title: Postoperative delirium is an independent risk factor for posttraumatic stress disorder in the elderly patient: a prospective observational study.
abstract: BACKGROUND
  Posttraumatic stress disorder (PTSD) may appear after hospitalisation for surgery with general anaesthesia in elderly patients. Prevalence and risk factors in this setting are unknown. Postoperative delirium could be a risk factor.
  
  
  OBJECTIVE
  The purpose of this study was to identify the prevalence of, and risk factors for, PTSD 3 months after surgery with general anaesthesia in elderly patients.
  
  
  METHODS
  A prospective, clinical observational study.
  
  
  METHODS
  This study was carried out between March 2009 and May 2010 in a German university hospital in Berlin and was part of a larger study focusing on depth of anaesthesia.
  
  
  METHODS
  
  
  
  METHODS
  at least 60 years of age; noncardiac surgery with general anaesthesia.
  
  
  METHODS
  impaired preoperative cognitive function [mini-mental state examination (MMSE) score <24]; expected surgery time less than 1 h; nonproficiency in the German language.
  
  
  METHODS
  None.
  
  
  METHODS
  Screening for PTSD 3 months after surgery using the screening instrument Post-Traumatic Stress Syndrome 14-Questions Inventory Score (PTSS-14). The following risk factors for PTSD 3 months after surgery were tested: age; American Society of Anesthesiologists physical status; sex; duration of anaesthesia; postoperative delirium; PTSS-14 score 7 days after surgery; postoperative vomiting and nausea; postoperative pain; and preoperative depression.
  
  
  METHODS
  Univariate statistical analysis was performed with Fisher's exact test and Spearman correlation. A backward logistic regression was performed.
  
  
  RESULTS
  A total of 559 out of 1277 patients were included. Sixty-six patients (12%) were identified with PTSD 3 months after surgery. Seventy-seven patients (14%) were identified with postoperative delirium. Independent associated factors in the backward logistic regression were postoperative delirium (risk factor) and preoperative depression (protective factor).
  
  
  CONCLUSIONS
  The prevalence of PTSD 3 months after surgery in elderly patients was high using the screening instrument PTSS-14. Postoperative delirium is a risk factor for PTSD 3 months after surgery.
  
  
  BACKGROUND
  ISRCTN Register: 36437985. http://www.controlled-trials.com/ISRCTN36437985/
authors: From the Department of Anaesthesiology and Surgical Intensive Care Medicine, Campus-Virchow-Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany *Both Tanja Drews and Martin Franck contributed equally.
authors: Tanja
authors: T
authors: Drews
authors: Martin
authors: M
authors: Franck
authors: Finn M
authors: FM
authors: Radtke
authors: Björn
authors: B
authors: Weiss
authors: Henning
authors: H
authors: Krampe
authors: Wolf R
authors: WR
authors: Brockhaus
authors: Georg
authors: G
authors: Winterer
authors: Claudia D
authors: CD
authors: Spies
mesh_terms: D000367:Age Factors; D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects*; D003071:Cognition; D003693:Delirium / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D003863:Depression / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome