Nonpharmacological Interventions as an Adjunct Therapy for the Treatment of Elderly Patients with Postoperative Delirium

Background: Postoperative delirium (POD) is a very common complication in elderly patients with gastric cancer (GC) and associated with poor prognosis. MicroRNAs (miRNAs) serve as key post-transcriptional regulators of gene expression via targeting mRNAs and play important roles in the nervous system. This study aimed to investigate the potential predictive role of miRNAs for POD. Methods: Elderly GC patients who were scheduled to undergo elective curative resection were consequently enrolled in this study. POD was assessed at 1 day before surgery and 1-7 days after surgery following the guidance of the 5th edition of Diagnostic and Statistical Manual of Mental Disorders (DSM V, 2013). The demographics, clinicopathologic characteristics and preoperative circulating miRNAs by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) were compared between patients with or without POD. Risk factors for POD were assessed via univariate and multivariate logistic regression analyses. Results: A total of 370 participants were enrolled, of which 63 had suffered from POD within postoperative 7 days with an incidence of 17.0%. Preoperative miR-210 was a predictor for POD with an area under the curve (AUC) of 0.921, a cut-off value of 1.67, a sensitivity of 95.11%, and a specificity of 92.06%, (P<0.001). In the multivariate logistic regression model, the relative expression of serum miR-210 was an independent risk factor for POD (OR: 3.37, 95%CI: 1.98–5.87, P=0.003). Conclusions: In conclusion, the present study highlighted that preoperative miR-210 could serve as a potential predictor for POD in elderly GC patients undergoing curative resection.

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Risk factors associated with treatment of hyperactive postoperative delirium in elderly patients following hip fracture surgery under regional anesthesia: a nationwide population-based study

Brazilian Journal of Anesthesiology (English Edition) ◽

10.1016/j.bjane.2021.03.020 ◽

2021 ◽

Author(s):

Eun-Jin Ahn ◽

Si Ra Bang

Keyword(s):

Risk Factors ◽

Hip Fracture ◽

Elderly Patients ◽

Regional Anesthesia ◽

Postoperative Delirium ◽

Population Based ◽

Population Based Study ◽

Factors Associated ◽

Hip Fracture Surgery ◽

Fracture Surgery

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Postoperative delirium after cardiac surgery of elderly patients as an independent risk factor for prolonged length of stay in intensive care unit and in hospital

Aging Clinical and Experimental Research ◽

10.1007/s40520-021-01842-x ◽

2021 ◽

Author(s):

Andrea Kirfel ◽

Jan Menzenbach ◽

Vera Guttenthaler ◽

Johanna Feggeler ◽

Andreas Mayr ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Length Of Stay ◽

Elderly Patients ◽

Postoperative Delirium ◽

Confusion Assessment Method ◽

Assessment Method ◽

Hospital Length Of Stay ◽

Confusion Assessment

Abstract Background Postoperative delirium (POD) is a relevant and underdiagnosed complication after cardiac surgery that is associated with increased intensive care unit (ICU) and hospital length of stay (LOS). The aim of this subgroup study was to compare the frequency of tested POD versus the coded International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis of POD and to evaluate the influence of POD on LOS in ICU and hospital. Methods 254 elective cardiac surgery patients (mean age, 70.5 ± 6.4 years) at the University Hospital Bonn between September 2018 and October 2019 were evaluated. The endpoint tested POD was considered positive, if one of the tests Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method (CAM), 4 'A's Test (4AT) or Delirium Observation Scale (DOS) was positive on one day. Results POD occurred in 127 patients (50.0%). LOS in ICU and hospital were significantly different based on presence (ICU 165.0 ± 362.7 h; Hospital 26.5 ± 26.1 days) or absence (ICU 64.5 ± 79.4 h; Hospital 14.6 ± 6.7 days) of POD (p < 0.001). The multiple linear regression showed POD as an independent predictor for a prolonged LOS in ICU (48%; 95%CI 31–67%) and in hospital (64%; 95%CI 27–110%) (p < 0.001). The frequency of POD in the study participants that was coded with the ICD F05.0 and F05.8 by hospital staff was considerably lower than tests revealed by the study personnel. Conclusion Approximately 50% of elderly patients who underwent cardiac surgery developed POD, which is associated with an increased ICU and hospital LOS. Furthermore, POD is highly underdiagnosed in clinical routine.

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Repeated Preoperative Intranasal Administration of Insulin Decreases the Incidence of Postoperative Delirium in Elderly Patients Undergoing Laparoscopic Radical Gastrointestinal Surgery: A Randomized, Placebo-Controlled, Double-Blinded Clinical Study

American Journal of Geriatric Psychiatry ◽

10.1016/j.jagp.2021.02.043 ◽

2021 ◽

Author(s):

Qingqing Huang ◽

Qin Li ◽

Fuen Qin ◽

Libang Yuan ◽

Zhihong Lu ◽

...

Keyword(s):

Clinical Study ◽

Elderly Patients ◽

Intranasal Administration ◽

Postoperative Delirium ◽

Gastrointestinal Surgery ◽

Double Blinded

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Postoperative delirium in elderly patients is associated with subsequent cognitive impairment

British Journal of Anaesthesia ◽

10.1093/bja/aex130 ◽

2017 ◽

Vol 119 (2) ◽

pp. 316-323 ◽

Cited By ~ 65

Author(s):

J. Sprung ◽

R.O. Roberts ◽

T.N. Weingarten ◽

A. Nunes Cavalcante ◽

D.S. Knopman ◽

...

Keyword(s):

Cognitive Impairment ◽

Elderly Patients ◽

Postoperative Delirium

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Melatonin for prevention of postoperative delirium after lower limb fracture surgery in elderly patients (DELIRLESS): study protocol for a multicentre randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2021-053908 ◽

2021 ◽

Vol 11 (12) ◽

pp. e053908

Author(s):

Stéphanie Sigaut ◽

Camille Couffignal ◽

Marina Esposito-Farèse ◽

Vincent Degos ◽

Serge Molliex ◽

...

Keyword(s):

Elderly Patients ◽

Lower Limb ◽

Postoperative Delirium ◽

Controlled Trial ◽

Functional Decline ◽

Assessment Method ◽

Phase Iii ◽

Double Blind ◽

Prolonged Length ◽

Surgery In Elderly

IntroductionPostoperative delirium (POD) is one of the most frequent complication after surgery in elderly patients, and is associated with increased morbidity and mortality, prolonged length of stay, cognitive and functional decline leading to loss of autonomy, and important additional healthcare costs. Perioperative inflammatory stress is a key element in POD genesis. Melatonin exhibits antioxidative and immune-modulatory proprieties that are promising concerning delirium prevention, but in perioperative context literature are scarce and conflicting. We hypothesise that perioperative melatonin can reduce the incidence of POD.Methods and analysisThe DELIRLESS trial is a prospective, national multicentric, phase III, superiority, comparative randomised (1:1) double-blind clinical trial. Among patients aged 70 or older, hospitalised and scheduled for surgery of a severe fracture of a lower limb, 718 will be randomly allocated to receive either melatonin 4 mg per os or placebo, every night from anaesthesiologist preoperative consultation and up to 5 days after surgery. The primary outcome is POD incidence measured by either the French validated translation of the Confusion Assessment Method (CAM) score for patients hospitalised in surgery, or CAM-ICU score for patients hospitalised in ICU (Intensive Care Unit). Daily delirium assessment will take place during 10 days after surgery, or until the end of hospital stay if it is shorter. POD cumulative incidence function will be compared at day 10 between the two randomised arms in a competing risks framework, using the Fine and Grey model with death as a competing risk of delirium.Ethics and disseminationThe DELIRLESS trial has been approved by an independent ethics committee the Comité de Protection des Personnes (CPP) Sud-Est (ref CPP2020-18-99 2019-003210-14) for all study centres. Participant recruitment begins in December 2020. Results will be published in international peer-reviewed medical journals.Trial registration numberNCT04335968, first posted 7 April 2020.Protocol version identifierN°3–0, 3 May 2021.

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