Document Detail


Anesthesia and Postoperative Delirium in Older Adults Undergoing Hip Surgery.
MedLine Citation:
PMID:  21718258     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: To examine the effects of general anesthesia on the risk of incident postoperative delirium in older adults undergoing hip surgery. DESIGN: Secondary analysis of haloperidol prophylaxis for delirium clinical trial data. Predefined risk factors for delirium were assessed prior to surgery. Primary outcome was postoperative delirium. Study outcome was compared across patient groups who received either general or regional anesthesia, and for individuals receiving various perioperative medications (benzodiazepines, anticholinergics, and opioids), using multivariable logistic regression after controlling for potential confounders. Subgroup analyses based on baseline cognitive impairment and delirium risk were also undertaken. SETTING: Large medical school-affiliated general hospital in Alkmaar, the Netherlands. PARTICIPANTS: Five hundred twenty-six adults aged 70 and older undergoing hip surgery. MEASUREMENTS: The primary outcome was the incidence of postoperative delirium (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and Confusion Assessment Method criteria). RESULTS: Sixty participants (11.4%) had incident postoperative delirium. One hundred eighty-nine (35.9%) received general anesthesia, 18 (9.5%) of whom developed postoperative delirium, and 337 (64.1%) received regional anesthesia, 42 (12.5%) of whom developed postoperative delirium (adjusted odds ratio=0.81, 95% confidence interval=0.43-1.52, P=.51). Results were stratified for baseline cognitive impairment, age, acute admission, perioperative medication and other delirium risk factors. Delirium was not independently associated with specific drugs or the medication classes opioids, benzodiazepines, and anticholinergics. CONCLUSION: General anesthesia has no distinct effect on incident postoperative delirium in older adults undergoing hip surgery. This also holds for individuals suffering from cognitive impairment or who are otherwise at risk for postoperative delirium. Perioperative use of narcotics, benzodiazepines, and anticholinergic agents was not associated with incident delirium in this cohort of older adults undergoing hip surgery.
Authors:
Chantal J Slor; Jos F M de Jonghe; Ralph Vreeswijk; Erwin Groot; Tjeerd V D Ploeg; Willem A van Gool; Piet Eikelenboom; Marc Snoeck; Ben Schmand; Kees J Kalisvaart
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-6-30
Journal Detail:
Title:  Journal of the American Geriatrics Society     Volume:  -     ISSN:  1532-5415     ISO Abbreviation:  -     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-7-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7503062     Medline TA:  J Am Geriatr Soc     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.
Affiliation:
From the Department of Geriatric MedicinePieter van Forest Institute for Education and Research, Medical Center Alkmaar, Alkmaar, the NetherlandsDepartment of Geriatric Medicine, Kennemer Gasthuis, Haarlem, the NetherlandsDepartment of Geriatric Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands; Departments ofNeurologyPsychology, Academic Medical Center, University of Amsterdam, Amsterdam, the NetherlandsDepartment of Psychiatry, Vrije Universiteit Medical Center, Amsterdam, the NetherlandsDepartment of Anesthesia, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands.
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