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Vol. 98. Issue 8.
Pages 450-455 (October 2020)
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Vol. 98. Issue 8.
Pages 450-455 (October 2020)
Original article
DOI: 10.1016/j.cireng.2020.09.014
Prospective Study of Factors Associated With Postoperative Delirium After Urgent Abdominal Surgery
Estudio prospectivo de los factores asociados al delirium en el postoperatorio de la cirugía abdominal urgente
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Pablo Sánchez Acedo
Corresponding author
pablosanchez_84@hotmail.com

Corresponding author.
, Inés Eguaras Córdoba, Cruz Zazpe Ripa, Javier Herrera Cabezón, Antonio Tarifa Castilla
Cirugía General, Complejo Hospitalario de Navarra, Navarra, Spain
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Tables (3)
Table 1. Demographic Data of the Study Patients (n = 446).
Table 2. Univariate Analysis of Factors Associated With Postoperative Delirium.
Table 3. Multivariate Analysis of Factors Associated With Postoperative Delirium.
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Figures (1)
Abstract
Introduction

Delirium is a frequent complication in elderly patients after urgent abdominal surgery.

Methods

Prospective study of consecutive patients aged ≥ 65 years who had undergone urgent abdominal surgery from 2017−2019. The following variables were recorded: age, sex, ASA, physiological state, cognitive impairment, frailty (FRAIL Scale), functional dependence (Barthel Scale), quality of life (Euroqol-5D-VAS), nutritional status (MNA-SF), preoperative diagnosis, type of surgery (BUPA Classification), approach and diagnosis of postoperative delirium (Confusion Assessment Method). Univariate and multivariate analyses were performed to analyze the correlation of these variables with delirium.

Results

The study includes 446 patients with a median age of 78 years, 63.6% were ASA ≥ III and 8% had prior cognitive impairment. 13.2% were frail and 5.4% of the patients had a severe or total degree of dependence. 13.6% developed delirium in the postoperative period. In the univariate analysis, all the variables were statistically significant except for sex, type of surgery (BUPA) and duration. In the multivariate analysis the associated factors were: age (P < .001; OR: 1,08; 95% CI: 1,038-1,139), ASA (P= .026; OR: 3.15; 95% CI: 1.149-8.668), physiological state (P < .001; OR: 5.8; 95% CI: 2.176-15.457), diagnosis (P= .006) and cognitive impairment (P < .001; OR: 5.8; 95% CI: 2.391-14.069).

Conclusion

The factors associated with delirium are age, ASA, physiological state in the emergency room, preoperative diagnosis and prior cognitive impairment.

Keywords:
Urgent abdominal surgery
Delirium
Postoperative complications
Resumen
Introducción

El delirium es una complicación frecuente en pacientes ancianos intervenidos de cirugía abdominal urgente.

Métodos

Estudio prospectivo que incluye pacientes consecutivos ≥ 65 años intervenidos de cirugía abdominal urgente entre 2017 y 2019. Se registró: edad, sexo, ASA, estado fisiológico, deterioro cognitivo, fragilidad (escala de Frail), dependencia funcional (escala de Barthel), calidad de vida (Euroqol-5D-EVA), estado nutricional (MNA-SF), diagnóstico preoperatorio, tipo de cirugía (clasificación BUPA), vía de abordaje y diagnóstico de delirium postoperatorio (Confusion Assessment Method). Se realizó un analysis univariante y multivariante para analizar la relación de estas variables con el delirium.

Resultados

El estudio incluye 446 pacientes con una median de edad de 78 años; el 63,6% eran ASA ≥ III y el 8% presentaban un deterioro cognitivo previo. El 13,2% eran frágiles y el 5,4% de los pacientes tenían un grado de dependencia grave o total. Un 13,6% desarrollaron delirium en el postoperatorio. En el analysis univariante todas las variables son estadísticamente significativas salvo el sexo, el tipo de cirugía (BUPA) y la duración. En el analysis multivariante los factores asociados fueron: la edad (p < 0,001; OR: 1,08 [IC 95%: 1,038-1,139]), el ASA (p = 0,026; OR: 3,15 [IC 95%: 1,149-8,668]), la alteración fisiológica (p < 0,001; OR: 5,8 [IC 95%: 2,176 15,457]), el diagnóstico (p = 0,006) y el deterioro cognitivo (p < 0,001; OR: 5,8 [IC 95%: 2,391-14,069]).

Conclusión

Los factores asociados al delirium son la edad, el ASA, la alteración fisiológica a su llegada a urgencias, el diagnóstico preoperatorio y el deterioro cognitivo previo.

Palabras clave:
Cirugía abdominal
Ancianos
Cirugía urgente
Delirium
Síndrome confusional agudo

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