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Sabha Ganai, MD; K. Francis Lee, MD, MPH; Andrea Merrill, BS; Maggie H. Lee, MS; Sandra Bellantonio, MD; Maura Brennan, MD; Peter Lindenauer, MD, MS

Arch Surg. 2007;142(11):1072-1078.

Hypothesis  Among geriatric patients undergoing abdominal surgery who are at high risk for in-hospital delirium, clinical factors associated with delirium correlate with adverse outcomes.

Design  Retrospective case series study.

Setting  University-affiliated referral hospital.

Patients  Among 228 consecutive patients 70 years or older who underwent major abdominal surgery from September 1, 2002, through December 31, 2003, 89 patients with risk factors for delirium were included in the study.

Main Outcome Measures  Preoperative, intraoperative, and postoperative clinical factors known to affect the incidence of in-hospital delirium were tested for correlation with adverse outcomes. Incidence of delirium, mortality, and prolonged length of stay (LOS) of 14 days or longer were evaluated as adverse outcomes.

Results  Postoperative delirium occurred in 60%, death in 20%, and prolonged LOS in 32% of patients. Multivariate analysis identified independent predictors of adverse outcomes. Poor preoperative functional and nutritional status correlated with postoperative delirium and mortality. Inadequate postoperative glycemic control also correlated with mortality. Complications in 2 or more organ systems and postoperative hypoalbuminemia (albumin level <3.0 mg/dL[<.003 g/dL; to convert to grams per liter, multiply by 10]) correlated with prolonged LOS. Suboptimal care was identified in the following clinical areas: use of precipitative medications, prolonged bedrest, uncontrolled pain, hypoxia, and glycemic control.

Conclusions  In a subset of geriatric patients undergoing abdominal surgery who are at high risk for in-hospital delirium, adverse outcomes correlated only with key clinical variables, such as hyperglycemia and poor nutritional and functional states. A high incidence of suboptimal care was observed in several clinical areas, suggesting opportunities for intervention.

Author Affiliations: Departments of Surgery (Drs Ganai and Lee and Ms Lee) and Medicine (Ms Merrill and Drs Bellantonio, Brennan, and Lindenauer), Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts.