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Perioperative Optimization of Senior Health in Spine Surgery: Impact on Postoperative Delirium.
J Am Geriatr Soc. 2021 05; 69(5):1240-1248.JA

Abstract

BACKGROUND

Delirium is a common postoperative complication in geriatric patients, especially in those with underlying risk factors. Multicomponent nonpharmacologic interventions are effective in preventing delirium, however, implementation of these measures is variable in perioperative care. The aim of our study was to assess the impact of our Perioperative Optimization of Senior Health Program (UTSW POSH) on postoperative delirium in patients undergoing elective spine surgery.

STUDY DESIGN

The UTSW POSH program is an interdisciplinary perioperative initiative involving geriatrics, surgery, and anesthesiology to improve care for high-risk geriatric patients undergoing elective spine surgery. Preoperatively, enrolled patients (n = 147) were referred for a geriatric assessment and optimization for surgery. Postoperatively, patients were co-managed by the primary surgical team and the geriatrics consult service. UTSW POSH patients were retrospectively compared to a matched historical control group (n = 177) treated with usual care. Main outcomes included postoperative delirium and provider recognition of delirium.

RESULTS

UTSW POSH patients were significantly older (75.5 vs 71.5 years; P < .001), had more comorbidities (8.02 vs 6.58; P < .001), and were more likely to undergo pelvic fixation (36.1% vs 17.5%; P < .001). The incidence of postoperative delirium was lower in the UTSW POSH group compared to historical controls, although not statistically significant (11.6% vs 19.2%; P = .065). Delirium was significantly lower in patients who underwent complex spine surgery (≥4 levels of vertebral fusion; N = 106) in the UTSW POSH group (11.7% vs 28.9%, P = .03). There was a threefold increase in the recognition of postoperative delirium by providers after program implementation, (76.5% vs 23.5%; P = .001).

CONCLUSIONS

This study suggests that interdisciplinary care for high-risk geriatric patients undergoing elective spine surgery may reduce the incidence of postoperative delirium and increase provider recognition of delirium. The benefit may be greater for those undergoing larger procedures.

Authors+Show Affiliations

Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA.Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA.Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA.Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA.Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA.Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA.Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA.Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA.Department of Neurological Surgery, St Louis University Hospital, St. Louis, Missouri, USA.Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.Department of Neurological Surgery, UT Southwestern Medical School, Dallas, Texas, USA. Department of Orthopedic Surgery, UT Southwestern Medical School, Dallas, Texas, USA.Department of Internal Medicine, Geriatrics Division, UT Southwestern Medical School, Dallas, Texas, USA.

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

33382460

Citation

Pernik, Mark N., et al. "Perioperative Optimization of Senior Health in Spine Surgery: Impact On Postoperative Delirium." Journal of the American Geriatrics Society, vol. 69, no. 5, 2021, pp. 1240-1248.
Pernik MN, Deme PR, Nguyen ML, et al. Perioperative Optimization of Senior Health in Spine Surgery: Impact on Postoperative Delirium. J Am Geriatr Soc. 2021;69(5):1240-1248.
Pernik, M. N., Deme, P. R., Nguyen, M. L., Aoun, S. G., Adogwa, O., Hall, K., Stewart, N. A., Dosselman, L. J., El Tecle, N. E., McDonald, S. R., Bagley, C. A., & Wingfield, S. A. (2021). Perioperative Optimization of Senior Health in Spine Surgery: Impact on Postoperative Delirium. Journal of the American Geriatrics Society, 69(5), 1240-1248. https://doi.org/10.1111/jgs.17006
Pernik MN, et al. Perioperative Optimization of Senior Health in Spine Surgery: Impact On Postoperative Delirium. J Am Geriatr Soc. 2021;69(5):1240-1248. PubMed PMID: 33382460.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Perioperative Optimization of Senior Health in Spine Surgery: Impact on Postoperative Delirium. AU - Pernik,Mark N, AU - Deme,Palvasha R, AU - Nguyen,Madelina L, AU - Aoun,Salah G, AU - Adogwa,Owoicho, AU - Hall,Kristen, AU - Stewart,Nick A, AU - Dosselman,Luke J, AU - El Tecle,Najib E, AU - McDonald,Shelley R, AU - Bagley,Carlos A, AU - Wingfield,Sarah A, Y1 - 2020/12/31/ PY - 2020/12/02/revised PY - 2020/07/17/received PY - 2020/12/04/accepted PY - 2021/1/1/pubmed PY - 2021/9/29/medline PY - 2020/12/31/entrez KW - deformity KW - delirium KW - geriatric KW - interdisciplinary | surgery KW - prevention KW - spine SP - 1240 EP - 1248 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 69 IS - 5 N2 - BACKGROUND: Delirium is a common postoperative complication in geriatric patients, especially in those with underlying risk factors. Multicomponent nonpharmacologic interventions are effective in preventing delirium, however, implementation of these measures is variable in perioperative care. The aim of our study was to assess the impact of our Perioperative Optimization of Senior Health Program (UTSW POSH) on postoperative delirium in patients undergoing elective spine surgery. STUDY DESIGN: The UTSW POSH program is an interdisciplinary perioperative initiative involving geriatrics, surgery, and anesthesiology to improve care for high-risk geriatric patients undergoing elective spine surgery. Preoperatively, enrolled patients (n = 147) were referred for a geriatric assessment and optimization for surgery. Postoperatively, patients were co-managed by the primary surgical team and the geriatrics consult service. UTSW POSH patients were retrospectively compared to a matched historical control group (n = 177) treated with usual care. Main outcomes included postoperative delirium and provider recognition of delirium. RESULTS: UTSW POSH patients were significantly older (75.5 vs 71.5 years; P < .001), had more comorbidities (8.02 vs 6.58; P < .001), and were more likely to undergo pelvic fixation (36.1% vs 17.5%; P < .001). The incidence of postoperative delirium was lower in the UTSW POSH group compared to historical controls, although not statistically significant (11.6% vs 19.2%; P = .065). Delirium was significantly lower in patients who underwent complex spine surgery (≥4 levels of vertebral fusion; N = 106) in the UTSW POSH group (11.7% vs 28.9%, P = .03). There was a threefold increase in the recognition of postoperative delirium by providers after program implementation, (76.5% vs 23.5%; P = .001). CONCLUSIONS: This study suggests that interdisciplinary care for high-risk geriatric patients undergoing elective spine surgery may reduce the incidence of postoperative delirium and increase provider recognition of delirium. The benefit may be greater for those undergoing larger procedures. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/33382460/Perioperative_Optimization_of_Senior_Health_in_Spine_Surgery:_Impact_on_Postoperative_Delirium_ L2 - https://doi.org/10.1111/jgs.17006 DB - PRIME DP - Unbound Medicine ER -