Originally published by our sister publication Anesthesiology News
As much as three-fourths of patients who have preexisting cognitive impairment (preCI) may experience postoperative delirium (POD), according to abstract P-58.
Although many preoperative risk factors for POD are known—including advanced age, medical comorbidities, frailty, specific medication usage and preCI—POD often is undetected and few anesthesiologists assess their patients for the condition.
“Delirium is a big deal and we don’t always do a good job screening for it,” said Stephen Choi, MD, the director of the Clinical Research Unit in the Department of Anesthesia at Sunnybrook Health Sciences Centre and an affiliate scientist at Sunnybrook Research Institute, in Toronto.
“We frequently don’t see our patients that often after surgery, except if they are on acute pain service,” Dr. Choi said. “So, we regularly aren’t aware of delirium until the patients come back to clinic for another surgical procedure and tell us about the experiences they had.”
Dr. Choi and his colleagues established the two-phase PROMoTE (optimizing PReOperative assessMent in the anesthesia clinic for adulT surgical patients) study to learn more about POD and how to detect it to reduce the incidence.
The study’s first phase aimed to risk-stratify, identify and target patients with preCI. Incidence of POD was assessed in a cohort of patients 60 years of age and older who were scheduled for major elective, noncardiac surgery, with a planned hospital stay of one day or longer. Assessment was performed via the CHART-DEL (Chart-based Delirium Identification Instrument) and 3D-CAM tool.
Of 275 patients who met inclusion criteria, 49.8% were determined to have preCI, and an interim analysis of the majority of the participants identified 20 cases of POD (21.7%).
“We’ve been surprised that the incidence of preCI in our patient population was higher than reported in contemporary literature,” said Lilia Kaustov, PhD, the research manager in the Department of Anesthesia at Sunnybrook Health Sciences Centre.
The study’s second phase will build on these findings to establish an interdepartmental communication network and implement education programs for patients, caregivers and healthcare providers.
“With implementation of the remote screening for preCI and delirium, we can now identify potentially delirious patients when they have been discharged from the hospital and are at home,” Dr. Kaustov said.
By Ethan Covey
Choi and Kaustov reported no relevant financial disclosures.
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