Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2022.02.002
Brazilian Journal of Anesthesiology
Original Investigation

Effect of seasons on delirium in postoperative critically ill patients: a retrospective analysis

Efeito das estações no delirium em pacientes críticos pós-operatórios: uma análise retrospectiva

Yuwei Qiu, Eva Rivas, Marianne Tanios, Roshni Sreedharan, Guangmei Mao, Ilker Ince, Ahmed Salih, Remie Saab, Jagan Devarajan, Kurt Ruetzler, Alparslan Turan

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Abstract

Background and objectives
Postoperative delirium is common in critically ill patients and is known to have several predisposing and precipitating factors. Seasonality affects cognitive function which has a more dysfunctional pattern during winter. We, therefore, aimed to test whether seasonal variation is associated with the occurrence of delirium and hospital Length Of Stay (LOS) in critically ill non-cardiac surgical populations.

Methods
We conducted a retrospective analysis of adult patients recovering from non-cardiac surgery at the Cleveland Clinic between March 2013 and March 2018 who stayed in Surgical Intensive Care Unit (SICU) for at least 48 hours and had daily Confusion Assessment Method Intensive Care Unit (CAM-ICU) assessments for delirium. The incidence of delirium and LOS were summarized by season and compared using chi-square test and non-parametric tests, respectively. A logistic regression model was used to assess the association between delirium and LOS with seasons, adjusted for potential confounding variables.

Results
Among 2300 patients admitted to SICU after non-cardiac surgeries, 1267 (55%) had postoperative delirium. The incidence of delirium was 55% in spring, 54% in summer, 55% in fall and 57% in winter, which was not significantly different over the four seasons (p = 0.69). The median LOS was 12 days (IQR = [8, 19]) overall. There was a significant difference in LOS across the four seasons (p = 0.018). LOS during summer was 12% longer (95% CI: 1.04, 1.21; p = 0.002) than in winter.

Conclusions
In adult non-cardiac critically ill surgical patients, the incidence of postoperative delirium is not associated with season. Noticeably, LOS was longer in summer than in winter.

Keywords

Postoperative delirium;  Seasonal;  Surgical Intensive care unit

Resumo

Introdução

O delirium pós-operatório é comum em pacientes gravemente enfermos e é conhecido por ter vários fatores predisponentes e precipitantes. A sazonalidade afeta a função cognitiva que tem um padrão mais disfuncional durante o inverno. Nosso objetivo, portanto, foi testar se a variação sazonal está associada à ocorrência de delirium e tempo de permanência hospitalar (TDP) em populações cirúrgicas não cardíacas criticamente doentes.

Métodos

Realizamos uma análise retrospectiva de pacientes adultos em recuperação de cirurgia não cardíaca na Cleveland Clinic entre março de 2013 e março de 2018, que permaneceram na Unidade de Terapia Intensiva Cirúrgica (UTI) por pelo menos 48 horas e receberam diariamente Confusion Assessment Method Intensive Care Unit (CAM -ICU) para delirium. A incidência de delirium e TDP foram resumidos por estação e comparadas usando o teste qui-quadrado e testes não paramétricos, respectivamente. Um modelo de regressão logística foi usado para avaliar a associação entre delirium e TDP com as estações do ano, ajustado para possíveis variáveis de confusão.

Resultados

Entre 2.300 pacientes internados na UTI após cirurgias não cardíacas, 1.267 (55%) apresentaram delirium pós-operatório. A incidência de delirium foi de 55% na primavera, 54% no verão, 55% no outono e 57% no inverno, não diferindo significativamente nas quatro estações (p = 0,69). O tempo médio de permanência foi de 12 dias (IQR = [8, 19]) no geral. Houve uma diferença significativa no TDP nas quatro estações (p = 0,018). O tempo de permanência no verão foi 12% maior (IC 95%: 1,04, 1,21; p = 0,002) do que no inverno.

Conclusões

Em pacientes cirúrgicos adultos não cardíacos em estado crítico, a incidência de delirium pós-operatório não está associada à estação do ano. Notavelmente, o TDP foi mais longo no verão do que no inverno.

References

1 A HN Delaney, E Litton Preventing delirium in the intensive care unit JAMA, 319 (2018), pp. 659-660

2 GL Bryson, A. Wyand Evidence-based clinical update: General anesthesia and the risk of delirium and postoperative cognitive dysfunction Can J Anesth, 53 (2006), pp. 669-677

3 JW Devlin, NE Brummel, NS. Al-Qadheeb Optimising the recognition of delirium in the intensive care unit Best Pract Res Clin Anaesthesiol, 26 (2012), pp. 385-393

4 AJC Slooter, RR Van De Leur, IJ. Zaal Handbook of clinical neurology, 141 (2017), pp. 449-466

5 JIF Salluh, H Wang, EB Schneider, et al. Outcome of delirium in critically ill patients: systematic review and meta-analysis BMJ (Clinical research ed), 350 (2015), p. h2538

6 JL Rudolph, ER. Marcantonio Review articles: postoperative delirium: acute change with long-term implications Anesth Analg, 112 (2011), pp. 1202-1211

7 ER Marcantonio, L Goldman, CM Mangione, et al. A clinical prediction rule for delirium after elective noncardiac surgery JAMA, 271 (1994), pp. 134-139

8 J Densky, A Eskander, S Kang, et al. Risk factors associated with postoperative delirium in patients undergoing head and neck free flap reconstructionpostoperative delirium in patients undergoing head and neck free flap reconstructionpostoperative delirium in patients undergoing head and neck free flap reconstruction JAMA Otolaryngology Head Neck Surg, 145 (2019), pp. 216-221

9 RA Morshed, JS Young, M Safaee, et al. Delirium risk factors and associated outcomes in a neurosurgical cohort: a case-control study World Neurosurg, 126 (2019), pp. e930-e936

10 C Meyer, V Muto, M Jaspar, et al. Seasonality in human cognitive brain responses Proc Natl Acad Sci U S A, 113 (2016), pp. 3066-3071

11 ASP Lim, C Gaiteri, L Yu, et al. Seasonal plasticity of cognition and related biological measures in adults with and without Alzheimer disease: Analysis of multiple cohorts PLoS Med, 15 (2018), Article e1002647

12 LM Lyall, CA Wyse, CA Celis-Morales, et al. Seasonality of depressive symptoms in women but not in men: A cross-sectional study in the UK Biobank cohort J Affect Disord, 229 (2018), pp. 296-305

13 DS Wynchank, D Bijlenga, F Lamers, et al. ADHD, circadian rhythms and seasonality J Psychiatr Res, 81 (2016), pp. 87-94

14 M Gallerani, R. Manfredini Seasonal variation in the occurrence of delirium in patients admitted to medical units of a general hospital in Italy Acta Neuropsychiatrica, 25 (2013), pp. 179-183

15 S Balan, A Leibovitz, L Freedman, et al. Seasonal variation in the incidence of delirium among the patients of a geriatric hospital Arch Gerontol Geriatr, 33 (2001), pp. 287-293

16 SA Quraishi, AA Litonjua, KM Elias, et al. Association between pre-hospital vitamin D status and hospital-acquired new-onset delirium Br J Nutr, 113 (2015), pp. 1753-1760

17 I Abraha, F Trotta, JM Rimland, et al. Efficacy of non-pharmacological interventions to prevent and treat delirium in older patients: a systematic overview. The SENATOR project ONTOP Series PLoS One, 10 (2015), Article e0123090

18 T Hanazawa, K Asayama, D Watabe, et al. Association between amplitude of seasonal variation in self-measured home blood pressure and cardiovascular outcomes: HOMED-BP (Hypertension Objective Treatment Based on Measurement By Electrical Devices of Blood Pressure) Study J Am Heart Assoc, 7 (2018), Article e008509

19 J. Abbasi Is There a Seasonal Influence on Cognition and Dementia? JAMA, 320 (2018), pp. 1848-1849

20 A Argha, A Savkin, S-T Liaw, BG. Celler Effect of seasonal variation on clinical outcome in patients with chronic conditions: analysis of the Commonwealth Scientific and Industrial Research Organization (CSIRO) National Telehealth Trial JMIR Med Inform, 6 (2018), p. e16

21 RN Jones, S Cizginer, L Pavlech, et al. Assessment of instruments for measurement of delirium severity: a systematic reviewassessment of instruments for measurement of delirium severityassessment of instruments for measurement of delirium severity JAMA Internal Medicine, 179 (2019), pp. 231-239

22 EW Ely, SK Inouye, GR Bernard, et al. Delirium in mechanically ventilated patientsvalidity and reliability of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) JAMA, 286 (2001), pp. 2703-2710

23 KD Krewulak, HT Stelfox, JP Leigh, EW Ely, KM. Fiest Incidence and prevalence of delirium subtypes in an adult icu: a systematic review and meta-Analysis* Crit Care Med, 46 (2018), pp. 2029-2035

24 JF Peterson, BT Pun, RS Dittus, et al. Delirium and its motoric subtypes: a study of 614 critically Ill patients J Am Geriatr Soc, 54 (2006), pp. 479-484

25 PS CB Romano, ME Schembri, JA Rainwater Can administrative data be used to compare postoperative complication rates across hospitals? Med Care, 40 (2002), pp. 856-867

26 KS Simons, JD Workum, AJC Slooter, M van den Boogaard, JG van der Hoeven, P. Pickkers Effect of preadmission sunlight exposure on intensive care unit–acquired delirium: A multicenter study J Crit Care, 29 (2014), pp. 283-286

27 MJ PS Englesbe, JC Magee, P Gauger, et al. Seasonal variation in surgical outcomes as measured by the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) Ann Surg, 246 (2007), pp. 456-462

28 AT JN Malik, TJ Scharschmidt, JL Mayerson, SN Khan Factors associated with post-operative sepsis following surgery for spinal tumors: An analysis of the ACS-NSQIP database Clin Neurol Neurosurg, 172 (2018), pp. 1-7

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