Impact of Emergence Delirium on Self-reported Postoperative Recovery After Noncardiac Surgery: A Prospective Cohort Study.

BACKGROUND

Patients' perception of their health outcomes after surgery has become increasingly important in perioperative medicine. This study aimed to evaluate whether emergence delirium in the postanesthesia care unit (PACU) has a relevant impact on self-reported quality of recovery on the first postoperative day.

METHODS

This prospective observational cohort study was conducted in a German tertiary care university hospital. Patients ≥60 years, scheduled for elective noncardiac surgery were included. Patients were screened for the presence of delirium signs 30 minutes after arrival in the PACU using the 3-Minute Diagnostic Interview for CAM-defined Delirium (3D-CAM). Self-reported quality of recovery after surgery was assessed with the German version of the Quality of Recovery-15 questionnaire (QoR-15GE), which patients completed preoperatively and on the first postoperative day. The association between emergence delirium and self-reported quality of recovery was analyzed using a linear multivariable regression model taking into account covariates with a potential impact on recovery after surgery.

RESULTS

A total of 428 patients were tested for emergence delirium. Of these, 397 were assessed for self-reported quality of recovery on the first postoperative day. The incidence of emergence delirium was 32.9% (141/428). Patients with emergence delirium showed a greater decline in QoR-15GE sum scores from pre- to postoperative (difference between preoperative and postoperative QoR-15GE sum scores [ΔQoR-15GE]), with a mean difference (± standard deviation [SD]) of 32.8 ± 25.3, compared to 21.6 ± 26.6 in patients without emergence delirium. The between-group difference was 11.2 points (95% confidence interval [CI], 5.5-16.8; P < .001). After adjusting for potentially confounding covariates, the negative impact of emergence delirium on ΔQoR-15GE (adjusted effect 10.11 [95% CI, 4.99-15.23]; P < .001) remained significant.

CONCLUSIONS

In a heterogeneous cohort of elderly patients who underwent elective noncardiac surgery, we found a significant negative impact of emergence delirium on self-reported quality of recovery on the first postoperative day. Our findings suggest that the presence of delirium symptoms in the PACU may be an important determinant of patient comfort after surgery.