Efficacy of Intervention for Prevention of Postoperative Delirium after Spine Surgery

Fumihiro Arizumi; Keishi Maruo; Kazuki Kusuyama; Kazuya Kishima; Toshiya Tachibana

doi:10.22603/ssrr.2020-0037

Efficacy of Intervention for Prevention of Postoperative Delirium after Spine Surgery

Spine Surg Relat Res. 2020 May 11;5(1):16-21. doi: 10.22603/ssrr.2020-0037. eCollection 2021.

Authors

Fumihiro Arizumi¹, Keishi Maruo¹, Kazuki Kusuyama¹, Kazuya Kishima¹, Toshiya Tachibana¹

Affiliation

¹ Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan.

Abstract

Introduction: Delirium after spine surgery is an important complication; identification of risk factors associated with postoperative delirium (PD) is essential for reducing its incidence. Prophylactic intervention for PD has been reported to be effective. This study aimed to identify risk factors for PD and determine the efficacy of a prevention program using a delirium risk scoring system for PD after spine surgery.

Methods: This study was conducted in two stages. First, 294 patients (167 males, 127 females) who underwent spine surgery from 2013 to 2014 were assessed to examine the incidence and risk factors of PD and to establish a novel PD screening tool (Group A). Second, preoperative intervention was performed on 265 patients who underwent surgery from 2016 to 2017 (Group B) for the purpose of preventing PD using a delirium risk scoring system. Outcomes, including PD incidence and rates of adverse events, were compared between Group A and Group B.

Results: A logistic regression analysis revealed that psychiatric disorders (odds ratio [OR] = 10.3, P < 0.001), benzodiazepine use (OR = 4.9, P < 0.001), age > 70 years (OR = 4.2, P < 0.001), hearing loss (OR = 3.7, P = 0.001), and admission to intensive care unit (ICU) (OR = 3.7, P = 0.006) were independent risk factors associated with PD. Based on these results, we established a novel delirium screening tool after spine surgery. PD incidence was significantly higher in Group A than in Group B (22% vs. 13%, P = 0.0008). The occurrence of dangerous behavioral symptoms was significantly higher in Group A than in Group B (66% vs. 40%, P = 0.02). The catheter problem tended to be higher in Group A than in Group B (19% vs. 9%, P = 0.245).

Conclusions: In this study, psychiatric disorders, benzodiazepine use, age > 70 years, hearing loss, and admission to ICU were independent risk factors associated with PD. With the introduction of the delirium risk score, the onset of delirium was delayed, and adverse outcomes of delirium were reduced.

Keywords: delirium risk scoring system; intervention program; post operative delirium; risk factor; spine surgery.