Perioperative Medicine  |   September 2019
Postoperative Delirium Is Associated with Long-term Decline in Activities of Daily Living
Author Notes
  • 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.) and 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.) and 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.); and the Divisions of General Medicine and Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (E.R.M.).
  • For a downloadable PPT slide containing this article’s citation information, please visit https://anesthesiology.pubs.asahq.org/ss/downloadable_slide.aspx.
    For a downloadable PPT slide containing this article’s citation information, please visit https://anesthesiology.pubs.asahq.org/ss/downloadable_slide.aspx.×
  • Submitted for publication January 1, 2019. Accepted for publication May 9, 2019.
    Submitted for publication January 1, 2019. Accepted for publication May 9, 2019.×
  • Address correspondence to Dr. Shen: Shanghai Tenth People’s Hospital, Anesthesia and Brain Research Institute, Tongji University School of Medicine, 301 Yanchang Road, Building 9, Room 4405, Shanghai 200072, China. kmshy@tongji.edu.cn. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Central and Peripheral Nervous Systems
Perioperative Medicine   |   September 2019
Postoperative Delirium Is Associated with Long-term Decline in Activities of Daily Living
Anesthesiology 9 2019, Vol.131, 492-500. doi:10.1097/ALN.0000000000002849
Anesthesiology 9 2019, Vol.131, 492-500. doi:10.1097/ALN.0000000000002849
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Postoperative delirium is common, but its long-term consequences remain unclear

What This Article Tells Us That Is New:

  • About a quarter of enrolled patients, averaging 80 yr of age, developed delirium after major elective and urgent major orthopedic surgery

  • Activities of daily living at 2 to 3 yr and mortality at 3 yr were both worse in patients who experienced delirium

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.