Postoperative delirium in the older patient.
Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.Journal of the American College of Surgeons (Impact Factor: 4.45). 06/2005; 200(5):767-73. DOI: 10.1016/j.jamcollsurg.2004.08.031
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ABSTRACT: With the current obesity epidemic, obstructive sleep apnea (OSA) has become increasingly common. Several studies have reported on the risk of post-operative complications in OSA patients undergoing non-upper airway surgeries. The objective of our study was to systematically review the medical literature reporting the incidence of post-operative complications in patients with OSA. We conducted a systematic review using the Cochrane Collaboration Methodology. We searched Medline via Ovid, Pubmed, Embase, and Evidence-Based Medicine Reviews databases from 1950 to 2012. We rated the quality of evidence for each outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Meta-analysis was done using Review Manager Version 5.0.20. Our search resulted in 18 eligible studies. OSA was found to be associated with a significantly increased incidence of post-operative hypoxemia (odds ratio [OR] = 3.06; 95 % confidence interval [CI] 2.35-3.97), respiratory complications (OR = 2.77, 95 % CI 1.73-4.43), cardiac complications (OR = 1.76 95 % CI 1.16-2.67), neurological complications (OR = 2.65, 95 % CI 1.43-4.92), and unplanned intensive care unit (ICU) transfer (OR = 2.97, 95 % CI 1.90-4.64). Re-intubation (OR = 1.37, 95 % CI 0.65-2.91) was not significantly increased in patients with OSA. The association between OSA and post-operative outcomes remained unchanged with sub-group analysis including only studies that used polysomnography (PSG) for diagnosis. OSA patients are at increased risk of post-operative complications from non-upper airway surgeries. Early diagnosis and treatment of OSA might decrease post-operative complications in these patients. There is a need for further studies to assess the benefit of peri-operative treatment of OSA on post-operative outcomes.Sleep And Breathing 12/2013; 18(3). DOI:10.1007/s11325-013-0925-1 · 2.26 Impact Factor
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ABSTRACT: The objective of this study is to evaluate the longitudinal construct validity of the Health Utilities Index Mark 2 (HUI2) and Health Utilities Index Mark 3 (HUI3) using a convergent/divergent validity approach in patients recovering from hip fracture, with the Functional Independence Measure (FIM) as the comparator. A total of 278 patients with a primary diagnosis of hip fracture were interviewed 3-5 days after surgery and then at 1 and 6 months using the HUI2, HUI3 and the FIM and a Likert-type rating of hip pain. A priori hypotheses were formulated. Convergent and divergent correlations between HUI2, HUI3 and FIM change scores for the baseline to 1-month and baseline to 6-month intervals were examined. Overall HUI2 detected continued gain in health-related quality of life between 1 and 6 months after fracture, as the change increased from 0.20 to 0.29 units. The correlation between change in the overall HUI2 score and total FIM score was moderate (r = 0.50) over the 6-month interval, but larger than the observed correlation over the 1-month interval (r = 0.36). The correlation between change in overall HUI3 score and total FIM over the 1-month interval was small (r = 0.32), and the correlation between change in overall HUI3 score and total FIM was moderate (r = 0.37) over the 6-month interval. All hypotheses for the divergent correlations were supported. Weaker correlations were reported for change over 1 month as compared to change over the 6 months after fracture. Findings supported the longitudinal construct validity of the overall HUI2 and HUI3 for the assessment of recovery following hip fracture, particularly for change over the 6 months following fracture.Quality of Life Research 10/2013; 23(3). DOI:10.1007/s11136-013-0531-5 · 2.86 Impact Factor
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ABSTRACT: Objectives To determine whether the postoperative administration of tryptophan would be beneficial for elderly adults undergoing surgery who are at risk of developing postoperative delirium.DesignRandomized, double-blind, placebo-controlled trial.SettingDenver Veterans Affairs Medical Center.ParticipantsIndividuals aged 60 and older undergoing major elective operations requiring a postoperative intensive care unit (ICU) admission (n = 325).InterventionL-tryptophan, 1 g orally three times a day or placebo was started after surgery and continued for up to 3 days postoperatively.MeasurementsDelirium and its motor subtypes were measured using the Confusion Assessment Method–Intensive Care Unit (CAM-ICU) and the Richmond Agitation and Sedation Scale. The primary outcome for between-group comparison was the incidence of excitatory (mixed and hyperactive) postoperative delirium. The secondary outcomes for comparison were the incidence and duration of overall postoperative delirium.ResultsThe overall incidence of postoperative delirium was 39% (95% confidence interval = 34–44%) (n = 116). Seventeen percent of participants in the tryptophan group and 9% in the placebo group had excitatory delirium (P = .18), and the duration of excitatory delirium was 3.3 ± 1.7 days for tryptophan and 3.1 ± 1.9 days for placebo (P = .74). Forty percent of participants in the tryptophan group and 37% in the placebo group had overall delirium (P = .60), and the duration of overall delirium was 2.9 ± 1.8 days for tryptophan and 2.4 ± 1.6 days for placebo (P = .17).Conclusion Postoperative tryptophan supplementation in older adults undergoing major elective operations requiring postoperative ICU admission did not reduce the incidence or duration of postoperative excitatory delirium or overall delirium.Journal of the American Geriatrics Society 08/2014; 62(9). DOI:10.1111/jgs.12972 · 4.22 Impact Factor
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