title: Delirium in fast-track colonic surgery.
abstract: BACKGROUND
  Postoperative delirium (PD) is a common but serious problem after major surgery with a multifactorial pathogenesis including age, pain, opioid use, sleep disturbances and the surgical stress response. These factors have been minimised by the "fast-track methodology" previously demonstrated to enhance recovery and reduce morbidity.
  
  
  METHODS
  Clinical symptoms of PD were routinely collected three times daily from preoperatively until discharge in a well-defined enhanced recovery program after colonic surgery in 247 consecutive patients.
  
  
  RESULTS
  Total median length of hospital stay was 3 days. Seven patients (2.8%) developed clinical signs of PD most within the first 72 postoperative hours and only 1 patient with PD extending to 120 h postoperatively. Only 1 PD patient required treatment with serenase. PD patients were older (83 vs. 73 years) and had longer median stay (6 vs. 3 days). No difference in development of PD between open and laparoscopic operation could be demonstrated. Among the 7 patients with PD, 3 of these patients had later surgical complications. One patient had a subsequent strangulated small intestine, another an anastomotic leakage complicated by a bleeding gastric ulcer and death on day 12 and 1 with fever, abdominal pain and suspected but disproven anastomotic leakage (stay 21, 12 and 22 days, respectively). The remaining 4 PD patients stayed 4, 4, 5 and 6 days with an uncomplicated course.
  
  
  CONCLUSIONS
  These data support that an enhanced postoperative recovery program may decrease the risk and duration of PD after colonic surgery.
authors.affiliation: Section of Surgical Pathophysiology, Rigshospitalet Copenhagen University, 4074, Blegdamsvej 9, 2100, Copenhagen, Denmark.
authors.forename: Sorel
authors.initials: S
authors.lastname: Kurbegovic
authors.forename: Jens
authors.initials: J
authors.lastname: Andersen
authors.forename: Lene
authors.initials: L
authors.lastname: Krenk
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D003693:Delirium / Q000517:prevention & control*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control / Q000523:psychology; D012189:Retrospective Studies