Delirium is associated with early postoperative cognitive dysfunction.
The purpose of this analysis was to determine if postoperative delirium was associated with early postoperative cognitive dysfunction (at 7 days) and long-term postoperative cognitive dysfunction (at 3 months). The International Study of Postoperative Cognitive Dysfunction recruited 1218 subjects >or= 60 years old undergoing elective, non-cardiac surgery. Postoperatively, subjects were evaluated for delirium using the criteria of the Diagnostic and Statistical Manual. Subjects underwent neuropsychological testing pre-operatively and postoperatively at 7 days (n = 1018) and 3 months (n = 946). Postoperative cognitive dysfunction was defined as a composite Z-score > 2 across tests or at least two individual test Z-scores > 2. Subjects with delirium were significantly less likely to participate in postoperative testing. Delirium was associated with an increased incidence of early postoperative cognitive dysfunction (adjusted risk ratio 1.6, 95% CI 1.1-2.1), but not long-term postoperative cognitive dysfunction (adjusted risk ratio 1.3, 95% CI 0.6-2.4). Delirium was associated with early postoperative cognitive dysfunction, but the relationship of delirium to long-term postoperative cognitive dysfunction remains unclear.
Rudolph
J L
JL
VA Boston Healthcare System, Geriatric Education and Clinical Center; Brigham and Women's Hospital, Division of Aging, Harvard Medical School, Boston, MA, USA. jrudolph@partners.org
Marcantonio
E R
ER
Culley
D J
DJ
Silverstein
J H
JH
Rasmussen
L S
LS
Crosby
G J
GJ
Inouye
S K
SK
D000368:Aged; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology*; D003693:Delirium / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period; D011379:Prognosis; D018570:Risk Assessment