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Delirium pós-operatório numa população idosa
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Introdução: Delirium pós-operatório (DPO) é definido como o quadro de delirium que surge em doentes submetidos a procedimentos cirúrgicos, sendo uma complicação frequente principalmente em doentes idosos. Neste estudo é analisada a incidência deste quadro em doentes idosos internados num Serviço de Cirurgia Geral. Métodos: Estudo comparativo, observacional, prospectivo em doentes idosos internados numa enfermaria de cirurgia. Foram realizadas avaliações neurológicas a doentes com idade igual ou superior a 65 anos e com uma duração de internamento mínima de um dia. A população foi dividida em dois grupos (estudo e controlo) consoante tivesse sido submetida a procedimento cirúrgico ou a tratamento conservador, respectivamente. Foram colhidos dados demográficos e clínicos bem como aplicados o Mini-Mental State Examination (MMSE) e o questionário Confusion Assessment Method 3-Minute (3D-CAM). Resultados: A incidência de delirium entre idosos internados foi 10%, a incidência de DPO em doentes idosos foi 14.9% versus 4.7% em doentes submetidos a tratamento conservador. As variáveis significativas no desenvolvimento de delirium foram a idade mais avançada, maior Índice de Comorbilidade de Charlson (ICC) e menor MMSE dos doentes. A realização de cirurgia não demonstrou uma associação significativa com o desenvolvimento de delirium, embora o odds ratio de 3.588 mostre uma tendência para maior incidência deste em doentes operados. Conclusões: O desenvolvimento de DPO é uma complicação importante e comum cuja génese é multifactorial. Este estudo demonstra o impacto do envelhecimento, estado basal cognitivo e carga de comorbilidades na vulnerabilidade para o desenvolvimento de delirium.
Background: Postoperative Delirium (POD) is defined as the occurrence of delirium among patients undergoing surgery, being particularly common among the elderly. This study focused on the incidence of POD among elderly patients admitted to a General Surgery department. Methods: This was a prospective, comparative study among elderly patients admitted to a General Surgery ward. Neurologic assessments were carried out in patients aged 65 years and above, with a minimum hospital stay of one day. The sample was split into two groups (study vs control) depending on whether the patient underwent a surgical procedure or medical treatment. We collected demographic and clinical data and a Mini-Mental State Examination (MMSE) and Confusion Assessment Method 3- Minute (3D-CAM) were performed. Results: The incidence of delirium among elderly patients was 10%, the incidence of POD in elderly patients found in this study was 14.9% versus 4.7% in patients undergoing medical treatment. Older age, higher Charlson Comorbidity Index (CCI), and a lower MMSE were considered significant for the development of delirium. Surgery did not show a statistically significant association with the occurrence of delirium, although an odds ratio of 3,588 shows a trend towards a greater occurrence of this condition among patients undergoing surgery. Conclusions: POD’s is an important and common complication whose etiology is multifactorial. This study seems to be in accordance with the literature regarding the impact of aging, cognitive basal state, and comorbidity burden on the vulnerability that renders patients prone to the development of an acute confusional state.
Background: Postoperative Delirium (POD) is defined as the occurrence of delirium among patients undergoing surgery, being particularly common among the elderly. This study focused on the incidence of POD among elderly patients admitted to a General Surgery department. Methods: This was a prospective, comparative study among elderly patients admitted to a General Surgery ward. Neurologic assessments were carried out in patients aged 65 years and above, with a minimum hospital stay of one day. The sample was split into two groups (study vs control) depending on whether the patient underwent a surgical procedure or medical treatment. We collected demographic and clinical data and a Mini-Mental State Examination (MMSE) and Confusion Assessment Method 3- Minute (3D-CAM) were performed. Results: The incidence of delirium among elderly patients was 10%, the incidence of POD in elderly patients found in this study was 14.9% versus 4.7% in patients undergoing medical treatment. Older age, higher Charlson Comorbidity Index (CCI), and a lower MMSE were considered significant for the development of delirium. Surgery did not show a statistically significant association with the occurrence of delirium, although an odds ratio of 3,588 shows a trend towards a greater occurrence of this condition among patients undergoing surgery. Conclusions: POD’s is an important and common complication whose etiology is multifactorial. This study seems to be in accordance with the literature regarding the impact of aging, cognitive basal state, and comorbidity burden on the vulnerability that renders patients prone to the development of an acute confusional state.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Delirium pós-operatório Cirurgia idosos