Comprehensive risk factor evaluation of postoperative delirium following major surgery: clinical data warehouse analysis
- 53 Downloads
Postoperative delirium (POD) in older adults is a very serious complication. Due to the complexity of too many risk factors (RFs), an overall assessment of RFs may be needed. The aim of this study was to evaluate comprehensively the RFs of POD regardless of the organ undergoing operation, efficiently incorporating the concept of comprehensive big data using a smart clinical data warehouse (CDW).
We reviewed the electronic medical data of inpatients aged 65 years or older who underwent major surgery between January 2010 and June 2016 at Hallym University Sacred Heart Hospital. The following six major operation types were selected: cardiac, stomach, colorectal, hip, knee, and spine. Clinical features, laboratory findings, perioperative variables, and medication history were compared between patients without POD and with POD.
Six hundred eighty-six of 3634 patients (18.9%) developed POD. In multivariate logistic regression analysis, common, independent RFs of POD were as follows (descending order of odds ratio): operation type ([hip] OR 8.858, 95%CI 3.432–22.863; p = 0.000; [knee] OR 7.492, 95%CI 2.739–20.487; p = 0.000; [spine] OR 6.919, 95%CI 2.687–17.815; p = 0.000; [colorectal] OR 2.037, 95%CI 0.784–5.291; p = 0.144; [stomach] OR 1.500, 95%CI 0.532–4.230; p = 0.443; [cardiac] reference), parkinsonism (OR 2.945, 95%CI 1.564–5.547; p = 0.001), intensive care unit stay (OR 1.675, 95%CI 1.354–2.072; p = 0.000), stroke history (OR 1.591, 95%CI 1.112–2.276; p = 0.011), use of hypnotics and sedatives (OR 1.307, 95%CI 1.072–1.594; p = 0.008), higher creatinine (OR 1.107, 95%CI 1.004–1.219; p = 0.040), lower hematocrit (OR 0.910, 95%CI 0.836–0.991; p = 0.031), older age (OR 1.053, 95%CI 1.037–1.069; p = 0.000), and lower body mass index (OR 0.967, 95%CI 0.942–0.993; p = 0.013). The use of analgesics (OR 0.644, 95%CI 0.467–0.887; p = 0.007) and antihistamines/antiallergics (OR 0.764, 95%CI 0.622–0.937; p = 0.010) were risk-reducing factors. Operation type with the highest odds ratio for POD was orthopedic surgery.
Big data analytics could be applied to evaluate RFs in electronic medical records. We identified common RFs of POD, regardless of operation type. Big data analytics may be helpful for the comprehensive understanding of POD RFs, which can help physicians develop a general plan to prevent POD.
KeywordsDelirium Operation Clinical data warehouse Risk factor Type of surgery Parkinsonism
This research is an award-winning work of the 2016 Clinical Research Competition at Hallym University Medical Center.
Compliance with ethical standards
Conflicts of interest
- 7.Vittinghoff E, Glidden DV, Shiboski SC, McCulloch CE (2012) Regression methods in biostatistics, linear, logistic, survival, and repeated measures models, 2nd edn. Springer, San FranciscoGoogle Scholar
- 14.Large MC, Reichard C, Williams JT, Chang C, Prasad S, Leung Y, DuBeau C, Bales GT, Steinberg GD (2013) Incidence, risk factors, and complications of postoperative delirium in elderly patients undergoing radical cystectomy. Urology 81(1):123–128. https://doi.org/10.1016/j.urology.2012.07.086 CrossRefPubMedGoogle Scholar
- 17.Oh ES, Li M, Fafowora TM, Inouye SK, Chen CH, Rosman LM, Lyketsos CG, Sieber FE, Puhan MA (2015) Preoperative risk factors for postoperative delirium following hip fracture repair: a systematic review. Int J Geriatr Psychiatry 30(9):900–910. https://doi.org/10.1002/gps.4233 CrossRefPubMedGoogle Scholar
- 20.Newman JM, Sodhi N, Dalton SE, Khlopas A, Newman RP, Higuera CA, Mont MA (2018) Does Parkinson disease increase the risk of perioperative complications after Total hip arthroplasty? A Nationwide Database Study. J Arthroplast 33:S162–S166. https://doi.org/10.1016/j.arth.2018.01.006 CrossRefGoogle Scholar
- 23.Elsamadicy AA, Adogwa O, Ongele M, Sergesketter AR, Tarnasky A, Lubkin DET, Drysdale N, Cheng J, Bagley CA, Karikari IO (2018) Preoperative hemoglobin level is associated with increased health care use after elective spinal fusion (>/=3 levels) in elderly male patients with spine deformity. World Neurosurg 112:e348–e354. https://doi.org/10.1016/j.wneu.2018.01.046 CrossRefPubMedGoogle Scholar
- 26.Bilotta F, Lauretta MP, Borozdina A, Mizikov VM, Rosa G (2013) Postoperative delirium: risk factors, diagnosis and perioperative care. Minerva Anestesiol 79(9):1066–1076Google Scholar
- 27.Katznelson R, Djaiani G, Mitsakakis N, Lindsay TF, Tait G, Friedman Z, Wasowicz M, Beattie WS (2009) Delirium following vascular surgery: increased incidence with preoperative beta-blocker administration. Can J Anaesth 56(11):793–801. https://doi.org/10.1007/s12630-009-9148-0 CrossRefPubMedGoogle Scholar
- 30.Son MJ, Choi SW, Hong YH, Lee HC, Yoo JH, Sung KH, Jang MU, Cho S-J, Kim JY, Kwon K-H, Kang SY (2017) Two cases of hallucination after administration of tramadol. J Pain Auton Disord 6(1):17–19Google Scholar