May 2023
Postoperative delirium is associated with long-term cognitive decline

Patients who develop delirium after major elective surgery showed a significantly faster pace of cognitive decline.

The cognitive effects of acute postoperative delirium can extend beyond the acute episode in older patients, but what about long-term adverse effects? To find out, researchers performed extended follow up of participants in a cohort study that involved 560 adults (age, over 70 years) who underwent major elective surgery (80% orthopaedic procedures). Previous investigation showed that 134 patients who developed postoperative delirium had significantly greater cognitive decline at 36 months than did patients without delirium. Now, researchers present cognitive outcomes at 72 months.

In adjusted analysis, cognitive decline (based on serial neuropsychological testing during the 72-month follow-up period) was 40% faster in patients who developed delirium than in those who did not.

Comment: Delirium itself might be a cause of accelerated cognitive decline following surgery or it simply might be a marker for underlying brain susceptibility. In any case, this study highlights the importance of efforts to prevent or minimise delirium in older patients who undergo elective surgery.

Neil H. Winawer, MD, SFHM, Director, Hospital Medicine Unit, Grady Memorial Hospital; Professor of Medicine, Emory University School of Medicine, Atlanta, USA.

Kunicki ZJ, et al. Six-year cognitive trajectory in older adults following major surgery and delirium. JAMA Intern Med 2023 Mar 20; e-pub (https://doi. org/10.1001/jamainternmed.2023.0144).

This summary is taken from the following Journal Watch titles: Hospital Medicine, General Medicine, Ambulatory Medicine, Psychiatry.

JAMA Intern Med