title: Adverse outcomes of geriatric patients undergoing abdominal surgery who are at high risk for delirium.
abstract: OBJECTIVE
  Among geriatric patients undergoing abdominal surgery who are at high risk for in-hospital delirium, clinical factors associated with delirium correlate with adverse outcomes.
  
  
  METHODS
  Retrospective case series study.
  
  
  METHODS
  University-affiliated referral hospital.
  
  
  METHODS
  Among 228 consecutive patients 70 years or older who underwent major abdominal surgery from September 1, 2002, through December 31, 2003, 89 patients with risk factors for delirium were included in the study.
  
  
  METHODS
  Preoperative, intraoperative, and postoperative clinical factors known to affect the incidence of in-hospital delirium were tested for correlation with adverse outcomes. Incidence of delirium, mortality, and prolonged length of stay (LOS) of 14 days or longer were evaluated as adverse outcomes.
  
  
  RESULTS
  Postoperative delirium occurred in 60%, death in 20%, and prolonged LOS in 32% of patients. Multivariate analysis identified independent predictors of adverse outcomes. Poor preoperative functional and nutritional status correlated with postoperative delirium and mortality. Inadequate postoperative glycemic control also correlated with mortality. Complications in 2 or more organ systems and postoperative hypoalbuminemia (albumin level <3.0 mg/dL[<.003 g/dL; to convert to grams per liter, multiply by 10]) correlated with prolonged LOS. Suboptimal care was identified in the following clinical areas: use of precipitative medications, prolonged bedrest, uncontrolled pain, hypoxia, and glycemic control.
  
  
  CONCLUSIONS
  In a subset of geriatric patients undergoing abdominal surgery who are at high risk for in-hospital delirium, adverse outcomes correlated only with key clinical variables, such as hyperglycemia and poor nutritional and functional states. A high incidence of suboptimal care was observed in several clinical areas, suggesting opportunities for intervention.
authors.affiliation: Department of Surgery, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts 01199, USA.
authors.forename: Sabha
authors.initials: S
authors.lastname: Ganai
authors.forename: K Francis
authors.initials: KF
authors.lastname: Lee
authors.forename: Andrea
authors.initials: A
authors.lastname: Merrill
authors.forename: Maggie H
authors.initials: MH
authors.lastname: Lee
authors.forename: Sandra
authors.initials: S
authors.lastname: Bellantonio
authors.forename: Maura
authors.initials: M
authors.lastname: Brennan
authors.forename: Peter
authors.initials: P
authors.lastname: Lindenauer
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D016896:Treatment Outcome