title: A Simple Tool to Predict Development of Delirium After Elective Surgery.
abstract: To identify a quick clinical tool to assess the risk of delirium after elective surgery.
  
  
  
  Prospective observational study.
  
  
  
  Preoperative assessment clinic at the Veterans Affairs Portland Health Care System.
  
  
  
  Community-living veterans aged 65 and older scheduled for elective surgery requiring general or major anesthesia.
  
  
  
  Confusion Assessment Method (CAM) or Family Confusion Assessment Method (FAM-CAM). Data on education, medications, substance use, Patient Health Questionnaire (PHQ-9), Study of Osteoporotic Fractures Frailty, Mini-Cog, and Charlson-Deyo score were collected preoperatively.
  
  
  
  Of 114 veterans who agreed to participate, 76 completed the final delirium assessment. Ten of the 76 (13%) developed delirium in the 72 hours after surgery as assessed using the CAM or FAM-CAM. In bivariate analysis, factors that increased the odds of delirium at least three times were low education; poor PHQ-9, clock draw, word recall, Mini-Cog, and poor preoperative orientation scores; alcohol use; and higher comorbidities as measured using Charlson-Deyo index. Scoring the Mini-Cog from 0 to 5 had a higher predictive power (area under the receiving operating characteristic curve = 0.77) than other approaches to scoring the Mini-Cog. Other models did not significantly improve prediction of postoperative delirium risk and would be complicated to use in a clinical setting.
  
  
  
  In this sample of veterans who had elective surgery with major anesthesia, Mini-Cog score predicted likelihood of postoperative delirium.
authors.affiliation: Department of Medicine, Legacy Health System, Portland, Oregon.
authors.forename: Andy
authors.initials: A
authors.lastname: Dworkin
authors.affiliation: College of Pharmacy, Oregon State University & Oregon Health and Science University, Portland, Oregon.
authors.forename: David S H
authors.initials: DS
authors.lastname: Lee
authors.affiliation: Geriatrics Section, Veterans Affairs Portland Health Services Center and Oregon Health & Science University, Portland, Oregon.
authors.forename: Amber R
authors.initials: AR
authors.lastname: An
authors.affiliation: Geriatrics Section, Veterans Affairs Portland Health Services Center and Oregon Health & Science University, Portland, Oregon.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Goodlin
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data; D007361:Intelligence Tests; D008297:Male; D008609:Mental Status Schedule; D009922:Oregon / Q000453:epidemiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D012107:Research Design; D012307:Risk Factors; D058014:Veterans Health / Q000706:statistics & numerical data
keywords: delirium; elderly; postoperative; prediction