Not knowing an older adult’s cognitive status before surgery can mean that doctors don’t know if a patient is at risk for delirium after surgery. As a result, that patient may miss out on much-needed interventions, a new study finds.
Postoperative delirium is a common complication in older adults who have surgery. Already having cognitive impairment or dementia is a risk factor for postoperative delirium, and interventions can prevent it in those at risk. The researchers looked at how often preventive interventions for delirium aren’t included in those at risk. Authors of the report said at least one of the three known preventative measures wasn’t applied to about 70% of people who underwent spine surgery.
The report was published Monday in Journal of the American Geriatrics Society, Researchers used data from the Perioperative Anesthesia Neurocognitive Disorder Assessment-Geriatric (PANDA-G) and clinical data from the University of California San Francisco delirium prevention initiative.
All of the 245 people involved in the study were 65 or over, and received a preoperative cognitive assessment as part of a research protocol prior to undergoing inpatient spine surgery at a single academic institution. The team used electronic health records to see which of the participants had cognitive impairment at baseline, and who received three of the delirium prevention standards among them. The prevention methods include delirium prevention orders, sleep orders and avoiding potentially inappropriate medications (PIMs) listed in the AGS Beers Criteria. Of the participants, 42% were women, and the average age was 72 years old.
Among the participants, 40% had cognitive impairment before surgery and 34% had delirium after surgery. Of the participants with cognitive impairment, 45% did not receive delirium preventive orders, 43% received PIMs and 49% were missing sleep orders. Overall, at least one of the three delirium preventive interventions was missing in 70% of the patients.
Among the other noteworthy findings: 20% of the people without cognitive impairment before surgery experienced delirium after their operations. This means that other factors such as surgery complexity should be considered when deciding which patients should receive delirium preventive interventions.
