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TEMPLATE DESIGN © 2008
www.PosterPresentations.com
David Supinski BA 1, Kelsey L. Wise MD 1, 2, Shanon Harper DNP 2, V.F. Sechriest MD 1, 2,
1 Minneapolis VA Department of Orthopeadic Surgery1, University of Minnesota Department of Orthopeadic Surgery2
Background
•Postoperative delirium is a common complication
in the elderly.1
•Risk factors include age, cognitive impairment,
psychotropic medications, and sensory
impairment, all of which are common in the
veteran population.1-3
•Little is known about the incidence of delirium after
patients undergo ambulatory surgery.
•Investigate prevalence of risk factors for
postoperative delirium in patients undergoing
ambulatory orthopedic surgery in a VA setting.
•Establish protocols for screening, education, and
prevention of postoperative delirium for patients
undergoing ambulatory orthopedic surgery.
Acknowledgements
Methods
Summary
Investigation of Postoperative Delirium in the Setting of
Ambulatory Surgery in a US Veteran Population
References
Brittney Betcher and Emily Grimshaw for their help with enrolling patients and
providing education materials prior to surgery.
•73% of patients had at least 1 risk factor, 51%
have 2 or more, 38% have 3 or more.
•The most common risk factors were depression,
antidepressants, sleep deprivation/disturbance,
antihistamines, and hearing impairment.
•Preoperative screening may identify at risk
patients, as well as help inform surgical planning
(choice of anesthesia, overnight stay, etc.) while
family counseling about delirium helps to
maximize awareness and minimize negative
outcomes of postoperative delirium.
•Novel education materials were created to
educate the patient’s family members, the most
likely people to recognize postoperative delirium.
1. Schenning KJ, Deiner SG. Postoperative Delirium in the Geriatric Patient. Anesthesiol Clin. 2015
Sep;33(3):505-16. doi: 10.1016/j.anclin.2015.05.007. Epub 2015 Jul 7. PMID: 26315635; PMCID:
PMC4555984.
2. Olenick M, Flowers M, Diaz VJ. US veterans and their unique issues: enhancing health care professional
awareness. Adv Med Educ Pract. 2015 Dec 1;6:635-9. doi: 10.2147/AMEP.S89479. PMID: 26664252;
PMCID: PMC4671760.
3. Eibner et al. Current and Projected Characteristics and Unique Health Care Needs of the Patient
Population Served by the Department of Veterans Affairs. Rand Health Q. 2016 May 9;5(4):13. PMID:
28083423; PMCID: PMC5158228.
Results
Next steps
•We better understand the amount of risk our patients
possess. More study is needed to correlate these
risk factors with incidence of postoperative delirium,
measured with the FAM-CAM tool (Figure 2).
•Design a system to organize ambulatory surgery
patients into risk categories for postoperative
delirium (Low, Medium, High) based on patient-
specific risk
factors.
Objective
Table 1: Patient Characteristics
Population
•All patients undergoing ambulatory orthopedic
shoulder surgery at the Minneapolis VAMC.
Data
Collection
•Patient demographics and known risk factors
for postoperative delirium.
Data
Analysis
•Quantify risk, design education materials on
delirium to provide to patients and their families.
•A total of 100 patients who underwent outpatient
shoulder surgery at the Minneapolis VAMC in 2019
were reviewed (Table 1).
•16 risk factors for delirium were identified (Table 2).
•Over half of patients had at least 2 delirium risk
factors, and over one third of patients had at least 3
risk factors (Figure 1).
Table 2. Risk Factors for Delirium
Neuropsychiatric Conditions
Cognitive dysfunction
1%
Dementia
0%
Parkinson’s Disease
0%
Depression
36%
Alcohol Abuse
10%
Sleep deprivation or disturbance
28%
History of postoperative delirium
0%
History of stroke
3%
Medications
Anitpsychotics
5%
Anti
-cholinergics
0%
Benzodiazepines
8%
Antihistamines
17%
Neuroleptics
6%
Antidepressants
35%
Immobilization
0%
Visual Impairment
0%
Hearing Impairment
13%
Current Hip Fracture
0%
Medical Comorbidities
Heart Failure
1%
Kidney Failure
2%
Anemia
9%
Hypoalbuminemia
0%
Hypernatremia
0%
Hyponatremia
6%
Cardiovascular Disease
9%
27
22
13
20
12
6
0 1 2 3 4 ≥5
Delirium Risk Factors
Figure 1
Figure 1. Number of delirium risk factors
Figure 2.The
Family
Confusion
Assessment
Method (FAM-
CAM) allows
providers to
identify patients
at risk for
delirium through
a short
questionnaire
with the patients’
caregiver.
Image 1
•Delirium education materials were designed for
patient’s families (Image 1).
Figure 2