• Lori A Daiello, Annie M Racine, Yun GouRayR, Edward R Marcantonio, Zhongcong Xie, Lisa J Kunze, Kamen V Vlassakov, Sharon K Inouye, Richard N Jones, David Alsop, Thomas Travison, Steven Arnold, Zara Cooper, Bradford Dickerson, Tamara Fong, Eran Metzger, Alvaro Pascual-Leone, Eva M Schmitt, Mouhsin Shafi, Michele Cavallari, Weiying Dai, Simon T Dillon, Janet McElhaney, Charles Guttmann, Tammy Hshieh, George Kuchel, Towia Libermann, Long Ngo, Daniel Press, Jane Saczynski, Sarinnapha Vasunilashorn, Margaret O'Connor, Eyal Kimchi, Jason Strauss, Bonnie Wong, Michael Belkin, Douglas Ayres, Mark Callery, Frank Pomposelli, John Wright, Marc Schermerhorn, Tatiana Abrantes, Asha Albuquerque, Sylvie Bertrand, Amanda Brown, Amy Callahan, Madeline D'Aquila, Sarah Dowal, Meaghan Fox, Jacqueline Gallagher, Rebecca Anna Gersten, Ariel Hodara, Ben Helfand, Jennifer Inloes, Jennifer Kettell, Aleksandra Kuczmarska, Jacqueline Nee, Emese Nemeth, Lisa Ochsner, Kerry Palihnich, Katelyn Parisi, Margaret Puelle, Sarah Rastegar, Margaret Vella, Guoquan Xu, Margaret Bryan, Jamey Guess, Dee Enghorn, Alden Gross, Yun Gou, Daniel Habtemariam, Ilean Isaza, Cyrus Kosar, Christopher Rockett, Douglas Tommet, Ted Gruen, Meg Ross, Katherine Tasker, James Gee, Ann Kolanowski, Margaret Pisani, Sophia de Rooij, Selwyn Rogers, Stephanie Studenski, Yaakov Stern, Anthony Whittemore, Gary Gottlieb, John Orav, Reisa Sperling, and SAGES Study Group*.
• From the Alzheimer's Disease and Memory Disorders Center, Rhode Island Hospital, Providence, Rhode Island (L.A.D.) Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts (A.M.R., R.Y.G., S.K.I.) Harvard Medical School, Boston, Massachusetts (A.M.R., E.R.M., Z.X., L.J.K., K.V.V., S.K.I.) Departments of Medicine (E.R.M., S.K.I.) Anesthesia and Critical Care (L.J.K.), Beth Israel Deaconess Medical Center, Boston, Massachusetts Department of Anesthesia, Massachusetts General Hospital, Boston, Massachusetts (Z.X.) Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts (K.V.V.) Departments of Psychiatry and Human Behavior (R.N.J.) Neurology (L.A.D., R.N.J.), Brown University Warren Alpert Medical School, Providence, Rhode Island.
• Anesthesiology. 2019 Sep 1; 131 (3): 477491477-491.

BackgroundPostoperative delirium and postoperative cognitive dysfunction share risk factors and may co-occur, but their relationship is not well established. The primary goals of this study were to describe the prevalence of postoperative cognitive dysfunction and to investigate its association with in-hospital delirium. The authors hypothesized that delirium would be a significant risk factor for postoperative cognitive dysfunction during follow-up.MethodsThis study used data from an observational study of cognitive outcomes after major noncardiac surgery, the Successful Aging after Elective Surgery study. Postoperative delirium was evaluated each hospital day with confusion assessment method-based interviews supplemented by chart reviews. Postoperative cognitive dysfunction was determined using methods adapted from the International Study of Postoperative Cognitive Dysfunction. Associations between delirium and postoperative cognitive dysfunction were examined at 1, 2, and 6 months.ResultsOne hundred thirty-four of 560 participants (24%) developed delirium during hospitalization. Slightly fewer than half (47%, 256 of 548) met the International Study of Postoperative Cognitive Dysfunction-defined threshold for postoperative cognitive dysfunction at 1 month, but this proportion decreased at 2 months (23%, 123 of 536) and 6 months (16%, 85 of 528). At each follow-up, the level of agreement between delirium and postoperative cognitive dysfunction was poor (kappa less than .08) and correlations were small (r less than .16). The relative risk of postoperative cognitive dysfunction was significantly elevated for patients with a history of postoperative delirium at 1 month (relative risk = 1.34; 95% CI, 1.07-1.67), but not 2 months (relative risk = 1.08; 95% CI, 0.72-1.64), or 6 months (relative risk = 1.21; 95% CI, 0.71-2.09).ConclusionsDelirium significantly increased the risk of postoperative cognitive dysfunction in the first postoperative month; this relationship did not hold in longer-term follow-up. At each evaluation, postoperative cognitive dysfunction was more common among patients without delirium. Postoperative delirium and postoperative cognitive dysfunction may be distinct manifestations of perioperative neurocognitive deficits.

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