Delirium and long-term psychopathology following surgery in older adults

• Published in: Journal of psychosomatic research Vol. 155; p. 110746
• Main Authors: de Mul, Nikki, van den Bos, Lisa M.E.C., Kant, Ilse M.J., van Montfort, Simone J.T., Schellekens, Willem-Jan M., Cremer, Olaf L., Slooter, Arjen J.C.
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.04.2022; Elsevier Science Ltd
• Subjects: Aged; Anxiety; Anxiety - epidemiology; Anxiety and PTSS; Chart reviews; Confusion; Delirium; Delirium - diagnosis; Delirium - epidemiology; Delirium - etiology; Depression; Elderly; General practice; Humans; Intelligence tests; Intensive care; Male; Medical screening; Mental depression; Older people; Patients; Post traumatic stress disorder; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative delirium; Postoperative psychopathology; Psychopathology; Risk Factors; Stress Disorders, Post-Traumatic - diagnosis; Stress Disorders, Post-Traumatic - epidemiology; Stress Disorders, Post-Traumatic - etiology; Surgery; Depression; Postoperative delirium; Anxiety and PTSS; Elderly; Postoperative psychopathology
• ISSN: 0022-3999; 1879-1360
• DOI: 10.1016/j.jpsychores.2022.110746

To describe the risk of postoperative delirium and long-term psychopathology (depression, anxiety or post-traumatic stress syndrome (PTSS)) in older adults. 255 elderly patients (≥ 65 years) undergoing major surgery (planned surgical time > 60 min) in a tertiary hospital were compared to 76 non-surgical controls from general practice. Patients were assessed twice daily for postoperative delirium using the Confusion Assessment Method (CAM(-ICU)), nursing delirium screening scale (NuDESC) and validated chart review. Before surgery and 3 and 12 months thereafter, the participants filled in the Hospital Anxiety and Depression Scale (HADS), the Geriatric Depression Scale (GDS-15) and the Post-Traumatic Stress Syndrome-14-Questions Inventory (PTSS-14). Non-surgical controls filled in the same questionnaires with similar follow-up. Patients were more often male, had higher American Society of Anesthesiologists scores and more often had a spouse compared to controls (p < 0.005). Forty-three patients (18%) developed postoperative delirium, who were significantly older, had higher ASA scores and lower estimated IQ scores compared to the patients who did not develop delirium (p < 0.05). There were no differences in psychopathology at baseline and 3-month follow-up between patients and controls. At 12-months, surgical patients less frequently scored positive for depression (7% versus 16%) and anxiety (2% versus 10%) compared to nonsurgical controls (p < 0.05). We did not observe differences in occurrence of psychopathology between patients who had and had not developed postoperative delirium. Our results suggest that the older surgical population, with or without postoperative delirium, does not appear to be at greater risk of developing psychopathology. The older surgical population does not appear to be at greater risk of developing psychopathology, neither seems this risk influenced by the occurrence of postoperative delirium •We compared elderly surgical patients to nonsurgical controls.•We assessed psychopathology symptoms at baseline, 3- and 12-month follow-up.•Surgical patients did not develop psychopathology more often.•Psychopathology occurrence did not differ based on postoperative delirium status.