Open AccessAn assessment of postoperative cognitive impairment in the elderly patients at the Port of Spain General Hospital
Author(s) -
Colin Ramoutar,
Dale Ventour
Publication year - 2019
Publication title -
caribbean medical journal
Language(s) - English
Resource type - Journals
eISSN - 2664-5599
pISSN - 0374-7042
DOI - 10.48107/cmj.2019.11.005
Subject(s) - medicine , delirium , general anaesthesia , incidence (geometry) , emergence delirium , anesthesiology , anesthesia , port (circuit theory) , general hospital , surgery , pediatrics , intensive care medicine , physics , electrical engineering , optics , engineering
Objectives: Post-operative delirium (POD) is a relatively common occurrence particularly in the elderly, especially after prolonged surgery. This study aimed to determine the incidence of post-operative delirium at the Port of Spain General Hospital, Trinidad, West Indies.Methods: After obtaining consent, elderly patients (≥ 65 years of age) were prospectively screened using the 4AT questionnaire pre and post-operatively. Post-operative assessment was done on day 0, 1 and 2 between the hours of 18:00 and 22:00. Demographic and clinical data were recorded.Results: Sixty-one (61) patients were recruited. After exclusion, a total of 42 were included for the study. The incidence of POD in elderly patients at the Port-of-Spain General Hospital in Trinidad was 21.4%. Overall, eighteen (43%) patients displayed cognitive impairment post-operatively. The factors associated with development of POD were duration of anaesthesia, with surgery lasting >120 min having a 17% incidence. Delirium occurred more frequently after general anaesthesia (27%) compared to regional anaesthesia (8%). Vasopressor use and malignancy was also associated with a higher incidence of POD (33%).Conclusion: Elderly patients had a higher risk of developing postoperative delirium following general anaesthesia compared to regional anaesthesia, and where the surgical duration exceeded 2 hours. Other factors included hypotension requiring vasopressor use and gynaecological malignancy. The 4AT is a useful tool in detecting postoperative delirium in our setting.