Long-Term Outcomes of Older Adults with and Without Delirium Immediately After Recovery from General Anesthesia for Surgery.
OBJECTIVE
Postoperative delirium, occurring days after surgery, is associated with both short- and long-term adverse events. Postanesthesia care unit (PACU) delirium, immediately after recovery from anesthesia, is associated with continued delirium in the succeeding days and adverse cognitive outcomes at discharge. Longer-term consequences are unclear. The objective was to evaluate 18-month outcomes of patients with versus without delirium in the PACU after surgery with general anesthesia.


METHODS
In a prospective, observational, cohort study, 91 consecutive English-speaking patients, aged at least 70 years and capable of independently providing informed consent before surgery, were followed after admission for a surgical procedure in one teaching hospital. Patients completed cognitive testing before surgery. After recovery from general anesthesia, they were evaluated for a DSM-IV diagnosis of delirium. Participants or proxies were evaluated, at a median of 19 months after surgery (interquartile range: 18-20 months), for survival, cognitive and physical functioning, and healthcare utilization outcomes.


RESULTS
All 91 patients or proxies (41 with delirium [45%]) were contacted at follow-up, with 7 deaths (8%) and 3 declining further participation (3%); 81 (96% of survivors) completed follow-up evaluations, demonstrating no significant cognitive or functional decline from baseline, with 75% of the cohort living independently in the community, and no differences in any outcomes between patients with versus without PACU delirium.


CONCLUSIONS
In a small cohort of older patients evaluated 18 months after surgery, we could not detect an association of delirium diagnosed in the PACU with patient survival, cognitive/physical functioning, and healthcare utilization.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: kneufel2@jhmi.edu.
Karin J
KJ
Neufeld
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
Jeannie-Marie S
JM
Leoutsakos
Division of Geriatrics and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Esther
E
Oh
Department of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD.
Frederick E
FE
Sieber
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Anita
A
Chandra
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Ankita
A
Ghosh
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
David J
DJ
Schretlen
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.
Dale M
DM
Needham
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000762:Anesthesia Recovery Period; D003071:Cognition; D003693:Delirium / Q000175:diagnosis*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008396:Maryland; D010351:Patient Discharge; D011183:Postoperative Complications / Q000175:diagnosis*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales
Delirium; cognitive outcomes; general anesthesia; older adults; postoperative recovery