Postoperative Delirium Is Associated with Long-term Decline in Activities of Daily Living

Zhongyong Shi; Xinchun Mei; Cheng Li; Yupeng Chen; Hailin Zheng; Yujie Wu; Hui Zheng; Liang Liu; Edward R Marcantonio; Zhongcong Xie; Yuan Shen

doi:10.1097/ALN.0000000000002849

Postoperative Delirium Is Associated with Long-term Decline in Activities of Daily Living

Anesthesiology. 2019 Sep;131(3):492-500. doi: 10.1097/ALN.0000000000002849.

Authors

Zhongyong Shi¹, Xinchun Mei, Cheng Li, Yupeng Chen, Hailin Zheng, Yujie Wu, Hui Zheng, Liang Liu, Edward R Marcantonio, Zhongcong Xie, Yuan Shen

Affiliation

¹ From the Department of Psychiatry, Shanghai Tenth People's Hospital, Anesthesia and Brain Research Institute (Z.S., X.M., Y.C., Hailin Zheng, Y.W., Y.S.) Department of Anesthesiology (C.L.), Tongji University School of Medicine, Shanghai, China the Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine (Z.S., Z.X.) the Biostatistics Center (Hui Zheng), Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts the Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai Pancreatic Cancer Institute, Fudan University, Shanghai 200032, China (L.L.) the Divisions of General Medicine and Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (E.R.M.).

Abstract

Background: Postoperative delirium is one of the most common complications in the elderly surgical population. However, its long-term outcomes remain largely to be determined. Therefore a prospective cohort study was conducted to determine the association between postoperative delirium and long-term decline in activities of daily living and postoperative mortality. The hypothesis in the present study was that postoperative delirium was associated with a greater decline in activities of daily living and higher mortality within 24 to 36 months after anesthesia and surgery.

Methods: The participants (at least 65 yr old) having the surgeries of (1) proximal femoral nail, (2) hip replacement, or (3) open reduction and internal fixation under general anesthesia were enrolled. The Confusion Assessment Method algorithm was administered to diagnose delirium before and on the first, second, and fourth days after the surgery. Activities of daily living were evaluated by using the Chinese version of the activities of daily living scale (range, 14 to 56 points), and preoperative cognitive function was assessed by using the Chinese Mini-Mental State Examination (range, 0 to 30 points). The follow-up assessments, including activities of daily living and mortality, were conducted between 24 and 36 months after anesthesia and surgery.

Results: Of 130 participants (80 ± 6 yr, 24% male), 34 (26%) developed postoperative delirium during the hospitalization. There were 32% of the participants who were lost to follow-up, resulting in 88 participants who were finally included in the data analysis. The participants with postoperative delirium had a greater decline in activities of daily living (16 ± 15 vs. 9 ± 15, P = 0.037) and higher 36-month mortality (8 of 28, 29% vs. 7 of 75, 9%; P = 0.009) as compared with the participants without postoperative delirium.

Conclusions: Postoperative delirium was associated with long-term detrimental outcomes, including greater decline in activities of daily living and a higher rate of postoperative mortality.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living / psychology*
Aged
Aged, 80 and over
China / epidemiology
Cohort Studies
Delirium / epidemiology*
Delirium / psychology*
Female
Humans
Longitudinal Studies
Male
Postoperative Complications / epidemiology*
Postoperative Complications / psychology*
Prospective Studies
Risk Factors

Abstract

Publication types

MeSH terms

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