• Minerva anestesiologica · Jan 2016

    How to advance prediction of postoperative delirium? A secondary analysis comparing three methods for very early assessment of elderly patients after surgery and early prediction of delirium.

    • Sebastian Stukenberg, Martin Franck, Claudia Doris Spies, Bruno Neuner, Isaac Myers, and Finn Michael Radtke.
    • Department of anesthesiology and surgical intensive care medicine, Campus-Virchow- Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany - fmr@regionsjaelland.dk.
    • Minerva Anestesiol. 2016 Jan 8.

    BackgroundPostoperative impairment of the cerebral function can appear immediately after general anesthesia and may be predictive for a postoperative delirium. We compared three tools assessing patients on recovery room admission in order to detect early signs of postoperative brain dysfunction: the Postanesthetic Recovery Score (PARS), the Richmond Agitation-Sedation Scale (RASS) and the Nursing Delirium Screening Scale (Nu-DESC).MethodsInclusion criteria of this secondary analysis of the randomized SuDoCo trial were: age ≥ 60 years, schedule for elective non-cardiac surgery with an anticipated duration of ≥ 60 minutes, general anesthesia, ability to communicate in German language. 996 patients were analysed. Investigated scores were assessed 10 minutes after recovery room admission and analysed in terms of association with postoperative delirium, mortality and length of stay in the recovery room. Multivariate analysis: linear or logistic regression.ResultsAbnormal scores in patients: RASS (values ≤ -2 and ≥ 1) 36.8%, Nu-DESC (≥ 2 points) 54.2%, PARS (≤ 7 points) 20.3%. Abnormal RASS values were associated with postoperative delirium (RASS values ≥ 1: Odds Ratio (OR)=3.1, 95%-CI: 1.7-5.6, p<0.001; RASS values ≤ -2: OR=2.1, 95%-CI: 1.3-3.3, p=0.001). Abnormal Nu-DESC values were also associated with postoperative delirium (OR=2.4, 95%-CI: 1.5-3.9, p<0.001). Abnormal PARS values were associated with a longer recovery room stay (in minutes, OR=16.6, 95%-CI: 1.7-31.4, p=0.029).ConclusionThe RASS and Nu-DESC were independent predictors for a delirium within seven postoperative days. Very early assessment of the cerebral function may help to advance detection, prevention and treatment of postoperative delirium in elderly patients.

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