Skip to main content
SpringerLink
Log in

Do Risk Prediction Models for Postoperative Delirium Consider Patients’ Preoperative Medication Use?

  • Systematic Review
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Background

Medicines are potentially modifiable risk factors for postoperative delirium. However, the extent to which preoperative medicines are included in risk prediction models (RPMs) is unknown.

Objective

This systematic review aimed to assess the extent of inclusion of preoperative medications in RPMs for postoperative delirium.

Methods

Articles were systematically searched from MEDLINE, EMBASE and CINAHL using Medical Subject Headings (MeSH) where possible and keywords for postoperative delirium and prediction model. Studies published until May 2017 with a primary outcome of postoperative delirium that developed an RPM containing preoperative patient information were considered. Where a study had two cohorts, a derivation and a validation cohort, findings from the derivation cohort were extracted and reported.

Results

Eighteen prospective and one retrospective cohort studies were included for review. Of the 19 studies, only nine considered preoperative medication data, with medications appearing as predictor variables in five models. There was wide variability in the factors included in the final models, with the most frequent predictors being age and cognitive impairment, appearing in 13 (68%) and 11 (58%) RPMs, respectively.

Conclusion

While medications are commonly cited risk factors for delirium, they are not adequately considered when developing RPMs. Future studies aiming to develop an RPM for postoperative delirium should include preoperative medication data as a potential predictor variable because of the modifiable nature of medication use and its impact on other factors commonly in models, such as cognition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Jackson MB, Mookherjee S, Hamlin NP. The perioperative medicine consult handbook. New York: Springer; 2015.

    Book  Google Scholar 

  2. Mu JL, Lee A, Joynt GM. Pharmacologic agents for the prevention and treatment of delirium in patients undergoing cardiac surgery: systematic review and metaanalysis. Crit Care Med. 2015;43(1):194–204. https://doi.org/10.1097/ccm.0000000000000673.

    Article  CAS  PubMed  Google Scholar 

  3. Rudolph JL, Jones RN, Levkoff SE, Rockett C, Inouye SK, Sellke FW, et al. Derivation and validation of a preoperative prediction rule for delirium after cardiac surgery. Circulation. 2009;119(2):229–36. https://doi.org/10.1161/circulationaha.108.795260.

    Article  PubMed  Google Scholar 

  4. Katznelson R, Djaiani GN, Borger MA, Friedman Z, Abbey SE, Fedorko L, et al. Preoperative use of statins is associated with reduced early delirium rates after cardiac surgery. Anesthesiology. 2009;110(1):67–73.

    Article  CAS  PubMed  Google Scholar 

  5. Marcantonio E, Ta T, Duthie E, Resnick NM. Delirium severity and psychomotor types: their relationship with outcomes after hip fracture repair. J Am Geriatr Soc. 2002;50(5):850–7.

    Article  PubMed  Google Scholar 

  6. Tropea J, Slee J, Holmes A, Gorelik A, Brand C. Use of antipsychotic medications for the management of delirium: an audit of current practice in the acute care setting. Int Psychogeriatr. 2009;21(01):172–9.

    Article  CAS  PubMed  Google Scholar 

  7. Mangusan RF, Hooper V, Denslow SA, Travis L. Outcomes associated with postoperative delirium after cardiac surgery. Am J Crit Care. 2015;24(2):156–63. https://doi.org/10.4037/ajcc2015137.

    Article  PubMed  Google Scholar 

  8. Pauley E, Lishmanov A, Schumann S, Gala GJ, van Diepen S, Katz JN. Delirium is a robust predictor of morbidity and mortality among critically ill patients treated in the cardiac intensive care unit. Am Heart J. 2015;170(1):79.e1–86.e1. https://doi.org/10.1016/j.ahj.2015.04.013.

    Article  Google Scholar 

  9. Hshieh TT, Yue J, Oh E, Puelle M, Dowal S, Travison T, et al. Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis. JAMA Intern Med. 2015;175(4):512–20. https://doi.org/10.1001/jamainternmed.2014.7779.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc. 2001;49(5):516–22.

    Article  CAS  PubMed  Google Scholar 

  11. Inouye SK, Bogardus ST Jr, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, Cooney LM Jr. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340(9):669–76.

    Article  CAS  PubMed  Google Scholar 

  12. Benoit AG, Campbell BI, Tanner JR, Staley JD, Wallbridge HR, Biehl DR, et al. Risk factors and prevalence of perioperative cognitive dysfunction in abdominal aneurysm patients. J Vasc Surg. 2005;42(5):884–90. https://doi.org/10.1016/j.jvs.2005.07.032.

    Article  PubMed  Google Scholar 

  13. Tully PJ, Baker RA, Winefield HR, Turnbull DA. Depression, anxiety disorders and type D personality as risk factors for delirium after cardiac surgery. Aust N Z J Psychiatry. 2010;44(11):1005–11. https://doi.org/10.3109/00048674.2010.495053.

    PubMed  Google Scholar 

  14. Chen YL, Lin HC, Lin KH, Lin LS, Hsieh CE, Ko CJ, et al. Low hemoglobin level is associated with the development of delirium after hepatectomy for hepatocellular carcinoma patients. PLoS One. 2015;10(3):e0119199. https://doi.org/10.1371/journal.pone.0119199.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Katznelson R, Djaiani G, Mitsakakis N, Lindsay TF, Tait G, Friedman Z, et al. Delirium following vascular surgery: increased incidence with preoperative β-blocker administration. Can J Anaesth. 2009;56(11):793–801.

    Article  PubMed  Google Scholar 

  16. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). Washington, DC: American Psychiatric Association; 2013.

    Book  Google Scholar 

  17. Wells G, Shea B, O’connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2000. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 7 July 2017.

  18. Choi NY, Kim EH, Baek CH, Sohn I, Yeon S, Chung MK. Development of a nomogram for predicting the probability of postoperative delirium in patients undergoing free flap reconstruction for head and neck cancer. Eur J Surg Oncol. 2017;43(4):683–8. https://doi.org/10.1016/j.ejso.2016.09.018.

    Article  CAS  PubMed  Google Scholar 

  19. Jeong YM, Lee E, Kim KI, Chung JE, In Park H, Lee BK, et al. Association of pre-operative medication use with post-operative delirium in surgical oncology patients receiving comprehensive geriatric assessment. BMC Geriatr. 2016;16:134. https://doi.org/10.1186/s12877-016-0311-5.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Visser L, Prent A, Van Der Laan MJ, Van Leeuwen BL, Izaks GJ, Zeebregts CJ, et al. Predicting postoperative delirium after vascular surgical procedures. J Vasc Surg. 2015;62(1):185–9. https://doi.org/10.1016/j.jvs.2015.01.041.

    Article  Google Scholar 

  21. Bohner H, Hummel TC, Habel U, Miller C, Reinbott S, Yang Q, et al. Predicting delirium after vascular surgery: a model based on pre- and intraoperative data. Ann Surg. 2003;238(1):149–56. https://doi.org/10.1097/00000658-200307000-00019.

    PubMed  PubMed Central  Google Scholar 

  22. Bakker RC, Osse RJ, Tulen JH, Kappetein AP, Bogers AJ. Preoperative and operative predictors of delirium after cardiac surgery in elderly patients. Eur J Cardiothorac Surg. 2012;41(3):544–9. https://doi.org/10.1093/ejcts/ezr031.

    Article  PubMed  Google Scholar 

  23. Van Der Mast RC, Van Den Broek WW, Fekkes D, Pepplinkhuizen L, Habbema JDF. Incidence of and preoperative predictors for delirium after cardiac surgery. J Psychosom Res. 1999;46(5):479–83. https://doi.org/10.1016/S0022-3999%2899%2900002-1.

    Article  PubMed  Google Scholar 

  24. Guenther U, Theuerkauf N, Frommann I, Brimmers K, Malik R, Stori S, et al. Predisposing and precipitating factors of delirium after cardiac surgery: a prospective observational cohort study. Ann Surg. 2013;257(6):1160–7. https://doi.org/10.1097/SLA.0b013e318281b01c.

    Article  PubMed  Google Scholar 

  25. Krzych LJ, Wybraniec MT, Krupka-Matuszczyk I, Skrzypek M, Bochenek AA. Delirium Screening in Cardiac Surgery (DESCARD): a useful tool for nonpsychiatrists. Can J Cardiol. 2014;30(8):932–9. https://doi.org/10.1016/j.cjca.2014.04.020.

    Article  PubMed  Google Scholar 

  26. Koster S, Hensens AG, Schuurmans MJ, van der Palen J. Prediction of delirium after cardiac surgery and the use of a risk checklist. Eur J Cardiovasc Nurs. 2013;12(3):284–92. https://doi.org/10.1177/1474515112450244.

    Article  PubMed  Google Scholar 

  27. Koster S, Oosterveld FG, Hensens AG, Wijma A, van der Palen J. Delirium after cardiac surgery and predictive validity of a risk checklist. Ann Thorac Surg. 2008;86(6):1883–7. https://doi.org/10.1016/j.athoracsur.2008.08.020.

    Article  PubMed  Google Scholar 

  28. Harasawa N, Mizuno T. A novel scale predicting postoperative delirium (POD) in patients undergoing cerebrovascular surgery. Arch Gerontol Geriatr. 2014;59(2):264–71. https://doi.org/10.1016/j.archger.2014.05.007.

    Article  PubMed  Google Scholar 

  29. Goldenberg G, Kiselev P, Bharathan T, Baccash E, Gill L, Madhav V, et al. Predicting post-operative delirium in elderly patients undergoing surgery for hip fracture. Psychogeriatrics. 2006;6(2):43–8. https://doi.org/10.1111/j.1479-8301.2006.00146.x.

    Article  Google Scholar 

  30. Liang CK, Chu CL, Chou MY, Lin YT, Lu T, Hsu CJ, et al. Developing a prediction model for post-operative delirium and long-term outcomes among older patients receiving elective orthopedic surgery: a prospective cohort study in taiwan. Rejuvenation Res. 2015;18(4):347–55. https://doi.org/10.1089/rej.2014.1645.

    Article  PubMed  Google Scholar 

  31. Litaker D, Locala J, Franco K, Bronson DL, Tannous Z. Preoperative risk factors for postoperative delirium. Gen Hosp Psychiatry. 2001;23(2):84–9. https://doi.org/10.1016/S0163-8343%2801%2900117-7.

    Article  CAS  PubMed  Google Scholar 

  32. Dworkin A, Lee DSH, An AR, Goodlin SJ. A simple tool to predict development of delirium after elective surgery. J Am Geriatr Soc. 2016;64(11):e149–53. https://doi.org/10.1111/jgs.14428.

    Article  PubMed  Google Scholar 

  33. Kim MY, Park UJ, Kim HT, Cho WH. DELirium prediction based on hospital information (Delphi) in general surgery patients. Medicine (Baltimore). 2016;95(12):e3072. https://doi.org/10.1097/MD.0000000000003072.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Marcantonio ER, Goldman L, Mangione CM, Ludwig LE, Muraca B, Haslauer CM, et al. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA. 1994;271(2):134–9.

    Article  CAS  PubMed  Google Scholar 

  35. Clinical Epidemiology and Health Service Evaluation Unit. Clinical practice guidelines for the management of delirium in older people. Melbourne: Clinical Epidemiology and Health Service Evaluation Unit; 2006. p. 42.

    Google Scholar 

  36. Duppils GS, Wikblad K. Acute confusional states in patients undergoing hip surgery. Gerontology. 2000;46(1):36–43.

    Article  CAS  PubMed  Google Scholar 

  37. Dai YT, Lou MF, Yip PK, Huang GS. Risk factors and incidence of postoperative delirium in elderly Chinese patients. Gerontology. 2000;46(1):28–35.

    Article  CAS  PubMed  Google Scholar 

  38. Ali S, Patel M, Jabeen S, Bailey RK, Patel T, Shahid M, et al. Insight into delirium. Innov Clin Neurosci. 2011;8(10):25.

    PubMed  PubMed Central  Google Scholar 

  39. Alagiakrishnan K, Wiens CA. An approach to drug induced delirium in the elderly. Postgrad Med J. 2004;80(945):388–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Dimsdale JE, Newton RP. Neuropsychological side effects of β-blockers. Arch Intern Med. 1989;149(3):514–25.

    Article  CAS  PubMed  Google Scholar 

  41. O’Neal JB, Liu X, Shotwell MS, Liang Y, Shaw A, Shah A, et al. Impact of preoperative statin or beta blocker use and delirium following cardiac surgery. Anesth Analg. 2016;122:S57. https://doi.org/10.1213/01.ane.0000499505.96779.a0.

    Google Scholar 

  42. Kassie GM, Nguyen TA, Ellett LMK, Pratt NL, Roughead EE. Preoperative medication use and postoperative delirium: a systematic review. BMC Geriatr. 2017;17(1):298.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Kassie GM, Ellett LMK, Nguyen TA, Roughead EE. Current practice and opinions of hospital pharmacists regarding their role in the screening, prevention and treatment of delirium. Int J Clin Pharm. 2017;39(6):1194–200.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the health librarians of the University of South Australia who assisted us in searching the literature.

Funding

GMK is supported by an Australian Government Research Training Program Scholarship. LMKE and TAN are both supported by National Health and Medical Research Council (NHMRC)–Australian Research Council (ARC) Dementia Research Development Fellowships (LMKE grant identification number APP1101788, TAN grant identification number APP1103860). EER is supported by an NHMRC Senior Principal Research Fellowship (grant identification number APP1110139). The contents of the published material are solely the responsibility of the individual authors and do not reflect the views of NHMRC.

Author information

Authors and Affiliations

  1. Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia

    Gizat M. Kassie, Tuan A. Nguyen, Lisa M. Kalisch Ellett, Nicole L. Pratt & Elizabeth E. Roughead

  2. University of South Australia, GPO Box 2471 (CEA-18), Adelaide, SA, 5001, Australia

    Tuan A. Nguyen

  3. University of South Australia, GPO Box 2471 (R3-17A), Adelaide, SA, 5001, Australia

    Nicole L. Pratt

Authors
  1. Gizat M. Kassie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tuan A. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lisa M. Kalisch Ellett
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nicole L. Pratt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elizabeth E. Roughead
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gizat M. Kassie.

Ethics declarations

Conflict of interest

Gizat M. Kassie, Tuan A. Nguyen, Lisa M. Kalisch Ellett, Nicole L. Pratt and Elizabeth E. Roughead declare that they have no conflicts of interest relevant to the content of this review.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 45 kb)

Supplementary material 2 (DOCX 19 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kassie, G.M., Nguyen, T.A., Kalisch Ellett, L.M. et al. Do Risk Prediction Models for Postoperative Delirium Consider Patients’ Preoperative Medication Use?. Drugs Aging 35, 213–222 (2018). https://doi.org/10.1007/s40266-018-0526-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-018-0526-6

Search

Navigation