Risk Factors and Outcomes for Postoperative Delirium after Major Surgery in Elderly Patients

“The number of people over 65 years is increasing and will continue to do so over the coming decades. Similarly, the number of elderly patients requiring surgery is expected to increase.
Delirium is a common and serious problem in hospitalized patients, especially in the elderly.
Postoperative delirium is associated with an increase in postoperative complications, a decrease in functional capacity, a prolonged hospital stay and a direct increase of healthcare costs.
Early identification of patients at risk for delirium is important because adequate well timed
interventions could prevent occurrence of delirium and the related detrimental outcome.
Several prediction models have been developed, including multiple risk factors for postoperative delirium. However, these studies are of varying quality and each with a heterogeneous population.
Measuring frailty may be a more sensitive marker of determining post-operative delirium. However, to this date, there is no consensus on a clear definition and quantification of
frailty. Several assessment instruments have been developed for frailty during the last decades.
The most evidence based process to identify frail patients at this moment is comprehensive
geriatric assessment. However, this is a resource intensive, time consuming process and therefore not suitable for clinical practice”

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The Confusion Assessment Method (CAM) for the ICU-7 Delirium Severity Scale

Khan BA, et al. The Confusion Assessment Method for the ICU-7 Delirium Severity
Scale: A Novel Delirium Severity Instrument for Use in the ICU
. Crit Care Med. 2017 May;45(5):851-857.

Measurements and Main Results: Patients received the CAM-ICU, Richmond Agitation-Sedation Scale (RASS), and Delirium Rating Scale-Revised (DRS-R)-98 assessments. A 7-point scale (0-7) was derived from responses to the CAM-ICU and RASS items. CAM-ICU-7 showed high internal consistency (Cronbach’s alpha=0.85) and good correlation with DRS-R-98 scores (correlation coefficient=0.64). Known-groups validity was supported by the separation of mechanically ventilated and non-ventilated assessments. Median CAM-ICU-7 scores demonstrated good predictive validity with higher odds (OR=1.47; 95% CI=1.30-1.66) of inhospital mortality, and lower odds (OR=0.8; 95% CI=0.72-0.9) of being discharged home after adjusting for age, race, gender, severity of illness, and chronic comorbidities. Higher CAM-ICU-7 scores were also associated with increased length of ICU stay (p=0.001).

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