Delirium Related to Gastrointestinal Surgery in Older Patients

Older patients who undergo gastrointestinal surgery often develop delirium, according to findings published in the British Journal of Surgery.

Researchers from Cardiff University in the United Kingdom searched databases for information about delirium related to older patients undergoing gastrointestinal surgery to collate and synthesize the published literature on risk factors for the mental state in this population.

The researchers used Medline, Web of Science, Embase, Cinahl, and Psychinfo to find 11 studies that were conducted between January 1987 and November 2014. The studies included 1427 patients, of which 318 had delirium and 1109 did not have delirium.

The researchers found that while age is a noted risk factor for post gastrointestinal surgery delirium, the more older patients undergo this surgery, the more important it is to further understand the connection. The study authors said that there is a gap in knowledge for other associated risk factors.

The incidence of postoperative delirium ranged between 8.2 to 54.4%. There were a total of 95 risk factors investigated for their relation to delirium, but the relevant ones included the patient’s age, poor physical status, low body mass index, low blood levels of albumin, hypotension, the need for blood transfusions and history of alcohol abuse, the researchers reported.

Also, they said, patients with delirium after surgery required longer hospital stays and died earlier than patients who did not demonstrate delirium.

“The importance of delirium in critical care and older adult patients is well recognized,” lead author Anna Scholz, MD, explained in a press release. “We have demonstrated that delirium is not exclusive to ‘medical’ healthcare settings; our review summarizes the available evidence in general surgery and highlights a number of areas where more research is urgently needed.”

The study was published as part of an issue of the British Journal of Surgery especially investigating the surgical care of elderly patients. The statement added that the other studies in the issue included those investigating individualizing surgery for elderly patients with cancer, making the elderly fit for surgery and tailoring emergency general surgery for geriatric patients.