Delirium in fast-track colonic surgery

Langenbeck's Archives of Surgery
Sorel KurbegovicH Kehlet

Abstract

Postoperative delirium (PD) is a common but serious problem after major surgery with a multifactorial pathogenesis including age, pain, opioid use, sleep disturbances and the surgical stress response. These factors have been minimised by the "fast-track methodology" previously demonstrated to enhance recovery and reduce morbidity. Clinical symptoms of PD were routinely collected three times daily from preoperatively until discharge in a well-defined enhanced recovery program after colonic surgery in 247 consecutive patients. Total median length of hospital stay was 3 days. Seven patients (2.8%) developed clinical signs of PD most within the first 72 postoperative hours and only 1 patient with PD extending to 120 h postoperatively. Only 1 PD patient required treatment with serenase. PD patients were older (83 vs. 73 years) and had longer median stay (6 vs. 3 days). No difference in development of PD between open and laparoscopic operation could be demonstrated. Among the 7 patients with PD, 3 of these patients had later surgical complications. One patient had a subsequent strangulated small intestine, another an anastomotic leakage complicated by a bleeding gastric ulcer and death on day 12 and 1 with fever, abdominal pain and s...Continue Reading

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Citations

Feb 12, 2017·European Journal of Anaesthesiology·César AldecoaClaudia D Spies
Jul 7, 2017·Acta Anaesthesiologica Scandinavica·P B PetersenUNKNOWN Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group
Dec 1, 2017·Anesthesia and Analgesia·Henrik Kehlet, Girish P Joshi
Mar 9, 2018·Dementia and Geriatric Cognitive Disorders Extra·Fiammetta MonacelliPatrizio Odetti
Jan 4, 2020·International Journal of Colorectal Disease·Seon Heui Lee, Sang Woo Lim
Feb 6, 2020·Anesthesia and Analgesia·Christopher G HughesUNKNOWN Perioperative Quality Initiative (POQI) 6 Workgroup
Oct 30, 2016·Journal of Visceral Surgery·D Benhamou, A Brouquet

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