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Postoperative delirium in older patients after undergoing pelvic organ prolapse surgery

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Abstract

Introduction and hypothesis

To determine the 7-day incidence and risk factors of postoperative delirium (POD) occurring after prolapse surgery in women aged ≥60 years.

Methods

A prospective study of women ≥60 years undergoing prolapse surgery at a large academic center. The primary outcome is positive Confusion Assessment Method delirium screen administered in person or by telephone at the time of hospital discharge and postoperative days 1, 3, 5, and 7.

Results

This analysis included 165 patients, mean ± SD age of 72.5 ± 6.1 years, with median (IQR) years of education of 13 (12–16), and baseline Modified Mini-Mental Status (3MS) Exam score of 95 (92-98). Prolapse repair type was vaginal for 70% (n=115) and laparoscopic for 30% (n=50) of patients; most under general anesthesia, 151 (92.1%). The incidence of positive delirium screen during the first week after surgery was 12.1% (n=20). Most of these participants screened positive on postoperative day 0, 8.4% (n=14). In univariate analyses, a positive screen was associated with older age and fewer education years, lower 3MS exam score, greater baseline geriatric depression scale score, and greater frailty score. Lower 3MS score was the only variable that remained significant in the final model (adjusted odds ratio 0.84, 95% CI 0.75-0.95).

Conclusions

One in 12 women ≥60 years deemed eligible for discharge on the day of prolapse surgery screens positive for delirium. The 7-day POD incidence is comparable to other elective non-cardiac surgery cohorts. Given the increasing trend toward same day discharge after major prolapse surgery, more research is needed to determine the impact of universal delirium screening as part of discharge assessments.

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Acknowledgements

This work was supported by the Audrey Hillman Fisher Foundation Grant, the American Urogynecologic Society Pelvic Floor Disorders Research Foundation Grant- Faculty Research Award, the National Institutes of Health NICHD Women’s Reproductive Health Research (WRHR) Career Development Program (5K12HD063087), and National Institutes of Health support through Clinical and Translational Sciences Institute (CTSI) at the University of Pittsburgh (UL1-TR-001857).

Funding

Author MF Ackenbom has received research funding support from the NIH NICHD (5K12HD063087), the American Urogynecologic Society Pelvic Floor Disorders Research Foundation, and the Audrey Hillman Foundation.

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Authors and Affiliations

  1. Magee Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Mary F. Ackenbom, Halina M. Zyczynski & Samia Lopa

  2. Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Mary F. Ackenbom & Halina M. Zyczynski

  3. Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Mary F. Ackenbom, Halina M. Zyczynski, Samia Lopa & Steven R. Orris

  4. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Meryl A. Butters

  5. Department of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Steven R. Orris & Esa M. Davis

Authors
  1. Mary F. Ackenbom
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  2. Halina M. Zyczynski
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  4. Samia Lopa
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Contributions

MF Ackenbom: Project development, data management, data analysis, manuscript writing

HM Zyczynski: Project development, data analysis, manuscript writing

MA Butters: Project development, data analysis, manuscript writing

S Lopa: Data analysis, manuscript writing

SR Orris: Data management, manuscript writing

EM Davis: Data analysis, manuscript writing

Corresponding author

Correspondence to Mary F. Ackenbom.

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Author EM Davis is a member of the US Preventive Services Task Force.

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Ackenbom, M.F., Zyczynski, H.M., Butters, M.A. et al. Postoperative delirium in older patients after undergoing pelvic organ prolapse surgery. Int Urogynecol J 34, 201–209 (2023). https://doi.org/10.1007/s00192-022-05170-0

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  • DOI: https://doi.org/10.1007/s00192-022-05170-0

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