Risk factors of post-anaesthesia care unit delirium in patients undergoing non-cardiac surgery in Singapore.

Yuhe KE; Sophia Chew; Edwin Seet; Wan Yi Wong; Vera Lim; Nelson Chua; Jinbin Zhang; Beatrice Lim; Vanessa Chua; Ne-hooi Will Loh; Lian Kah TI

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Risk factors of post-anaesthesia care unit delirium in patients undergoing non-cardiac surgery in Singapore.

Author: Yuhe KE ¹ ; Sophia CHEW ¹ ; Edwin SEET ² ; Wan Yi WONG ³ ; Vera LIM ³ ; Nelson CHUA ³ ; Jinbin ZHANG ³ ; Beatrice LIM ³ ; Vanessa CHUA ⁴ ; Ne-Hooi Will LOH ⁴ ; Lian Kah TI ⁴
Author Information

1. Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore.
2. Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore.
3. Department of Anaesthesia, Tan Tock Seng Hospital, Singapore.
4. Department of Anaesthesia, National University Health System, Singapore.
Publication Type:Journal Article
Keywords: Geriatrics; major non-cardiac surgery; postoperative delirium
MeSH: Female; Humans; Delirium/epidemiology*; Postoperative Complications/etiology*; Singapore/epidemiology*; Prospective Studies; Anesthesia/adverse effects*; Risk Factors; Neoplasms
From:Singapore medical journal 2023;64(12):728-731
CountrySingapore
Language:English
Abstract: INTRODUCTION:Post-anaesthesia care unit (PACU) delirium affects 5%-45% of patients after surgery and is associated with postoperative delirium and increased mortality. Up to 40% of PACU delirium is preventable, but it remains under-recognised due to a lack of awareness of its diagnosis. The nursing delirium screening scale (Nu-DESC) has been validated for diagnosing PACU delirium, but is not routinely used locally. This study aimed to use Nu-DESC to establish the incidence and risk factors of PACU delirium in patients undergoing non-cardiac surgery in the surgical population.
METHODS:We conducted an audit of eligible patients undergoing major surgery in three public hospitals in Singapore over 1 week. Patients were assessed for delirium 30-60 min following their arrival in PACU using Nu-DESC, with a total score of ≥2 indicative of delirium.
RESULTS:A total of 478 patients were assessed. The overall incidence rate of PACU delirium was 18/478 (3.8%), and the incidence was 9/146 (6.2%) in patients aged > 65 years. Post-anaesthesia care unit delirium was more common in females, patients with malignancy and those who underwent longer operations. Logistic regression analysis showed that the use of bispectral index (P < 0.001) and the presence of malignancy (P < 0.001) were significantly associated with a higher incidence of PACU delirium.
CONCLUSION:In this first local study, the incidence of PACU delirium was 3.8%, increasing to 6.2% in those aged > 65 years. Understanding these risk factors will form the basis for which protocols can be established to optimise resource management and prevent long-term morbidities and mortality in PACU delirium.