Incidence and risk factors of postoperative delirium in cervical spine surgery.
METHODS
Retrospective clinical review and prospective report of postoperative delirium after cervical spine surgeries.


OBJECTIVE
To investigate factors contributing to the development of delirium after cervical surgery and see whether amended therapeutic protocols could improve or alter postoperative outcomes.


BACKGROUND
Important consequences of postoperative delirium for the orthopedic patients include impaired recovery and increased morbidity and mortality. Although its risk factors have been reported in orthopedic surgery, there are a very few reports regarding postoperative delirium in spine surgery.


METHODS
Eighty-one cervical myelopathy patients were retrospectively examined about the incidence of postoperative delirium and the risk factors. Similarly, 41 patients who received postoperative care under modified protocols were prospectively examined.


RESULTS
Postoperative delirium occurred more commonly in patients over 70 years and those with hearing impairment. Patients who received high-dose methylprednisolone (>1000 mg) demonstrated an increased incidence of postoperative delirium. Under modified protocol, we reduced the usage of methylprednisolone and encouraged free body movement with cervical orthosis immediately after surgery. The incidence of postoperative delirium was significantly lower under the modified protocol.


CONCLUSIONS
Early commencement of mobilization after cervical spine surgery would be crucial to the prevention of postoperative delirium in the elderly.
Ushida
Takahiro
T
Department of Orthopaedic Surgery, Kochi Medical School, Kochi, Japan. ushidat-koc@umin.ac.jp
Yokoyama
Takeshi
T
Kishida
Yasuyo
Y
Hosokawa
Mika
M
Taniguchi
Shinichirou
S
Inoue
Shinsuke
S
Takemasa
Ryuichi
R
Suetomi
Katsutoshi
K
Arai
Young-Chang P
YC
McLaughlin
Matthew
M
Tani
Toshikazu
T
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery; D016009:Chi-Square Distribution; D019299:Decompression, Surgical; D003693:Delirium / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D034381:Hearing Loss / Q000150:complications; D006801:Humans; D015994:Incidence; D008297:Male; D008499:Medical Records; D008775:Methylprednisolone / Q000009:adverse effects; D008875:Middle Aged; D019637:Orthopedic Procedures; D018579:Patient Selection; D011183:Postoperative Complications; D011184:Postoperative Period; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D013118:Spinal Cord Diseases / Q000601:surgery*; D013131:Spine / Q000601:surgery*
D008775:Methylprednisolone