Post-Op Delirium Results in Poor Outcomes for Older Patients

BOSTON — Researchers from the Aging Brain Center at the Institute for Aging Research (IFAR) at Hebrew SeniorLife confirm that delirium is a significant and independent contributing factor to poor postsurgical outcomes in older adults. Findings published in JAMA Surgery suggest that the combination of major postoperative complications and delirium demonstrate a strong combined effect on adverse outcomes in older adults undergoing major surgery.

Of all inpatient operations in the U.S. in 2007, 36% were performed on patients 65 years of age or older, and that number is expected to climb with the aging population. Previous research shows that postoperative complications occur in up to 25% of older individuals and may cause adverse outcomes including disability, reduced quality of life, or even death.

Senior author Dr. Sharon K. Inouye, Director of the Aging Brain Center at IFAR, Hebrew SeniorLife in Boston, Massachusetts and Professor of Medicine, Harvard Medical School said, “Delirium, which is characterized by a sudden onset of confusion, is a concern for older adults having surgery or who are hospitalized. Our study explores the association of postoperative complications and delirium, with adverse results following surgery.”

For this prospective study, the research team included 566 patients without dementia or delirium who were age 70 or older at the time of elective major orthopedic, vascular, or abdominal surgeries. Participants had a minimum hospital stay of three days. Major postoperative complications were defined as life altering or threatening, and based on the Accordion Severity (grade 2 or more). Daily measures of delirium were determined using the Confusion Assessment Method and validated chart-review.

Study results report that a major complication occurred in 8% of study subjects and 24% of participants developed delirium. Major postoperative complications alone contributed to prolonged length of hospital stay. Delirium alone was found to significantly increase all adverse outcomes following surgery, including prolonged hospital stay, institutional discharge, and 30-day readmission.

Furthermore, the group who experience both major complications following surgery and delirium had the highest rates of all adverse outcomes. While, delirium alone exerted the highest risk of adverse outcomes at the population level compared to other major surgical complications.

First author, Dr. Lauren Gleason from the Division of Aging at Brigham and Women’s Hospital in Boston, Massachusetts, concludes, “Delirium is highly prevalent among older adults who undergo surgery or are hospitalized and should be considered a leading postoperative complication leading to adverse outcomes. Clinicians should be aware of the negative impact of delirium and look for ways to mitigate its effect on older patients in their care through use of preventative strategies such as the Hospital Elder Life Program (HELP), proactive geriatric consultation, and co-management services.”

Study co-authors include Eva M. Schmitt, Ph.D.; Cyrus M. Kosar, MA; Patricia Tabloski, Ph.D.; Jane S. Saczynski, Ph.D.; Thomas Robinson, M.D.; Zara Cooper, M.D.; Selwyn O. Rogers, Jr., M.D., M.P.H.; Richard N. Jones, Sc.D.; Edward R. Marcantonio, M.D., S.M.

This work was funded by grants from the National Institute on Aging (P01AG031720, R01AG044518, R03AG045633, K07AG041835, K01AG033643, K24AG035075), HRSA Training Grant (D01HP08794) and the John A. Hartford Foundation. For a copy of the study, email the JAMA Network Media Relations department at mediarelations@jamanetwork.org.

About JAMA Surgery
JAMA Surgery (formerly Archives of Surgery), which began publication in 1920, is an international peerreviewed journal. JAMA Surgery is the official publication of the Pacific Coast Surgical Association and the Association of VA Surgeons and is a member of The JAMA Network family of journals, which include JAMA and 10 specialty journals.

About the Institute for Aging Research
Scientists at the Institute for Aging Research seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity and productivity into advanced age. The Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment and cure of disease; advance the standard of care for older people; and inform public decision-making. The Aging Brain Center within IFAR studies cognitive aging and conditions affecting brain health.

About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching and redefining the possibilities of aging. Based in Boston, the nonprofit, non-sectarian organization has provided communities and health care for seniors, research into aging, and education for geriatric care providers since 1903. For more information about Hebrew SeniorLife, visit https://www.hebrewseniorlife.org, follow us on Twitter @H_SeniorLife, like us on Facebook, or read our blog.