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Motor Subtypes of Postoperative Delirium in Older Adults
Open accessAbstract
HYPOTHESIS: Increased knowledge about motor subtypes of delirium may aid clinicians in the management of postoperative geriatric patients. DESIGN: Prospective cohort study defining preoperative risk factors, outcomes, and adverse events related to motor subtypes of postoperative delirium. SETTING: Referral medical center. PATIENTS: Persons 50 years and older with planned postoperative intensive care unit (ICU) admission following an elective operation were recruited. MAIN OUTCOME MEASURES: Before surgery, a standardized frailty assessment was performed. After surgery, delirium and its motor subtypes were measured using the validated tools of the Confusion Assessment Method-ICU and the Richmond Agitation-Sedation Scale. Statistical analysis included the univariate t and χ(2) tests and analysis of variance with post hoc analysis. RESULTS: Delirium occurred in 43.0% (74 of 172) of patients, representing 67.6% (50 of 74) hypoactive, 31.1% (23 of 74) mixed, and 1.4% (1 of 74) hyperactive motor subtypes. Compared with those having mixed delirium, patients having hypoactive delirium were older (mean [SD] age, 71 [9] vs 65 [9] years) and more anemic (mean [SD] hematocrit, 36% [8%] vs 41% [6%]) (P = .002 for both). Patients with hypoactive delirium had higher 6-month mortality (32.0% [16 of 50] vs 8.7% [2 of 23], P = .04). Delirium-related adverse events occurred in 24.3% (18 of 74) of patients with delirium; inadvertent tube or line removals occurred more frequently in the mixed group (P = .006), and sacral skin breakdown was more common in the hypoactive group (P = .002). CONCLUSIONS: Motor subtypes of delirium alert clinicians to differing prognosis and adverse event profiles in postoperative geriatric patients. Hypoactive delirium is the most common motor subtype and is associated with worse prognosis (6-month mortality, 1 in 3 patients). Knowledge of differing adverse event profiles can modify clinicians' management of older patients with postoperative delirium.
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“Two forms of delirium – hyperactive and hypoactive – have been described, with the hypoactive form being more common in older people and having a worse prognosis 181 .”
From Mental health care for older adults: recent advances and new directions in clinical practice and research (2022) · cites this paper as [181]
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Devlin, J. W., Skrobik, Y. K., Gélinas, C., Needham, D. M., Slooter, A. J. C., Pandharipande, P. P., Watson, P. L., Weinhouse, G. L., Nunnally, M., Rochwerg, B. N., et al. (2018) · Critical Care Medicine · doi:10.1097/ccm.0000000000003299 · Cited by 4,280
Wilson, J. E., Mart, M. F., Cunningham, C. M., Shehabi, Y., Girard, T. D., MacLullich, A. M. J., Slooter, A. J. C., & Ely, E. W. (2020) · Nature Reviews Disease Primers · doi:10.1038/s41572-020-00223-4 · Cited by 1,371
Aldecoa, C., Bettelli, G., Bilotta, F., Sanders, R. D., Audisio, R. A., Borozdina, A., Cherubini, A., Jones, C., Kehlet, H., MacLullich, A. M. J., et al. (2017) · European Journal of Anaesthesiology · doi:10.1097/eja.0000000000000594 · Cited by 1,131
Delirium in Older Persons: Advances in Diagnosis and Treatment
Oh, E. S., Fong, T. G., Hshieh, T. T., & Inouye, S. K. (2017) · JAMA · doi:10.1001/jama.2017.12067 · Cited by 926
Postoperative Delirium in Older Adults: Best Practice Statement from the American Geriatrics Society
Inouye, S. K., Robinson, T., Blaum, C. S., Busby‐Whitehead, J., Boustani, M. A., Chalian, A. A., Deiner, S. G., Fick, D. M., Hutchison, L. C., Johanning, J. M., et al. (2014) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2014.10.019 · Cited by 521
Self-citation
Metadata
- Authors
- Robinson, T. N.
- Affiliations
- University of Colorado Anschutz (US)
- Corresponding author
- Robinson, Thomas N.
- Venue
- Archives of Surgery
- Publisher
- American Medical Association (AMA)
- Published
- 2011-03-01
- Volume
- 146
- Issue
- 3
- Pages
- 295
- ISSN
- 0004-0010 (ISSN-L)
- PMC
- PMC3346288
- OpenAlex
- W2143587366
- Cited by
- 250
- References
- 28
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 25 · 2023: 14 · 2022: 22 · 2021: 27 · 2020: 24 · 2019: 18 · 2018: 16 · 2017: 20 · 2016: 19 · 2015: 13 · 2014: 11 · 2013: 11 · 2012: 11
- FWCI
- 9.28
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (K23AG034632)
- National Heart, Lung, and Blood Institute (K24HL089223)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Medicine › Clinical Neurology › Alcoholism and Thiamine Deficiency
- Keywords
- postoperative delirium, hypoactive delirium, mixed delirium, hyperactive delirium, older adults, geriatric surgery, intensive care unit admission, frailty, anemia, 6-month mortality
- MeSH terms
- Age Factors, Aged, Analysis of Variance, Delirium, Female, Humans, Male, Middle Aged, Postoperative Complications, Preoperative Care, Prospective Studies, Psychomotor Agitation, Cohort Studies, Geriatric Assessment, Incidence, Survival Analysis, Elective Surgical Procedures, Risk Assessment
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