Postoperative Delirium and Postoperative Cognitive Dysfunction: Overlap and Divergence.
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Daiello Lori A, Racine Annie M, Yun Gou Ray, Marcantonio Edward R, Xie Zhongcong, Kunze Lisa J, Vlassakov Kamen V, Inouye Sharon K, Jones Richard N, Alsop David, Travison Thomas, Arnold Steven, Cooper Zara, Dickerson Bradford, Fong Tamara, Metzger Eran, Pascual-Leone Alvaro, Schmitt Eva M, Shafi Mouhsin, Cavallari Michele, Dai Weiying, Dillon Simon T, McElhaney Janet, Guttmann Charles, Hshieh Tammy, Kuchel George, Libermann Towia, Ngo Long, Press Daniel, Saczynski Jane, Vasunilashorn Sarinnapha, O'Connor Margaret, Kimchi Eyal, Strauss Jason, Wong Bonnie, Belkin Michael, Ayres Douglas, Callery Mark, Pomposelli Frank, Wright John, Schermerhorn Marc, Abrantes Tatiana, Albuquerque Asha, Bertrand Sylvie, Brown Amanda, Callahan Amy, D'Aquila Madeline, Dowal Sarah, Fox Meaghan, Gallagher Jacqueline, Anna Gersten Rebecca, Hodara Ariel, Helfand Ben, Inloes Jennifer, Kettell Jennifer, Kuczmarska Aleksandra, Nee Jacqueline, Nemeth Emese, Ochsner Lisa, Palihnich Kerry, Parisi Katelyn, Puelle Margaret, Rastegar Sarah, Vella Margaret, Xu Guoquan, Bryan Margaret, Guess Jamey, Enghorn Dee, Gross Alden, Gou Yun, Habtemariam Daniel, Isaza Ilean, Kosar Cyrus, Rockett Christopher, Tommet Douglas, Gruen Ted, Ross Meg, Tasker Katherine, Gee James, Kolanowski Ann, Pisani Margaret, de Rooij Sophia, Rogers Selwyn, Studenski Stephanie, Stern Yaakov, Whittemore Anthony, Gottlieb Gary, Orav John, Sperling Reisa, SAGES Study Group*
Аннотация
METHODS: This study used data from an observational study of cognitive outcomes after major noncardiac surgery, the Successful Aging after Elective Surgery study. Postoperative delirium was evaluated each hospital day with confusion assessment method-based interviews supplemented by chart reviews. Postoperative cognitive dysfunction was determined using methods adapted from the International Study of Postoperative Cognitive Dysfunction. Associations between delirium and postoperative cognitive dysfunction were examined at 1, 2, and 6 months.
RESULTS: One hundred thirty-four of 560 participants (24%) developed delirium during hospitalization. Slightly fewer than half (47%, 256 of 548) met the International Study of Postoperative Cognitive Dysfunction-defined threshold for postoperative cognitive dysfunction at 1 month, but this proportion decreased at 2 months (23%, 123 of 536) and 6 months (16%, 85 of 528). At each follow-up, the level of agreement between delirium and postoperative cognitive dysfunction was poor (kappa less than .08) and correlations were small (r less than .16). The relative risk of postoperative cognitive dysfunction was significantly elevated for patients with a history of postoperative delirium at 1 month (relative risk = 1.34; 95% CI, 1.07-1.67), but not 2 months (relative risk = 1.08; 95% CI, 0.72-1.64), or 6 months (relative risk = 1.21; 95% CI, 0.71-2.09).
CONCLUSIONS: Delirium significantly increased the risk of postoperative cognitive dysfunction in the first postoperative month; this relationship did not hold in longer-term follow-up. At each evaluation, postoperative cognitive dysfunction was more common among patients without delirium. Postoperative delirium and postoperative cognitive dysfunction may be distinct manifestations of perioperative neurocognitive deficits.