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A Simple Tool to Predict Development of Delirium After Elective Surgery
Author(s) -
Dworkin Andy,
Lee David S.H.,
An Amber R.,
Goodlin Sarah J.
Publication year - 2016
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.14428
Subject(s) - medicine , delirium , veterans affairs , elective surgery , observational study , physical therapy , emergency medicine , surgery , intensive care medicine
Objectives To identify a quick clinical tool to assess the risk of delirium after elective surgery. Design Prospective observational study. Setting Preoperative assessment clinic at the Veterans Affairs Portland Health Care System. Participants Community‐living veterans aged 65 and older scheduled for elective surgery requiring general or major anesthesia. Measurements 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. Results 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. Conclusion In this sample of veterans who had elective surgery with major anesthesia, Mini‐Cog score predicted likelihood of postoperative delirium.