Incidences, Characteristics, Management and Outcomes of Different Subtypes of Postoperative Delirium in Elderly Patients Admitted to the Surgical Intensive Care Unit: A Secondary Analysis of a Prospective Cohort Study
Issued Date
2024-01-01
Resource Type
eISSN
22288082
Scopus ID
2-s2.0-85200503322
Journal Title
Siriraj Medical Journal
Volume
76
Issue
7
Start Page
406
End Page
414
Rights Holder(s)
SCOPUS
Bibliographic Citation
Siriraj Medical Journal Vol.76 No.7 (2024) , 406-414
Suggested Citation
Srinil T., Lao-amornphunkul S., Narksut A., Thikom N., Pansangar C., Thanakiattiwibun C., Yuyen T., Chaiwat O., Piriyapatsom A. Incidences, Characteristics, Management and Outcomes of Different Subtypes of Postoperative Delirium in Elderly Patients Admitted to the Surgical Intensive Care Unit: A Secondary Analysis of a Prospective Cohort Study. Siriraj Medical Journal Vol.76 No.7 (2024) , 406-414. 414. doi:10.33192/SMJ.V76I7.267145 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/100427
Title
Incidences, Characteristics, Management and Outcomes of Different Subtypes of Postoperative Delirium in Elderly Patients Admitted to the Surgical Intensive Care Unit: A Secondary Analysis of a Prospective Cohort Study
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Abstract
Objective: Postoperative delirium (POD) has three subtypes: hyperactive, hypoactive, and mixed, with each having distinct features and implications. This study aimed to determine the incidence, management, and clinical outcomes of each POD subtype in elderly patients admitted to the surgical intensive care unit (SICU) after surgery. Materials and Methods: This was a secondary analysis of a prospective cohort study of POD in the SICU. Patients aged ≥65 years admitted to the SICU and expected to stay in the SICU for >24 h were recruited. POD was screened using the Confusion Assessment Method for the ICU (CAM-ICU). Patients with positive CAM-ICU were defined as having POD and included in the analysis. The POD subtypes were categorized, pharmacological and nonpharmacological treatments were identified, and clinical outcomes were reported. Results: Of the 300 included patients, 117 developed POD, with 20 (17.1%) having hypoactive, 45 (38.5%) hyperactive, and 52 (44.4%) mixed. Medications were prescribed in 1 (5.0%), 34 (75.6%), and 35 (67.3 %) in patients with hypoactive, hyperactive, and mixed POD, respectively (P <0.001). Patients with hypoactive POD had the longest duration of delirium, longest length of stay in both the SICU and hospital, and highest hospital mortality. Multivariate regression analysis revealed that hypoactive POD was significantly associated with increased hospital mortality (odds ratio, 3.88; 95% confidence interval, 1.15–13.11). Conclusion: Different POD subtypes resulted in different outcomes. Although hypoactive POD had the lowest incidence, it carried the highest mortality risk.