title: Incidence and risk factors of postoperative delirium in cervical spine surgery.
abstract: 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.
authors.affiliation: Department of Orthopaedic Surgery, Kochi Medical School, Kochi, Japan. ushidat-koc@umin.ac.jp
authors.forename: Takahiro
authors.initials: T
authors.lastname: Ushida
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yokoyama
authors.forename: Yasuyo
authors.initials: Y
authors.lastname: Kishida
authors.forename: Mika
authors.initials: M
authors.lastname: Hosokawa
authors.forename: Shinichirou
authors.initials: S
authors.lastname: Taniguchi
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Inoue
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Takemasa
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Suetomi
authors.forename: Young-Chang P
authors.initials: YC
authors.lastname: Arai
authors.forename: Matthew
authors.initials: M
authors.lastname: McLaughlin
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Tani
mesh_terms: 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*
chemical_list: D008775:Methylprednisolone