Postoperative Delirium: A Review of 80 Primary Data-Collection Studies

doi:10.1001/archinte.1995.00430050035004

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Vol. 155 No. 5, 13 MARCH 1995

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Postoperative Delirium

A Review of 80 Primary Data-Collection Studies

Carmel Bitondo Dyer, MD; Carol M. Ashton, MD, MPH; Tom A. Teasdale, MPH

Arch Intern Med. 1995;155(5):461-465.

Abstract

We conducted an on-line search and manual searches for 1966through 1992 to determine the incidence, diagnosis, risk factors,and treatment of postoperative delirium. Of the 374 citationsfound, 277 articles were excluded after criteria of relevancewere applied. After methodologic criteria for validity wereapplied to the remaining 80 articles, 26 studies were retainedfor the final information synthesis. The incidence of postoperativedelirium was 36.8% (range, 0% to 73.5%). Primary reasons forthis disparity were insufficient sample size and inconsistentapplication of numerous diagnostic tools. One study providedstatistically significant data that demonstrated that postoperativedelirium is underdiagnosed by physicians and nurses. Four ofthe articles that met the established criteria provided riskfactor data. Although age, preoperative cognitive impairment,and the use of anticholinergic drugs were significantly associatedwith postoperative delirium, gender, type and route of anesthesia,and sleep deprivation were not. Two studies demonstrated a decreasedincidence of postoperative delirium when patients underwentpreoperative psychiatric counseling or participated in a structuredperioperative program. These findings indicate a need for (1)accurate incidence data with further definition of risk factorsand (2) studies that address the diagnosis and treatment ofthis common postoperative problem.

(Arch Intern Med. 1995;155:461-465)

Author Affiliations

From the Section of Geriatrics and the Huffington Center on Aging (Dr Dyer and Mr Teasdale) and Section of General Medicine and Veterans Affairs Health Service Research and Development Field Program (Dr Ashton), Houston (Tex) Veterans Affairs Medical Center and the Department of Internal Medicine, Baylor College of Medicine, Houston.

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