Early diagnosis of postoperative delirium in general surgery patients

Early Diagnosis of Postoperative Delirium in General Surgery Patients Objective: Postoperative Delirium (POD) has been shown to be a frequent post-operative complication. POD has been reported up to 25% in eldery patients. We performed POD early diagnosis in General Surgery patients and investigated its relation with the characteristics of the patient / surgery / anesthesia; to shorten the hospitalization period of the patients, to prevent the hospitalization after discharge and to decrease the morbidity / mortality. Materials and Methods: It is aimed to reach the data of patients over 18 years who have received general anesthesia by Akdeniz University Faculty of Medicine Department of Anesthesiology and Reanimation and operated by the Department of General Surgery of Akdeniz University Faculty of Medicine from March 2018 to May 2018. Also preoperative, intraoperative and postoperative routine follow-up done by Akdeniz University Faculty of Medicine Department of Anesthesiology and Reanimation in Akdeniz University Medical Faculty Hospital Anesthesiology and Reanimation Department of Polyclinics, Operating Room, Anesthesia Intensive Care Units (ICU), Post-Anesthesia Care Unit (PACU), General Surgery Clinic. A total of 303 patients were included in this study. Preoperative demographic data (name, surname and patient file number, age, weight, height and body mass index) and occupation, educational status, income status, additional diseases, ASA (American Society of Anesthesia) score, previous operation, psychiatric or neurological disease history, use of alcohol-cigarette, drug abuse, memory problems were recorded. In addition, Mini Mental State Examination (MMSE) was applied to determine the preoperative cognitive levels of the patients. The patient's diagnosis, name and the duration of the operation, the operation being emergency or elective, medications used, catheterization (arterial, central, foley, NG), Hb value, waking score (Aldrete Score) data was taken from anesthesia records and evaluated. In addition, intraoperative vital signs of the patients (blood pressure, middle arterial pressure, oxygen saturation and End Tidal CO2) were recorded at intervals of 30 minutes on anesthesia recording papers. POD diagnosis of patients were evaluated by CAM test. Postoperative hospital discharge times of the patients were also recorded. Results: POD developed in 8 (2.6%) out of 303 patients. There was a significant relationship between POD diagnosis and age (p: 0,0001) and ASA score (p= 0.004), which is correlated to underlying diseases. As the education levels of the patients increased, the risk of delirium was reduced and a significant relationship was shown (p: 0.019). Among the used anesthetic agents, a significant correlation was found only between midazolam and delirium (p: 0.028). There was a significant correlation between hypercarbia developed during operation and delirium development (p:0.001). The factors associated with the development of POD include invasive procedures (arterial cannula, central venous catheter, foley catheter, nasogastric catheter) (p: 0,000-0,002), increased operation durations (p: 0,0001), ICU and PACU admissions (p:0,000) a significant relationship was found in our patients. Conclusion: In our study we found POD in 8 of 303 patients (2.6%) in the early period. This rate is consistent with POD rates, which are defined as POD diagnosis in the literature in the longer term. We also found that the factors considered as risk factors for POD and the characteristics of the patients / operation / anesthesia were compatible with the literature in our patients. In patients who underwent general surgery, POD diagnosis by using CAM in the first 3 days postoperatively gives us an advantage which allowed early treatment of patients with POD. Key words: Postoperative delirium, general surgery, laparoscopic surgery, hypercarbia, MMSE, CAM