Abstract
Background
Postoperative delirium (PD) is a frequent and serious complication of surgery that
is associated with a prolonged hospital stay, increased mortality, and decreased quality
of life. Identifying the risk factors for PD in elderly patients exposed to anesthetic
agents during the perioperative period has the potential to improve patient response
to surgery. This prospective cohort study aims to delineate the role of analgesic
drugs in the onset of PD in elderly patients undergoing major surgery.
Methods
A total of 732 patients aged 60 years or more and scheduled for elective major surgery
were enrolled in the study. All patients underwent general or combined anesthetic
management. The type of analgesia, whether patient-controlled intravenous analgesia
or patient-controlled epidural analgesia, depended on the type of surgery and the
individual's condition. PD assessment was performed for 7 consecutive days using the
Confusion Assessment Method for the Intensive Care Unit.
Results
Overall, PD occurred in 47 (6.5%) patients from the postoperative day (POD) 1 to POD
5. Multivariate analysis revealed that age (odds ratio [OR]: 1.076; 95% confidence
interval [CI]: 1.027–1.128; p = 0.002), cardiac surgery (OR: 2.823; 95% CI: 1.152–6.915; p = 0.023), tramadol administration (OR: 2.060; 95% CI: 1.079–3.933; p = 0.028), and ondansetron administration (OR: 2.158; 95% CI: 1.132–4.111; p = 0.019) were the independent risk factors for PD after major surgery, and the use
of sufentanil is a protective factor (OR: 0.317; 95% CI: 0.153–0.656; p = 0.002). The incidence of PD increased with both age and the dose of tramadol. Moreover,
gender, preoperative analgesia, preoperative Mini-Mental State Examination score,
type of analgesia, anesthetics during surgery, postoperative pain score, rescue analgesics,
and medications including fentanyl, flurbiprofen, midazolam, droperidol, and anticholinergics
appeared not to associate with PD occurrence.
Conclusion
Older age, cardiac surgery, and the perioperative use of tramadol and ondansetron
are independent risk factors for PD in patients aged ≥60 years, whereas sufentanil
serves as a protective factor when used for analgesia. These results indicate that
using sufentanil instead of tramadol may help decrease the occurrence of PD in elderly
patients following major surgery.
Keywords
postoperative delirium - cardiac surgery - ondansetron - tramadol - 5-HT
