Intraoperative blood transfusion predicts postoperative delirium among older patients undergoing elective orthopedic surgery: A prospective cohort study

ABSTRACTObjectives:Dementia and cognitive impairment are associated with higher rates of complications and mortality during hospitalization in older patients. Moreover, length of hospital stay and costs are increased. In this prospective cohort study, we investigated the frequency of hospitalizations caused by ambulatory care-sensitive conditions (ACSCs), for which proactive ambulatory care might prevent the need for a hospital stay, in older patients with and without cognitive impairments.Design:Prospective cohort study.Setting:Eight hospitals in Germany.Participants:A total of 1,320 patients aged 70 years and older.Measurements:The Mini-Cog test has been used to assess cognition and to categorize patients in the groups no/moderate cognitive impairments (probably no dementia) and severe cognitive impairments (probable dementia). Moreover, lengths of hospital stay and complication rates have been assessed, using a binary questionnaire (if occurred during hospital stay or not; behavioral symptoms were adapted from the Cohen-Mansfield Agitation Inventory). Data have been acquired by the nursing staff who received a special multi-day training.Results:Patients with severe cognitive impairments showed higher complication rates (including incontinence, disorientation, irritability/aggression, restlessness/anxiety, necessity of Tranquilizers and psychiatric consults, application of measures limiting freedom, and falls) and longer hospital stays (+1.4 days) than patients with no/moderate cognitive impairments. Both groups showed comparably high ACSC-caused admission rates of around 23%.Conclusions:The study indicates that about one-fourth of hospital admissions of cognitively normal and impaired older adults are caused by ACSCs, which are mostly treatable on an ambulatory basis. This implies that an improved ambulatory care might reduce the frequency of hospitalizations, which is of particular importance in cognitively impaired elderly due to increased complication rates.

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Postoperative anaemia might be a risk factor for postoperative delirium and prolonged hospital stay: A secondary analysis of a prospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0229325 ◽

2020 ◽

Vol 15 (2) ◽

pp. e0229325 ◽

Cited By ~ 1

Author(s):

Julius Valentin Kunz ◽

Claudia D. Spies ◽

Anna Bichmann ◽

Miriam Sieg ◽

Anika Mueller

Keyword(s):

Risk Factor ◽

Cohort Study ◽

Hospital Stay ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Postoperative Delirium ◽

Secondary Analysis ◽

Prolonged Hospital Stay ◽

Prolonged Hospital

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Indwelling urinary catheters, aortic valve treatment and delirium: a prospective cohort study

BMJ Open ◽

10.1136/bmjopen-2018-021708 ◽

2018 ◽

Vol 8 (11) ◽

pp. e021708 ◽

Cited By ~ 2

Author(s):

Leslie SP Eide ◽

Anette H Ranhoff ◽

Sandra Lauck ◽

Bengt Fridlund ◽

Rune Haaverstad ◽

...

Keyword(s):

Cohort Study ◽

Aortic Valve ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Postoperative Delirium ◽

Primary Outcome ◽

University Hospital ◽

Transcatheter Aortic Valve ◽

The Difference ◽

Valve Implantation

ObjectivesTo determine whether an association exists between delirium and length of time indwelling urine catheters (IUC) are used in octogenarian patients treated with surgical aortic valve treatment (SAVR) or transcatheter aortic valve implantation (TAVI).DesignProspective cohort study.SettingTertiary university hospital covering the western region of Norway.ParticipantsOctogenarian patients undergoing elective SAVR or TAVI and willing to participate in the study were eligible. Patients unable to speak Norwegian were excluded. Between 2011 and 2013, 143 consecutive patients were included, and data from 136 of them are presented.Primary outcomeDelirium.ResultsLogistic regression analysis shows that lower cognitive function was positively associated with delirium (OR 0.86, CI 0.74 to 0.99, p=0.047). Besides, the interaction term in the model shows that IUC use and delirium differed between SAVR and TAVI patients (p=0.04). The difference corresponded to a weaker association between hours of IUC use and delirium for SAVR (OR 1.01, CI: 0.99 to 1.03, p=0.54) compared with that for TAVI (OR 1.04, CI: 1.01 to 1.08, p=0.004).ConclusionsThe association between IUC use and delirium is stronger for octogenarian patients treated with TAVI than for patients who received SAVR. Our results revealed a previously unknown association between the number of hours an IUC is used and postoperative delirium in octogenarian patients treated with TAVI.

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