Postoperative delirium in elderly after elective and acute colorectal surgery: A prospective cohort study.
OBJECTIVE
To assess the frailty and the incidence of delirium in elderly patients undergoing elective and acute colorectal surgery in correlation with morbidity and mortality.


METHODS
Patients aged 65 years and older having elective and acute colorectal surgery, between April 2013 and December 2013 were included in a prospective database. Patients diagnosed with a colorectal carcinoma or diverticulitis who were operated on were included. Factors that characterize frailty of patients were noted. The incidence rates of delirium after elective and acute surgery were recorded. Delirium was diagnosed using the Delirium Observation Screening Scale (DOSS). Preoperative evaluation, surgical outcome including morbidity, hospital stay and mortality were analyzed.


RESULTS
Patients ≥ 65 years were included, 83 (75%) received elective and 28 (25%) acute surgery. The overall incidence of delirium was 21%, 18% for elective and 29% for patients having urgent surgery (p = 0.24). Patients with delirium were older than the non-delirious patients (median 82 years vs. 74 years; p < 0.001). Delirious patients showed higher incidence of adverse events. Hospital stay, mortality and discharge to a nursing home were significant higher in the delirious compared to the non-delirious group (p = 0.01; 0.01; 0.02 respectively).


CONCLUSIONS
High incidence of delirium was found in both acute and elective colorectal surgery. Delirium was associated with adverse outcomes.
Department of Surgery, Amphia Hospital, Breda, The Netherlands. Electronic address: JRaats@amphia.nl.
J W
JW
Raats
Department of Surgery, Amphia Hospital, Breda, The Netherlands.
S L
SL
Steunenberg
Department of Surgery, Amphia Hospital, Breda, The Netherlands.
R M P H
RM
Crolla
Department of Surgery, Amphia Hospital, Breda, The Netherlands.
J H H
JH
Wijsman
Department of Surgery, Amphia Hospital, Breda, The Netherlands.
A
A
te Slaa
Department of Surgery, Amphia Hospital, Breda, The Netherlands.
L
L
van der Laan
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery; D003693:Delirium / Q000453:epidemiology* / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000523:psychology*; D004238:Diverticulitis / Q000601:surgery; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000523:psychology*; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors
Acute surgery; Colorectal surgery; Post-operative delirium