scholarly journals Risk factors for postoperative delirium and subsyndromal delirium in older patients in the surgical ward: A prospective observational study

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255607
Author(s):  
Maya Kanno ◽  
Mana Doi ◽  
Kazumi Kubota ◽  
Yuka Kanoya
Keyword(s):  
Risk Factors ◽  
Observational Study ◽  
Older Patients ◽  
Postoperative Delirium ◽  
Prospective Observational Study ◽  
Physical Restraint ◽  
Assessment Method ◽  
Subsyndromal Delirium ◽  
Laboratory Test Results ◽  
Surgical Ward

Postoperative delirium (POD) and subsyndromal delirium (SSD) among older patients is a common, serious condition associated with a high incidence of negative outcomes. However, there are few accurate methods for the early detection of POD and SSD in surgical wards. This study aimed to identify risk factors of POD and SSD in older patients who were scheduled for surgery in a surgical ward. This was a prospective observational study. Study participants were older than 65 years, underwent urology surgery, and were hospitalized in the surgical ward between April and September 2019. Delirium symptoms were assessed using the Confusion Assessment Method (CAM) on the preoperative day, the day of surgery, and postoperative days 1–3 by the surgical ward nurses. SSD was defined as the presence of one or more CAM criteria and the absence of a diagnosis of delirium based on the CAM algorithm. Personal characteristics, clinical data, cognitive function, physical functions, laboratory test results, medication use, type of surgery and anesthesia, and use of physical restraint and bed sensor were collected from medical records. Multiple logistic regression analyses were conducted to identify the risk factors for both POD and SSD. A total of 101 participants (mean age 74.9 years) were enrolled; 19 (18.8%) developed POD (n = 4) and SSD (n = 15). The use of bed sensors (odds ratio 10.2, p = .001) was identified as a risk factor for both POD and SSD. Our findings suggest that the use of bed sensors might be related to the development of both POD and SSD among older patients in surgical wards.

scholarly journals Risk factors for postoperative delirium and subsyndromal delirium in older surgical patients in the surgical ward: a prospective observational study

2020 ◽  
Author(s):  
Maya Kanno ◽  
Mana Doi ◽  
Kazumi Kubota ◽  
Yuka Kanoya
Keyword(s):  
Risk Factors ◽  
Observational Study ◽  
Older Patients ◽  
Postoperative Delirium ◽  
Prospective Observational Study ◽  
Physical Restraint ◽  
Assessment Method ◽  
Subsyndromal Delirium ◽  
Laboratory Test Results ◽  
Surgical Ward

Abstract Background: Postoperative delirium (POD) among older patients is a common, serious disease and is associated with a high incidence of negative outcomes. For early detection of POD and subsyndromal delirium (SSD), this study was conducted to identify risk factors of POD and SSD in older patients who were scheduled for surgery in a surgical ward.Methods: This was a prospective observational study. Study participants were older than 65 years, underwent urology surgery, and were hospitalized in the surgical ward between April and September 2019. Both POD and SSD were assessed by using the Confusion Assessment Method (CAM) on the preoperative day, the day of surgery, and postoperative days 1–3 by the surgical ward nurses. SSD was defined as the presence of one or more CAM criteria and the absence of a diagnosis of delirium based on the CAM algorithm. Personal characteristics, clinical data, cognitive function, physical functions, laboratory test results, medication use, type of surgery and anesthesia, and use of physical restraint were collected from medical records. Logistic regression analyses were conducted to identify the risk factors for POD and SSD.Results: A total of 101 participants (mean age 74.9 years) were enrolled; 19 (18.8%) developed POD and SSD. The use of bed sensors (odds ratio 10.2, p=.001) were identified as risk factors for POD and SSD.Conclusions: Our study shows that the use of bed sensors might be related to the development of POD and SSD among older patients in surgical wards.

scholarly journals Risk factors for postoperative delirium and subsyndromal delirium in older surgical patients in the general ward: a prospective observational study

2020 ◽  
Author(s):  
Maya Kanno ◽  
Mana Doi ◽  
Kazumi Kubota ◽  
Yuka Kanoya
Keyword(s):  
Risk Factors ◽  
Observational Study ◽  
Odds Ratio ◽  
Older Patients ◽  
Postoperative Delirium ◽  
Prospective Observational Study ◽  
General Ward ◽  
Subsyndromal Delirium ◽  
Laboratory Test Results ◽  
General Wards

Abstract Background Postoperative delirium (POD) among older patients is a common, serious disease and is associated with a high incidence of negative outcomes. For early detection of POD and subsyndromal delirium (SSD), this study was conducted to identify risk factors of POD and SSD in older patients in a general ward who were scheduled for surgery. Methods This was a prospective observational study. Study participants were older than 65 years, underwent urology surgery, and were hospitalized in the general ward between April and September 2019. Both POD and SSD were assessed by using the Confusion Assessment Method on the preoperative day, the day of surgery, and postoperative days 1–3. Personal characteristics, clinical data, cognitive function, physical functions, laboratory test results, medication use, type of surgery and anesthesia, and use of restraints were collected from medical records. Univariate and multivariate analyses were conducted to identify the risk factors for POD and SSD. Results A total of 101 participants (mean age 74.9 years) were enrolled; 19 (18.8%) developed POD and SSD. The use of bed sensors (odds ratio 10.2, p = .001) and preoperative level of C-reactive protein (CRP; odds ratio 1.5, p = .054) were identified as risk factors for POD and SSD. Conclusions POD and SSD among older patients in general wards were related to bed sensor use and the preoperative CRP level. Therefore, this study suggests that in order prevent POD and SSD for older patients in general wards, it is necessary to avoid bed sensor use as restraints and to assess the preoperative CRP level.

scholarly journals Risk factors of thrombophlebitis at infusion sites in patients admitted in surgical ward: a prospective observational study

2018 ◽  
Vol 5 (5) ◽  
pp. 1781 ◽  
Author(s):  
Atul Kumar Singh ◽  
Rajeev Dwivedi ◽  
A. P. S. Ghaharwar
Keyword(s):  
Risk Factors ◽  
Observational Study ◽  
Burden Of Disease ◽  
Prospective Observational Study ◽  
Causative Factor ◽  
Postoperative Recovery ◽  
Age Group ◽  
Infusion Site ◽  
Medical College ◽  
Surgical Ward

Background: Peripheral venous canualation is indispensable in admitted patients in surgical ward, thrombophlebitis following infusion is seldom serious, but it effects on postoperative recovery, hospital stay and hence burden of disease are magnanimous. The main aim and objective of the study to find out the incidence of thrombophlebitis at the intravenous infusion site in surgical ward.Methods: This prospective observational study was conducted on 300 patients admitted in surgical ward of S.S Medical College and associated S.G.M. hospital, Rewa (M.P.) patients selected randomly. These Patients were visited daily for any sign and symptoms at infusion site. The incidence of thrombophlebitis according to age, sex and duration of infusion were recorded. The tool designed to collect the data were socio demographic performa and observational check list.Results: In total 300 patients the incidence of thrombophlebits is highest in age group of 41-50(20%), Male (64.66%) and incidence increases as the duration of infusion increased it is 100% after 5 days. The incidence of Grade -1 thrmbophlebitis (71.33%) is higher as compared to Grade- 2 (22.67%).Conclusions: Thrombophelebitis is still an important ongoing problem in admitted patients in surgical ward. Incidence of grade-I thrombophlebitis is higher. It is more in male in the age group of 40-50 and duration of infusion is main causative factor for development of thrombophlebitis.

scholarly journals Emergence delirium is associated with increased postoperative delirium in elderly: a prospective observational study

2020 ◽  
Vol 34 (5) ◽  
pp. 675-687
Author(s):  
Yan Zhang ◽  
Shu-Ting He ◽  
Bin Nie ◽  
Xue-Ying Li ◽  
Dong-Xin Wang
Keyword(s):  
Observational Study ◽  
General Anesthesia ◽  
Postoperative Delirium ◽  
Prospective Observational Study ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Emergence Delirium ◽  
Confusion Assessment ◽  
Increased Risk ◽  
Pacu Stay

Abstract Background The clinical significance of emergence delirium remains unclear. The purpose of this study was to investigate the association between emergence delirium and postoperative delirium in elderly after general anesthesia and surgery. Methods This prospective observational study was done in a tertiary hospital in Beijing, China. Elderly patients (65–90 years) who underwent major noncardiac surgery under general anesthesia and admitted to the postanesthesia care unit (PACU) after surgery were enrolled. Emergence delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit during PACU stay. Postoperative delirium was assessed with the Confusion Assessment Method during the first 5 postoperative days. The association between emergence delirium and postoperative delirium was analyzed with a multivariable logistic regression model. Results A total of 942 patients were enrolled and 915 completed the study. Emergence delirium developed in 37.0% (339/915) of patients during PACU stay; and postoperative delirium developed in 11.4% (104/915) of patients within the first 5 postoperative days. After adjusted confounding factors, the occurrence of emergence delirium is independently associated with an increased risk of postoperative delirium (OR 1.717, 95% CI 1.078–2.735, P = 0.023). Patients with emergence delirium stayed longer in PACU and hospital after surgery, and developed more non-delirium complications within 30 days. Conclusions Emergence delirium in elderly admitted to the PACU after general anesthesia and major surgery is independently associated with an increased risk of postoperative delirium. Patients with emergence delirium had worse perioperative outcomes. Chinese Clinical Trial Registry (chictr.org.cn) ChiCTR-OOC-17012734

scholarly journals Protocol for the Prognosticating Delirium Recovery Outcomes Using Wakefulness and Sleep Electroencephalography (P-DROWS-E) study: a prospective observational study of delirium in elderly cardiac surgical patients

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e044295
Author(s):  
S Kendall Smith ◽  
Thomas Nguyen ◽  
Alyssa K Labonte ◽  
MohammadMehdi Kafashan ◽  
Orlandrea Hyche ◽  
...  
Keyword(s):  
Observational Study ◽  
Postoperative Delirium ◽  
Prospective Observational Study ◽  
Peak Frequency ◽  
Assessment Method ◽  
Clinical Syndrome ◽  
Study Patient ◽  
Eligibility Criteria ◽  
Scientific Publications ◽  
Elective Cardiac Surgery

IntroductionDelirium is a potentially preventable disorder characterised by acute disturbances in attention and cognition with fluctuating severity. Postoperative delirium is associated with prolonged intensive care unit and hospital stay, cognitive decline and mortality. The development of biomarkers for tracking delirium could potentially aid in the early detection, mitigation and assessment of response to interventions. Because sleep disruption has been posited as a contributor to the development of this syndrome, expression of abnormal electroencephalography (EEG) patterns during sleep and wakefulness may be informative. Here we hypothesise that abnormal EEG patterns of sleep and wakefulness may serve as predictive and diagnostic markers for postoperative delirium. Such abnormal EEG patterns would mechanistically link disrupted thalamocortical connectivity to this important clinical syndrome.Methods and analysisP-DROWS-E (Prognosticating Delirium Recovery Outcomes Using Wakefulness and Sleep Electroencephalography) is a 220-patient prospective observational study. Patient eligibility criteria include those who are English-speaking, age 60 years or older and undergoing elective cardiac surgery requiring cardiopulmonary bypass. EEG acquisition will occur 1–2 nights preoperatively, intraoperatively, and up to 7 days postoperatively. Concurrent with EEG recordings, two times per day postoperative Confusion Assessment Method (CAM) evaluations will quantify the presence and severity of delirium. EEG slow wave activity, sleep spindle density and peak frequency of the posterior dominant rhythm will be quantified. Linear mixed-effects models will be used to evaluate the relationships between delirium severity/duration and EEG measures as a function of time.Ethics and disseminationP-DROWS-E is approved by the ethics board at Washington University in St. Louis. Recruitment began in October 2018. Dissemination plans include presentations at scientific conferences, scientific publications and mass media.Trial registration numberNCT03291626.

scholarly journals Hallucinations after Cardiac Surgery: A Prospective Observational Study

Medicina ◽  
2020 ◽  
Vol 56 (3) ◽  
pp. 104
Author(s):  
Thomas H. Ottens ◽  
Iris E.C. Sommer ◽  
Marieke J. Begemann ◽  
Maya Schutte ◽  
Maarten Jan Cramer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cardiac Surgery ◽  
Observational Study ◽  
Postoperative Delirium ◽  
Prospective Observational Study ◽  
Common Type ◽  
Control Group ◽  
Visual Hallucinations ◽  
Psychotic Experiences

Background and Objective: Hallucinations after cardiac surgery can be a burden, but their prevalence and phenomenology have not been studied well. Risk factors for postoperative hallucinations, as well as their relation to delirium are unclear. We aimed to study the prevalence and phenomenology of hallucinations after cardiac surgery, and to study the association between hallucinations and delirium in this population. Materials and Methods: We used the Questionnaire for Psychotic Experiences to detect hallucinations in cardiac surgery patients and a control group of cardiology outpatients. We assessed postoperative delirium with validated instruments. Risk factors for postoperative hallucinations and the association between hallucinations and delirium were analysed using logistic regression. Results: We included 201 cardiac surgery patients and 99 cardiology outpatient controls. Forty-four cardiac surgery patients (21.9%) experienced postoperative hallucinations in the first four postoperative days. This was significantly higher compared to cardiology outpatient controls (n = 4, 4.1%, p < 0.001). Visual hallucinations were the most common type of hallucinations in cardiac surgery patients, and less common in outpatient controls. Cardiac surgery patients who experienced hallucinations were more likely to also have delirium (10/44, 22.7%) compared to patients without postoperative hallucinations (16/157, 10.2% p = 0.03). However, the majority of patients with postoperative hallucinations (34/44, 77.3%) did not develop delirium. Conclusion: After cardiac surgery, hallucinations occurred more frequently than in outpatient controls. Hallucinations after cardiac surgery were most often visual in character. Although postoperative hallucinations were associated with delirium, most patients with hallucinations did not develop delirium.

scholarly journals Cognitive and brain reserve and the risk of postoperative delirium in older patients: analysis of data from a prospective observational study

2014 ◽  
Vol 1 (6) ◽  
pp. 437-443 ◽  
Author(s):  
Jane S Saczynski ◽  
Sharon K Inouye ◽  
Cyrus M Kosar ◽  
Doug Tommet ◽  
Edward R Marcantonio ◽  
...  
Keyword(s):  
Observational Study ◽  
Older Patients ◽  
Postoperative Delirium ◽  
Prospective Observational Study ◽  
Brain Reserve

scholarly journals POS0441 DEVELOPMENT OF RHEUMATOID ARTHRITIS AMONG ANTI-CITRULLINATED PROTEIN ANTIBODIES POSITIVE ASYMPTOMATIC INDIVIDUALS: A PROSPECTIVE OBSERVATIONAL STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 449.1-449
Author(s):  
S. Mizuki ◽  
K. Horie ◽  
K. Imabayashi ◽  
K. Mishima ◽  
K. Oryoji
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Observational Study ◽  
Rheumatoid Factor ◽  
Prospective Observational Study ◽  
Enzyme Linked Immunosorbent Assay ◽  
P Value ◽  
Healthy Population ◽  
Asymptomatic Individuals ◽  
Citrullinated Protein

Background:In the idividuals with genetic and enviromental risk factors, immune events at mucosal surfaces occur and may precede systemic autoimmunity. Anti-citrullinated protein antibodies (ACPA) are present in the serum for an average of 3-5 years prior to the onset of rheumatoid arthritis (RA) during an asymptomatic period. In ACPA-positivite individuals, the additional presence of RA-related risk factors appears to add significant power for the development of RA. To date, there have been few reports in which clinical courses of ACPA-positive asymptomatic individuals were investigated prospectively.Objectives:To observe the clinical time course of ACPA-positive healthy population for the development of RA.Methods:Healthy volunteers without joint pain or stiffness, who attended the comprehensive health screening of our hospital, were enrolled in this prospective observational study. The serum ACPA levels were quantified by Ig-G anti-cyclic citrullinated peptide enzyme-linked immunosorbent assay with levels > 4.4 U/mL considered positive. ACPA-positive subjects were followed by rheumatologists of our department clinically or a questionnaire sent by mail for screening to detect arthritis.Results:5,971 healthy individuals without joint symptons were included. Ninty-two (1.5%) were positive for ACPA. Of these, 19 (20.7%) developed RA and two were suspected as RA by mail questionnaire. Their average age were 58-years, and women were 68%. The average duration between the date of serum sampling and diagnosis was 10.7 months. ACPA-positive individuals who developed to RA had higher serum ACPA and Ig-M rheumatoid factor levels than ACPA-positive individuals who did not (P value by Mann-Whitney U test: 0.002, 0.005, respectively).Conclusion:Among ACPA-positive asymptomatic individuals, 20% developed RA. The higher titer of ACPA and Ig-M rheumatoid factor levels are risk factors for devoloping RA.Disclosure of Interests:None declared

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