TY - JOUR
T1 - Postoperative Delirium and Postoperative Cognitive Dysfunction
T2 - Overlap and Divergence
AU - SAGES Study Group
AU - Daiello, Lori A.
AU - Racine, Annie M.
AU - Yun Gou, Ray
AU - Marcantonio, Edward R.
AU - Xie, Zhongcong
AU - Kunze, Lisa J.
AU - Vlassakov, Kamen V.
AU - Inouye, Sharon K.
AU - Jones, Richard N.
AU - Alsop, David
AU - Travison, Thomas
AU - Arnold, Steven
AU - Cooper, Zara
AU - Dickerson, Bradford
AU - Fong, Tamara
AU - Metzger, Eran
AU - Pascual-Leone, Alvaro
AU - Schmitt, Eva M.
AU - Shafi, Mouhsin
AU - Cavallari, Michele
AU - Dai, Weiying
AU - Dillon, Simon T.
AU - McElhaney, Janet
AU - Guttmann, Charles
AU - Hshieh, Tammy
AU - Kuchel, George
AU - Libermann, Towia
AU - Ngo, Long
AU - Press, Daniel
AU - Saczynski, Jane
AU - Vasunilashorn, Sarinnapha
AU - O'Connor, Margaret
AU - Kimchi, Eyal
AU - Strauss, Jason
AU - Wong, Bonnie
AU - Belkin, Michael
AU - Ayres, Douglas
AU - Callery, Mark
AU - Pomposelli, Frank
AU - Wright, John
AU - Schermerhorn, Marc
AU - Abrantes, Tatiana
AU - Albuquerque, Asha
AU - Bertrand, Sylvie
AU - Brown, Amanda
AU - Callahan, Amy
AU - D'Aquila, Madeline
AU - Dowal, Sarah
AU - Fox, Meaghan
AU - Gross, Alden
PY - 2019/9/1
Y1 - 2019/9/1
N2 - BACKGROUND: Postoperative 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. METHODS: This 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. RESULTS: One 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). CONCLUSIONS: Delirium 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.
AB - BACKGROUND: Postoperative 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. METHODS: This 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. RESULTS: One 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). CONCLUSIONS: Delirium 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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U2 - 10.1097/ALN.0000000000002729
DO - 10.1097/ALN.0000000000002729
M3 - Article
C2 - 31166241
AN - SCOPUS:85071351290
SN - 0003-3022
VL - 131
SP - 477
EP - 491
JO - Anesthesiology
JF - Anesthesiology
IS - 3
ER -