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Predicting postoperative delirium severity in older adults: The role of surgical risk and executive function
Objectives Delirium is an important postoperative complication, yet predictive risk factors for postoperative delirium severity remain elusive. We hypothesized that the NSQIP risk calculation for serious complications (NSQIP‐SC) or risk of death (NSQIP‐D), and cognitive tests of executive function (...
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| Published in: | International journal of geriatric psychiatry 2019-07, Vol.34 (7), p.1018-1028 |
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| Main Authors: | , , , , , , , , , |
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| container_end_page | 1028 |
| container_issue | 7 |
| container_start_page | 1018 |
| container_title | International journal of geriatric psychiatry |
| container_volume | 34 |
| creator | Lindroth, Heidi Bratzke, Lisa Twadell, Sara Rowley, Paul Kildow, Janie Danner, Mara Turner, Lily Hernandez, Brandon Brown, Roger Sanders, Robert D. |
| description | Objectives
Delirium is an important postoperative complication, yet predictive risk factors for postoperative delirium severity remain elusive. We hypothesized that the NSQIP risk calculation for serious complications (NSQIP‐SC) or risk of death (NSQIP‐D), and cognitive tests of executive function (Trail Making Tests A and B [TMTA and TMTB]), would be predictive of postoperative delirium severity. Further, we demonstrate how advanced statistical techniques can be used to identify candidate predictors.
Methods/Design
Data from an ongoing perioperative prospective cohort study of 100 adults (65 y old or older) undergoing noncardiac surgery were analyzed. In addition to NSQIP‐SC, NSQIP‐D, TMTA, and TMTB, participant age, sex, American Society of Anesthesiologists (ASA) score, tobacco use, surgery type, depression, Framingham risk score, and preoperative blood pressure were collected. The Delirium Rating Scale‐R‐98 (DRS) measured delirium severity; the Confusion Assessment Method (CAM) identified delirium. LASSO and best subsets linear regression were employed to identify predictive risk factors.
Results
Ninety‐seven participants with a mean age of 71.68 ± 4.55, 55% male (31/97 CAM+, 32%), and a mean peak DRS of 21.5 ± 6.40 were analyzed. LASSO and best subsets regression identified NSQIP‐SC and TMTB to predict postoperative delirium severity (P |
| doi_str_mv | 10.1002/gps.5104 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6579704</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2197323234</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4384-45ff816e1121e9359130fc714e6d84b24c20ec8d9d8115d2d737b1c40b053dc83</originalsourceid><addsrcrecordid>eNp1kVFrFDEQx4Mo9mwFP4EEfPFlaybJ7mZ9EEqxVSi0YPsccsnsNTWXrMnu6X377rW1akHmYR7mx29m-BPyBtghMMY_rIZyWAOTz8gCWNdVAE3znCyYUnXVcMH2yKtSbhibZ6Bekj3BOtZK2S1IuMjovB19XNEhlTENmM3oN0gdBp_9tKYFN5j9uKU-0hQcZmrcFMbykV5eI80pIE09LVNeeWsCzb58pyY6ir_QTneqforzhhQPyIvehIKvH_o-uTr5fHn8pTo7P_16fHRWWSmUrGTd9woaBOCAnag7EKy3LUhsnJJLLi1naJXrnAKoHXetaJdgJVuyWjirxD75dO8dpuUancU4ZhP0kP3a5K1Oxut_J9Ff61Xa6KZuu5bJWfD-QZDTjwnLqNe-WAzBRExT0Ry6VvC5dui7J-hNmnKc39OcSxBKKF7_EdqcSsnYPx4DTO8i1HOEehfhjL79-_hH8HdmM1DdAz99wO1_Rfr04tud8BYuUqbF</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2241383825</pqid></control><display><type>article</type><title>Predicting postoperative delirium severity in older adults: The role of surgical risk and executive function</title><source>Wiley</source><creator>Lindroth, Heidi ; Bratzke, Lisa ; Twadell, Sara ; Rowley, Paul ; Kildow, Janie ; Danner, Mara ; Turner, Lily ; Hernandez, Brandon ; Brown, Roger ; Sanders, Robert D.</creator><creatorcontrib>Lindroth, Heidi ; Bratzke, Lisa ; Twadell, Sara ; Rowley, Paul ; Kildow, Janie ; Danner, Mara ; Turner, Lily ; Hernandez, Brandon ; Brown, Roger ; Sanders, Robert D.</creatorcontrib><description>Objectives
Delirium is an important postoperative complication, yet predictive risk factors for postoperative delirium severity remain elusive. We hypothesized that the NSQIP risk calculation for serious complications (NSQIP‐SC) or risk of death (NSQIP‐D), and cognitive tests of executive function (Trail Making Tests A and B [TMTA and TMTB]), would be predictive of postoperative delirium severity. Further, we demonstrate how advanced statistical techniques can be used to identify candidate predictors.
Methods/Design
Data from an ongoing perioperative prospective cohort study of 100 adults (65 y old or older) undergoing noncardiac surgery were analyzed. In addition to NSQIP‐SC, NSQIP‐D, TMTA, and TMTB, participant age, sex, American Society of Anesthesiologists (ASA) score, tobacco use, surgery type, depression, Framingham risk score, and preoperative blood pressure were collected. The Delirium Rating Scale‐R‐98 (DRS) measured delirium severity; the Confusion Assessment Method (CAM) identified delirium. LASSO and best subsets linear regression were employed to identify predictive risk factors.
Results
Ninety‐seven participants with a mean age of 71.68 ± 4.55, 55% male (31/97 CAM+, 32%), and a mean peak DRS of 21.5 ± 6.40 were analyzed. LASSO and best subsets regression identified NSQIP‐SC and TMTB to predict postoperative delirium severity (P < 00.001, adjusted R2: 0.30). NSQIP‐SC and TMTB were also selected as predictors for postoperative delirium incidence (AUROC 0.81, 95% CI, 0.72‐0.90).
Conclusions
In this cohort, we identified NSQIP risk score for serious complications and a measure of executive function, TMT‐B, to predict postoperative delirium severity using advanced modeling techniques. Future studies should investigate the utility of these variables in a formal delirium severity prediction model.</description><identifier>ISSN: 0885-6230</identifier><identifier>EISSN: 1099-1166</identifier><identifier>DOI: 10.1002/gps.5104</identifier><identifier>PMID: 30907449</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Aged ; Aged, 80 and over ; aging ; Blood pressure ; Cognitive ability ; Cohort Studies ; Delirium ; Delirium - epidemiology ; Delirium - etiology ; Delirium - psychology ; Executive function ; Executive Function - physiology ; Female ; Geriatric psychiatry ; Health risk assessment ; Humans ; Incidence ; Linear Models ; Male ; Middle Aged ; perioperative ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Postoperative Complications - psychology ; Prediction models ; Predictive Value of Tests ; Prospective Studies ; risk ; Risk Factors ; severity ; Statistical analysis ; Surgery ; Surgical Procedures, Operative - adverse effects ; Tobacco</subject><ispartof>International journal of geriatric psychiatry, 2019-07, Vol.34 (7), p.1018-1028</ispartof><rights>2019 John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4384-45ff816e1121e9359130fc714e6d84b24c20ec8d9d8115d2d737b1c40b053dc83</citedby><cites>FETCH-LOGICAL-c4384-45ff816e1121e9359130fc714e6d84b24c20ec8d9d8115d2d737b1c40b053dc83</cites><orcidid>0000-0002-5389-4701 ; 0000-0003-0113-0328</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30907449$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lindroth, Heidi</creatorcontrib><creatorcontrib>Bratzke, Lisa</creatorcontrib><creatorcontrib>Twadell, Sara</creatorcontrib><creatorcontrib>Rowley, Paul</creatorcontrib><creatorcontrib>Kildow, Janie</creatorcontrib><creatorcontrib>Danner, Mara</creatorcontrib><creatorcontrib>Turner, Lily</creatorcontrib><creatorcontrib>Hernandez, Brandon</creatorcontrib><creatorcontrib>Brown, Roger</creatorcontrib><creatorcontrib>Sanders, Robert D.</creatorcontrib><title>Predicting postoperative delirium severity in older adults: The role of surgical risk and executive function</title><title>International journal of geriatric psychiatry</title><addtitle>Int J Geriatr Psychiatry</addtitle><description>Objectives
Delirium is an important postoperative complication, yet predictive risk factors for postoperative delirium severity remain elusive. We hypothesized that the NSQIP risk calculation for serious complications (NSQIP‐SC) or risk of death (NSQIP‐D), and cognitive tests of executive function (Trail Making Tests A and B [TMTA and TMTB]), would be predictive of postoperative delirium severity. Further, we demonstrate how advanced statistical techniques can be used to identify candidate predictors.
Methods/Design
Data from an ongoing perioperative prospective cohort study of 100 adults (65 y old or older) undergoing noncardiac surgery were analyzed. In addition to NSQIP‐SC, NSQIP‐D, TMTA, and TMTB, participant age, sex, American Society of Anesthesiologists (ASA) score, tobacco use, surgery type, depression, Framingham risk score, and preoperative blood pressure were collected. The Delirium Rating Scale‐R‐98 (DRS) measured delirium severity; the Confusion Assessment Method (CAM) identified delirium. LASSO and best subsets linear regression were employed to identify predictive risk factors.
Results
Ninety‐seven participants with a mean age of 71.68 ± 4.55, 55% male (31/97 CAM+, 32%), and a mean peak DRS of 21.5 ± 6.40 were analyzed. LASSO and best subsets regression identified NSQIP‐SC and TMTB to predict postoperative delirium severity (P < 00.001, adjusted R2: 0.30). NSQIP‐SC and TMTB were also selected as predictors for postoperative delirium incidence (AUROC 0.81, 95% CI, 0.72‐0.90).
Conclusions
In this cohort, we identified NSQIP risk score for serious complications and a measure of executive function, TMT‐B, to predict postoperative delirium severity using advanced modeling techniques. Future studies should investigate the utility of these variables in a formal delirium severity prediction model.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>aging</subject><subject>Blood pressure</subject><subject>Cognitive ability</subject><subject>Cohort Studies</subject><subject>Delirium</subject><subject>Delirium - epidemiology</subject><subject>Delirium - etiology</subject><subject>Delirium - psychology</subject><subject>Executive function</subject><subject>Executive Function - physiology</subject><subject>Female</subject><subject>Geriatric psychiatry</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Incidence</subject><subject>Linear Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>perioperative</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - psychology</subject><subject>Prediction models</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>risk</subject><subject>Risk Factors</subject><subject>severity</subject><subject>Statistical analysis</subject><subject>Surgery</subject><subject>Surgical Procedures, Operative - adverse effects</subject><subject>Tobacco</subject><issn>0885-6230</issn><issn>1099-1166</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp1kVFrFDEQx4Mo9mwFP4EEfPFlaybJ7mZ9EEqxVSi0YPsccsnsNTWXrMnu6X377rW1akHmYR7mx29m-BPyBtghMMY_rIZyWAOTz8gCWNdVAE3znCyYUnXVcMH2yKtSbhibZ6Bekj3BOtZK2S1IuMjovB19XNEhlTENmM3oN0gdBp_9tKYFN5j9uKU-0hQcZmrcFMbykV5eI80pIE09LVNeeWsCzb58pyY6ir_QTneqforzhhQPyIvehIKvH_o-uTr5fHn8pTo7P_16fHRWWSmUrGTd9woaBOCAnag7EKy3LUhsnJJLLi1naJXrnAKoHXetaJdgJVuyWjirxD75dO8dpuUancU4ZhP0kP3a5K1Oxut_J9Ff61Xa6KZuu5bJWfD-QZDTjwnLqNe-WAzBRExT0Ry6VvC5dui7J-hNmnKc39OcSxBKKF7_EdqcSsnYPx4DTO8i1HOEehfhjL79-_hH8HdmM1DdAz99wO1_Rfr04tud8BYuUqbF</recordid><startdate>201907</startdate><enddate>201907</enddate><creator>Lindroth, Heidi</creator><creator>Bratzke, Lisa</creator><creator>Twadell, Sara</creator><creator>Rowley, Paul</creator><creator>Kildow, Janie</creator><creator>Danner, Mara</creator><creator>Turner, Lily</creator><creator>Hernandez, Brandon</creator><creator>Brown, Roger</creator><creator>Sanders, Robert D.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-5389-4701</orcidid><orcidid>https://orcid.org/0000-0003-0113-0328</orcidid></search><sort><creationdate>201907</creationdate><title>Predicting postoperative delirium severity in older adults: The role of surgical risk and executive function</title><author>Lindroth, Heidi ; Bratzke, Lisa ; Twadell, Sara ; Rowley, Paul ; Kildow, Janie ; Danner, Mara ; Turner, Lily ; Hernandez, Brandon ; Brown, Roger ; Sanders, Robert D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4384-45ff816e1121e9359130fc714e6d84b24c20ec8d9d8115d2d737b1c40b053dc83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>aging</topic><topic>Blood pressure</topic><topic>Cognitive ability</topic><topic>Cohort Studies</topic><topic>Delirium</topic><topic>Delirium - epidemiology</topic><topic>Delirium - etiology</topic><topic>Delirium - psychology</topic><topic>Executive function</topic><topic>Executive Function - physiology</topic><topic>Female</topic><topic>Geriatric psychiatry</topic><topic>Health risk assessment</topic><topic>Humans</topic><topic>Incidence</topic><topic>Linear Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>perioperative</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - psychology</topic><topic>Prediction models</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>risk</topic><topic>Risk Factors</topic><topic>severity</topic><topic>Statistical analysis</topic><topic>Surgery</topic><topic>Surgical Procedures, Operative - adverse effects</topic><topic>Tobacco</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lindroth, Heidi</creatorcontrib><creatorcontrib>Bratzke, Lisa</creatorcontrib><creatorcontrib>Twadell, Sara</creatorcontrib><creatorcontrib>Rowley, Paul</creatorcontrib><creatorcontrib>Kildow, Janie</creatorcontrib><creatorcontrib>Danner, Mara</creatorcontrib><creatorcontrib>Turner, Lily</creatorcontrib><creatorcontrib>Hernandez, Brandon</creatorcontrib><creatorcontrib>Brown, Roger</creatorcontrib><creatorcontrib>Sanders, Robert D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of geriatric psychiatry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lindroth, Heidi</au><au>Bratzke, Lisa</au><au>Twadell, Sara</au><au>Rowley, Paul</au><au>Kildow, Janie</au><au>Danner, Mara</au><au>Turner, Lily</au><au>Hernandez, Brandon</au><au>Brown, Roger</au><au>Sanders, Robert D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predicting postoperative delirium severity in older adults: The role of surgical risk and executive function</atitle><jtitle>International journal of geriatric psychiatry</jtitle><addtitle>Int J Geriatr Psychiatry</addtitle><date>2019-07</date><risdate>2019</risdate><volume>34</volume><issue>7</issue><spage>1018</spage><epage>1028</epage><pages>1018-1028</pages><issn>0885-6230</issn><eissn>1099-1166</eissn><abstract>Objectives
Delirium is an important postoperative complication, yet predictive risk factors for postoperative delirium severity remain elusive. We hypothesized that the NSQIP risk calculation for serious complications (NSQIP‐SC) or risk of death (NSQIP‐D), and cognitive tests of executive function (Trail Making Tests A and B [TMTA and TMTB]), would be predictive of postoperative delirium severity. Further, we demonstrate how advanced statistical techniques can be used to identify candidate predictors.
Methods/Design
Data from an ongoing perioperative prospective cohort study of 100 adults (65 y old or older) undergoing noncardiac surgery were analyzed. In addition to NSQIP‐SC, NSQIP‐D, TMTA, and TMTB, participant age, sex, American Society of Anesthesiologists (ASA) score, tobacco use, surgery type, depression, Framingham risk score, and preoperative blood pressure were collected. The Delirium Rating Scale‐R‐98 (DRS) measured delirium severity; the Confusion Assessment Method (CAM) identified delirium. LASSO and best subsets linear regression were employed to identify predictive risk factors.
Results
Ninety‐seven participants with a mean age of 71.68 ± 4.55, 55% male (31/97 CAM+, 32%), and a mean peak DRS of 21.5 ± 6.40 were analyzed. LASSO and best subsets regression identified NSQIP‐SC and TMTB to predict postoperative delirium severity (P < 00.001, adjusted R2: 0.30). NSQIP‐SC and TMTB were also selected as predictors for postoperative delirium incidence (AUROC 0.81, 95% CI, 0.72‐0.90).
Conclusions
In this cohort, we identified NSQIP risk score for serious complications and a measure of executive function, TMT‐B, to predict postoperative delirium severity using advanced modeling techniques. Future studies should investigate the utility of these variables in a formal delirium severity prediction model.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>30907449</pmid><doi>10.1002/gps.5104</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-5389-4701</orcidid><orcidid>https://orcid.org/0000-0003-0113-0328</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over aging Blood pressure Cognitive ability Cohort Studies Delirium Delirium - epidemiology Delirium - etiology Delirium - psychology Executive function Executive Function - physiology Female Geriatric psychiatry Health risk assessment Humans Incidence Linear Models Male Middle Aged perioperative Postoperative Complications - epidemiology Postoperative Complications - etiology Postoperative Complications - psychology Prediction models Predictive Value of Tests Prospective Studies risk Risk Factors severity Statistical analysis Surgery Surgical Procedures, Operative - adverse effects Tobacco |
| title | Predicting postoperative delirium severity in older adults: The role of surgical risk and executive function |
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