Immediate Post-Op Delirium Common in Elderly Patients

(HealthDay News) – Delirium in the post-anesthesia care unit (PACU) is relatively common among elderly patients undergoing surgery with general anesthesia, according to a study published in the August issue of Anesthesia & Analgesia.

Karin J. Neufeld, MD, MPH, from Johns Hopkins University in Baltimore, and colleagues prospectively studied English-speaking surgical candidates, aged ≥70 years, to examine the prevalence and in-hospital outcomes of delirium diagnosed immediately after general anesthesia and surgery. Ninety-one patients were evaluated for a Diagnostic and Statistical Manual of Mental Disorders IV diagnosis of delirium in the PACU after surgery and repeatedly during hospitalization.

The researchers found that the prevalence of delirium in the PACU was 45%. Of the 19 delirium episodes detected during subsequent hospitalization, 74% started in the PACU. There was a significant, independent correlation between early delirium and impaired cognition (as measured by decreased category word fluency) relative to presurgery baseline testing. Severity of negative outcomes was intermediate for patients whose delirium had resolved by postoperative day one (26%), between those who were never delirious during hospitalization (3%), and those whose delirium in the PACU persisted after transfer to hospital wards (39%).

“Delirium in the PACU is common, but not universal,” the authors write. “It is associated with subsequent delirium on the ward, and potentially with a decline in cognitive function and increased institutionalization at hospital discharge.”

One author disclosed receiving royalties from Psychological Assessment Resources for sales of a test used in this study.

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