Postoperative Delirium After Intracranial Surgery: A Retrospective Cohort Study

Pablo R. Kappen; Hilbert J. Kappen; Clemens M.F. Dirven; Markus Klimek; Johannes Jeekel; Elrozy R. Andrinopoulou; Robert J. Osse; Arnaud J.P.E. Vincent

doi:10.1016/j.wneu.2022.12.132

Postoperative Delirium After Intracranial Surgery: A Retrospective Cohort Study

Pablo R. Kappen^*, Hilbert J. Kappen, Clemens M.F. Dirven, Markus Klimek, Johannes Jeekel, Elrozy R. Andrinopoulou, Robert J. Osse, Arnaud J.P.E. Vincent

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: The clinical relevance of postoperative delirium (POD) in neurosurgery remains unclear and should be investigated because these patients are vulnerable. Hence, we investigated the impact of POD, by means of incidence and health outcomes, and identified independent risk factors. Methods: Adult patients undergoing an intracranial surgical procedure in the Erasmus Medical Center Rotterdam between June 2017 and September 2020 were retrospectively included. POD incidence, defined by a Delirium Observation Screening Scale (DOSS) ≥3 or antipsychotic treatment for delirium within 5 days after surgery, was calculated. Logistic regression analysis on the full data set was conducted for the multivariable risk factor and health outcome analyses. Results: After including 2901 intracranial surgical procedures, POD was present in 19.4% with a mean onset in days of 2.62 (standard deviation, 1.22) and associated with more intensive care unit admissions and more discharge toward residential care. Onset of POD was not associated with increased length of hospitalization or mortality. We identified several independent nonmodifiable risk factors such as age, preexisting memory problems, emergency operations, craniotomy compared with burr-hole surgery, and severe blood loss. Moreover, we identified modifiable risk factors such as low preoperative potassium and opioid and dexamethasone administration. Conclusions: Our POD incidence rates and correlation with more intensive care unit admission and discharge toward residential care suggest a significant impact of POD on neurosurgical patients. We identified several modifiable and nonmodifiable risk factors, which shed light on the pathophysiologic mechanisms of POD in this cohort and could be targeted for future intervention studies.

Original language	English
Pages (from-to)	e212-e219
Journal	World Neurosurgery
Volume	172
DOIs	https://doi.org/10.1016/j.wneu.2022.12.132
Publication status	Published - Apr 2023

Bibliographical note

Funding Information:
We would like to thank Tim Lafleur (medical student) for independently extracting a part of the data for validation purposes. Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher Copyright:
© 2023 The Authors

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@article{6b4aa6e5952e438184709c0238cf0f24,

title = "Postoperative Delirium After Intracranial Surgery: A Retrospective Cohort Study",

abstract = "Background: The clinical relevance of postoperative delirium (POD) in neurosurgery remains unclear and should be investigated because these patients are vulnerable. Hence, we investigated the impact of POD, by means of incidence and health outcomes, and identified independent risk factors. Methods: Adult patients undergoing an intracranial surgical procedure in the Erasmus Medical Center Rotterdam between June 2017 and September 2020 were retrospectively included. POD incidence, defined by a Delirium Observation Screening Scale (DOSS) ≥3 or antipsychotic treatment for delirium within 5 days after surgery, was calculated. Logistic regression analysis on the full data set was conducted for the multivariable risk factor and health outcome analyses. Results: After including 2901 intracranial surgical procedures, POD was present in 19.4% with a mean onset in days of 2.62 (standard deviation, 1.22) and associated with more intensive care unit admissions and more discharge toward residential care. Onset of POD was not associated with increased length of hospitalization or mortality. We identified several independent nonmodifiable risk factors such as age, preexisting memory problems, emergency operations, craniotomy compared with burr-hole surgery, and severe blood loss. Moreover, we identified modifiable risk factors such as low preoperative potassium and opioid and dexamethasone administration. Conclusions: Our POD incidence rates and correlation with more intensive care unit admission and discharge toward residential care suggest a significant impact of POD on neurosurgical patients. We identified several modifiable and nonmodifiable risk factors, which shed light on the pathophysiologic mechanisms of POD in this cohort and could be targeted for future intervention studies.",

author = "Kappen, {Pablo R.} and Kappen, {Hilbert J.} and Dirven, {Clemens M.F.} and Markus Klimek and Johannes Jeekel and Andrinopoulou, {Elrozy R.} and Osse, {Robert J.} and Vincent, {Arnaud J.P.E.}",

note = "Funding Information: We would like to thank Tim Lafleur (medical student) for independently extracting a part of the data for validation purposes. Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2023",

month = apr,

doi = "10.1016/j.wneu.2022.12.132",

language = "English",

volume = "172",

pages = "e212--e219",

journal = "World Neurosurgery",

issn = "1878-8750",

publisher = "Elsevier Inc.",

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TY - JOUR

T1 - Postoperative Delirium After Intracranial Surgery

T2 - A Retrospective Cohort Study

AU - Kappen, Pablo R.

AU - Kappen, Hilbert J.

AU - Dirven, Clemens M.F.

AU - Klimek, Markus

AU - Jeekel, Johannes

AU - Andrinopoulou, Elrozy R.

AU - Osse, Robert J.

AU - Vincent, Arnaud J.P.E.

N1 - Funding Information: We would like to thank Tim Lafleur (medical student) for independently extracting a part of the data for validation purposes. Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Publisher Copyright: © 2023 The Authors

PY - 2023/4

Y1 - 2023/4

N2 - Background: The clinical relevance of postoperative delirium (POD) in neurosurgery remains unclear and should be investigated because these patients are vulnerable. Hence, we investigated the impact of POD, by means of incidence and health outcomes, and identified independent risk factors. Methods: Adult patients undergoing an intracranial surgical procedure in the Erasmus Medical Center Rotterdam between June 2017 and September 2020 were retrospectively included. POD incidence, defined by a Delirium Observation Screening Scale (DOSS) ≥3 or antipsychotic treatment for delirium within 5 days after surgery, was calculated. Logistic regression analysis on the full data set was conducted for the multivariable risk factor and health outcome analyses. Results: After including 2901 intracranial surgical procedures, POD was present in 19.4% with a mean onset in days of 2.62 (standard deviation, 1.22) and associated with more intensive care unit admissions and more discharge toward residential care. Onset of POD was not associated with increased length of hospitalization or mortality. We identified several independent nonmodifiable risk factors such as age, preexisting memory problems, emergency operations, craniotomy compared with burr-hole surgery, and severe blood loss. Moreover, we identified modifiable risk factors such as low preoperative potassium and opioid and dexamethasone administration. Conclusions: Our POD incidence rates and correlation with more intensive care unit admission and discharge toward residential care suggest a significant impact of POD on neurosurgical patients. We identified several modifiable and nonmodifiable risk factors, which shed light on the pathophysiologic mechanisms of POD in this cohort and could be targeted for future intervention studies.

AB - Background: The clinical relevance of postoperative delirium (POD) in neurosurgery remains unclear and should be investigated because these patients are vulnerable. Hence, we investigated the impact of POD, by means of incidence and health outcomes, and identified independent risk factors. Methods: Adult patients undergoing an intracranial surgical procedure in the Erasmus Medical Center Rotterdam between June 2017 and September 2020 were retrospectively included. POD incidence, defined by a Delirium Observation Screening Scale (DOSS) ≥3 or antipsychotic treatment for delirium within 5 days after surgery, was calculated. Logistic regression analysis on the full data set was conducted for the multivariable risk factor and health outcome analyses. Results: After including 2901 intracranial surgical procedures, POD was present in 19.4% with a mean onset in days of 2.62 (standard deviation, 1.22) and associated with more intensive care unit admissions and more discharge toward residential care. Onset of POD was not associated with increased length of hospitalization or mortality. We identified several independent nonmodifiable risk factors such as age, preexisting memory problems, emergency operations, craniotomy compared with burr-hole surgery, and severe blood loss. Moreover, we identified modifiable risk factors such as low preoperative potassium and opioid and dexamethasone administration. Conclusions: Our POD incidence rates and correlation with more intensive care unit admission and discharge toward residential care suggest a significant impact of POD on neurosurgical patients. We identified several modifiable and nonmodifiable risk factors, which shed light on the pathophysiologic mechanisms of POD in this cohort and could be targeted for future intervention studies.

UR - http://www.scopus.com/inward/record.url?scp=85147222557&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2022.12.132

DO - 10.1016/j.wneu.2022.12.132

M3 - Article

C2 - 36608800

AN - SCOPUS:85147222557

SN - 1878-8750

VL - 172

SP - e212-e219

JO - World Neurosurgery

JF - World Neurosurgery

ER -

Postoperative Delirium After Intracranial Surgery: A Retrospective Cohort Study

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