Document Detail


Motor subtypes of postoperative delirium in older adults.
MedLine Citation:
PMID:  21422360     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
HYPOTHESIS: Increased knowledge about motor subtypes of delirium may aid clinicians in the management of postoperative geriatric patients.
DESIGN: Prospective cohort study defining preoperative risk factors, outcomes, and adverse events related to motor subtypes of postoperative delirium.
SETTING: Referral medical center.
PATIENTS: Persons 50 years and older with planned postoperative intensive care unit (ICU) admission following an elective operation were recruited.
MAIN OUTCOME MEASURES: Before surgery, a standardized frailty assessment was performed. After surgery, delirium and its motor subtypes were measured using the validated tools of the Confusion Assessment Method-ICU and the Richmond Agitation-Sedation Scale. Statistical analysis included the univariate t and χ(2) tests and analysis of variance with post hoc analysis.
RESULTS: Delirium occurred in 43.0% (74 of 172) of patients, representing 67.6% (50 of 74) hypoactive, 31.1% (23 of 74) mixed, and 1.4% (1 of 74) hyperactive motor subtypes. Compared with those having mixed delirium, patients having hypoactive delirium were older (mean [SD] age, 71 [9] vs 65 [9] years) and more anemic (mean [SD] hematocrit, 36% [8%] vs 41% [6%]) (P = .002 for both). Patients with hypoactive delirium had higher 6-month mortality (32.0% [16 of 50] vs 8.7% [2 of 23], P = .04). Delirium-related adverse events occurred in 24.3% (18 of 74) of patients with delirium; inadvertent tube or line removals occurred more frequently in the mixed group (P = .006), and sacral skin breakdown was more common in the hypoactive group (P = .002).
CONCLUSIONS: Motor subtypes of delirium alert clinicians to differing prognosis and adverse event profiles in postoperative geriatric patients. Hypoactive delirium is the most common motor subtype and is associated with worse prognosis (6-month mortality, 1 in 3 patients). Knowledge of differing adverse event profiles can modify clinicians' management of older patients with postoperative delirium.
Authors:
Thomas N Robinson; Christopher D Raeburn; Zung V Tran; Lisa A Brenner; Marc Moss
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Archives of surgery (Chicago, Ill. : 1960)     Volume:  146     ISSN:  1538-3644     ISO Abbreviation:  Arch Surg     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-03-22     Completed Date:  2011-05-25     Revised Date:  2013-07-15    
Medline Journal Info:
Nlm Unique ID:  9716528     Medline TA:  Arch Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  295-300     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, University of Colorado at Denver School of Medicine, 12631 E 17th Ave., Aurora, CO 80045, USA. thomas.robinson@ucdenver.edu
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Analysis of Variance
Cohort Studies
Delirium / classification*,  diagnosis*,  mortality
Female
Geriatric Assessment
Humans
Incidence
Male
Middle Aged
Postoperative Complications / diagnosis,  mortality
Preoperative Care / methods
Prospective Studies
Psychomotor Agitation / classification*,  diagnosis*,  mortality
Risk Assessment
Surgical Procedures, Elective / methods,  mortality*
Survival Analysis
Grant Support
ID/Acronym/Agency:
K23 AG034632/AG/NIA NIH HHS; K23 AG034632-01A1/AG/NIA NIH HHS; K24 HL089223-04/HL/NHLBI NIH HHS; K24-HL-089223/HL/NHLBI NIH HHS
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