Test To Identify Vulnerable Patients

Paychological and cognitive tests
can help find the patients at
greatest risk; © Picture Disc

Postoperative delirium is a state of confusion affecting approximately 15 percent of older surgical patients. Episodes of delirium may occur for several hours or even for days. Some patients may even experience a longer-lasting state of confusion with a serious decline in cognition and attention. Postoperative delirium has been associated with increased postoperative complications, medical costs and death.

The first study, from Terri G. Monk and colleagues, explored the impact of multiple risk factors on the probability for postoperative delirium among older adults undergoing non-cardiac surgery with general anaesthesia. 100 patients 50 years or older undergoing non-cardiac surgery were submitted to a preoperative screening for depression and a battery of five tests designed to measure general cognition and their ability to process information, concentrate and self monitor. Postoperative delirium occurred in 16 percent of patients.

Results indicated that the most reliable predictors of postoperative delirium were tests measuring depression and cognitive flexibility. Patients whose scores indicated underlying depression and less cognitive flexibility, also known as executive function, were most likely to experience delirium following their surgery.

“This study demonstrates that a short preoperative test lasting just ten minutes or less can help to identify which patients may be at risk for the development of postoperative delirium,” said Monk. “Once patients at risk can be identified, interventions to prevent or minimise delirium can be investigated and implemented, to the benefit of the aging population.”

A companion study evaluates the relationship between executive function, depression and delirium, furthering evidence that patients who exhibit test results of executive dysfunction and depression before surgery are most at risk for developing postoperative delirium.

The researchers performed a retrospective review of 998 patients undergoing major non-cardiac surgery. Patients were screened preoperatively using tests to measure confusion, executive function and depression. 3.5 percent, or 35 patients, developed delirium following surgery. Patients who exhibited both executive dysfunction and clinically significant depression were determined to be at greatest risk for developing delirium postoperatively.

MEDICA.de; Source: American Society of Anesthesiologists (ASA)