Tests May ID Older Patients at Risk for Post-Op Delirium
Two simple tests may predict which older patients have underlying depression or less cognitive flexibility, leaving them vulnerable to post-surgery delirium, says a study presented at a meeting of the American Society of Anesthesiologists.
Delirium, a state of extreme confusion that can be short-lived or more long-term, can be frightening to families and costly for the health care system, explains study author Dr. Terri Monk, at Duke University School of Medicine.
A recent study showed that health care costs go up another $2,500 for each patient with delirium following surgery, because of longer hospital stays, higher death rates, and the need sometimes to admit patients to long-term care.
The annual national cost may reach as high as $152 billion a year, says Dr. Monk.
"When you look at the increase in the aging population, this is going to be more of a problem," she adds.
Increasing Concern as Population Ages
Dr. Arnold Berry, at Emory University School of Medicine in Atlanta, says the impact of the problem is already clear, considering that about 12 percent of the US population is 65 or older and this group accounts for one-third of expenditures on surgery.
The Duke study of 100 patients, average age 65, found that 16 percent experienced post-operative delirium after they had received general anesthesia for non-cardiac surgery.
Specific percentages can be as high as 50 percent or more for patients having surgery following a hip fracture, notes Dr. Monk.
The two pre-surgery tests - the Geriatric Depression Scale-Short Form and the Trail Making Test - can be administered by nurses and other health care staff in as little as 15 minutes.
Verifying these tests as effective screening tools could prompt further research to identify measures to prevent or reduce post-operative delirium.
Screening Tools May Help
Dr. Monk says further research might show that treating depression in older patients prior to elective surgery may reduce their likelihood of post-operative delirium.
Dr. Berry, who leads a group of anesthesiologists interested in geriatric issues, says Dr. Monk's findings are "one piece to a big puzzle."
Because of changes in the aging brain, it is difficult to determine how much the stress of surgery and how much the anesthesia add to the risk of post-operative delirium, he says.
Dr. Berry explains that the Duke study identifies screening tools that could spur more research into ways of dealing with both factors as they relate to post-op delirium.
He says he does not plan to add the screening tools used in the Duke study to his pre-operative work-ups - at least not yet. He is awaiting further study and confirmation of the findings.
Always consult your physician for more information.
Online Resources
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American Board of Surgery
National Institute of Mental Health
National Institute on Aging
National Institutes of Health (NIH)
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