Among a range of common surgeries for older adults, an endarterectomy—opening blood vessels blocked by plaques—may pose the highest risk of postoperative delirium, reports a study in Journal of the American Geriatrics Society. Endarterectomy patients are more likely to have delirium risk factors such as frailty and a history of stroke and/or depression, the study researchers noted.
Patients undergoing other surgeries such as hernia repair or knee/hip replacement also had elevated delirium risk, but for different underlying risk factors.
“By identifying and targeting specific risk factors within each surgical phenotype, healthcare providers may be more efficiently able to enhance postoperative care and outcomes for this vulnerable population,” wrote Hyundeok Joo, M.D., M.A.S., and colleagues at the University of San Francisco.
Joo and colleagues used data from the Health and Retirement Study—a nationwide cohort of older adults in the U.S.—to assess preoperative health characteristics of 7,424 adults ages 65 or older who underwent one or more of 10 noncardiac surgeries from 2000 to 2018. The surgeries were: total knee arthroplasty (TKA), total hip arthroplasty (THA), spine surgery, cholecystectomy, colorectal surgery, hernia repair, endarterectomy, prostatectomy, transurethral resection of the prostate (TURP), and hysterectomy.
The researchers identified distinct patterns of delirium risk:
- Endarterectomy patients presented with the highest burden of medical and cognitive risk factors, including advanced age, high rates of stroke (22%), depression (30%), frailty (42%), and high school or less education (73%).
- Patients receiving a general surgery—cholecystectomy, colorectal surgery, or hernia repair also had elevated delirium risk due to higher rates of frailty (29-32%) and depression (24-26%), with moderate rates of other comorbidities.
- Patients receiving a pain-related surgery—THA, TKA, or spine surgery—had elevated delirium risk due to higher rates of pain (47-53%) and more reported impairment of daily activities, despite low rates of other medical comorbidities.
- Patients in the remaining surgical groups—hysterectomy, prostatectomy, and TURP—generally had a lower risk for delirium.
“The observed variation in delirium risk profiles across different surgical types…suggests that different surgical populations may benefit from different types of delirium prevention strategies,” Joo and colleagues wrote. For example, they noted endarterectomy patients might benefit from resource-intensive interventions such as preoperative cognitive training, prehabilitation to build physical and psychological health, and enhanced perioperative monitoring. Patients receiving one of the pain-related surgeries, meanwhile, would not necessarily need significant prehabilitation, but rather multimodal pain management protocols and early mobilization strategies after surgery.
For related information, see the Psychiatric Research & Clinical Practice article “Simple and Objective Evaluation Items for the Prognosis and Mortality of Delirium in Real‐World Clinical Practice: A Preliminary Retrospective Study.”
(Image: Getty Images/iStock/Ninoon)
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