Brief Report: Preoperative Frailty in Older Surgical Patients is Associated with Early Postoperative Delirium

Overview

Journal Anesth Analg

Specialty Anesthesiology

Date 2011 Mar 5

PMID 21372278

Citations 43

Authors

Jacqueline M Leung

Tiffany L Tsai

Laura P Sands

Affiliations

Soon will be listed here.

Abstract

We investigated whether preoperative frailty among older noncardiac surgical patients provides information about the development of postoperative delirium that is in addition to traditional geriatric risk factors. One-third of patients had a frailty score ≥3, which is considered "frail" in others' research. Twenty-five percent of patients developed postoperative delirium, which was measured using the confusion assessment method. Multivariable logistic regression showed that age, activities of daily living dependence, instrumental activities of daily living dependence, and cognitive functioning did not contribute significantly to the prediction of postoperative delirium. Only preoperative symptoms of depression (odds ratio=1.42; 95% confidence interval=1.06-1.91; P=0.018) and the frailty score (odds ratio=1.84; 95% confidence interval=1.07-3.1; P=0.028) were independently associated with the development of postoperative delirium.

Citing Articles

Unraveling the impact of frailty on postoperative delirium in elderly surgical patients: a systematic review and meta-analysis.

Wu H, Yan S, Cao H, Feng C, Zhang H BMC Anesthesiol. 2025; 25(1):114.

PMID: 40050707 PMC: 11884039. DOI: 10.1186/s12871-025-02994-3.

Incidence and risk factors of postoperative delirium in elderly surgical patients 2023.

Fenta E, Teshome D, Kibret S, Hunie M, Tiruneh A, Belete A Sci Rep. 2025; 15(1):1400.

PMID: 39789093 PMC: 11718272. DOI: 10.1038/s41598-024-84554-2.

A Retrospective Study Establishing a Nomogram Predictive Model for Postoperative High-Activity Delirium After Non-Cardiac Surgery.

Tu Y, Du W, Pan Y, Zhang X, Mo Y, Sun C Neuropsychiatr Dis Treat. 2024; 20:1655-1665.

PMID: 39246738 PMC: 11380854. DOI: 10.2147/NDT.S471598.

Incidence of post-operative delirium increases as severity of frailty increases.

Ehrlich A, Oh E, Psoter K, Bettick D, Wang N, Gearhart S Age Ageing. 2024; 53(8).

PMID: 39148434 PMC: 11327404. DOI: 10.1093/ageing/afae168.

Association between modified frailty index and postoperative delirium in patients after cardiac surgery: A cohort study of 2080 older adults.

Cheng H, Ling Y, Li Q, Li X, Tang Y, Guo J CNS Neurosci Ther. 2024; 30(6):e14762.

PMID: 38924691 PMC: 11199331. DOI: 10.1111/cns.14762.

References

Inouye S, van Dyck C, Alessi C, Balkin S, Siegal A, Horwitz R . Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990; 113(12):941-8. DOI: 10.7326/0003-4819-113-12-941. View

Mitchell S, Rockwood K . The association between parkinsonism, Alzheimer's disease, and mortality: a comprehensive approach. J Am Geriatr Soc. 2000; 48(4):422-5. DOI: 10.1111/j.1532-5415.2000.tb04701.x. View

Puts M, Visser M, Twisk J, Deeg D, Lips P . Endocrine and inflammatory markers as predictors of frailty. Clin Endocrinol (Oxf). 2005; 63(4):403-11. DOI: 10.1111/j.1365-2265.2005.02355.x. View

Wang L, Larson E, Bowen J, van Belle G . Performance-based physical function and future dementia in older people. Arch Intern Med. 2006; 166(10):1115-20. DOI: 10.1001/archinte.166.10.1115. View

Newman A, Gottdiener J, McBurnie M, Hirsch C, Kop W, Tracy R . Associations of subclinical cardiovascular disease with frailty. J Gerontol A Biol Sci Med Sci. 2001; 56(3):M158-66. DOI: 10.1093/gerona/56.3.m158. View

Winograd C, Gerety M, Chung M, Goldstein M, Dominguez Jr F, Vallone R . Screening for frailty: criteria and predictors of outcomes. J Am Geriatr Soc. 1991; 39(8):778-84. DOI: 10.1111/j.1532-5415.1991.tb02700.x. View

Waite L, Grayson D, Piguet O, Creasey H, Bennett H, Broe G . Gait slowing as a predictor of incident dementia: 6-year longitudinal data from the Sydney Older Persons Study. J Neurol Sci. 2005; 229-230:89-93. DOI: 10.1016/j.jns.2004.11.009. View

Ferrucci L, Guralnik J, Studenski S, Fried L, Cutler Jr G, Walston J . Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc. 2004; 52(4):625-34. DOI: 10.1111/j.1532-5415.2004.52174.x. View

Simone M, Tan Z . The role of inflammation in the pathogenesis of delirium and dementia in older adults: a review. CNS Neurosci Ther. 2010; 17(5):506-13. PMC: 6493838. DOI: 10.1111/j.1755-5949.2010.00173.x. View

10.

Fried L, Tangen C, Walston J, Newman A, Hirsch C, Gottdiener J . Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001; 56(3):M146-56. DOI: 10.1093/gerona/56.3.m146. View

11.

Weaver J, Huang M, Albert M, Harris T, Rowe J, Seeman T . Interleukin-6 and risk of cognitive decline: MacArthur studies of successful aging. Neurology. 2002; 59(3):371-8. DOI: 10.1212/wnl.59.3.371. View

12.

Buchman A, Wilson R, Bienias J, Shah R, Evans D, Bennett D . Change in body mass index and risk of incident Alzheimer disease. Neurology. 2005; 65(6):892-7. DOI: 10.1212/01.wnl.0000176061.33817.90. View

13.

Zeevi N, Pachter J, McCullough L, Wolfson L, Kuchel G . The blood-brain barrier: geriatric relevance of a critical brain-body interface. J Am Geriatr Soc. 2010; 58(9):1749-57. PMC: 4667839. DOI: 10.1111/j.1532-5415.2010.03011.x. View

14.

Dasgupta M, Rolfson D, Stolee P, Borrie M, Speechley M . Frailty is associated with postoperative complications in older adults with medical problems. Arch Gerontol Geriatr. 2007; 48(1):78-83. DOI: 10.1016/j.archger.2007.10.007. View

15.

Parikh S, Chung F . Postoperative delirium in the elderly. Anesth Analg. 1995; 80(6):1223-32. DOI: 10.1097/00000539-199506000-00027. View

16.

Buchman A, Boyle P, Wilson R, Tang Y, Bennett D . Frailty is associated with incident Alzheimer's disease and cognitive decline in the elderly. Psychosom Med. 2007; 69(5):483-9. DOI: 10.1097/psy.0b013e318068de1d. View

17.

Leung J, Sands L, Wang Y, Poon A, Kwok P, Kane J . Apolipoprotein E e4 allele increases the risk of early postoperative delirium in older patients undergoing noncardiac surgery. Anesthesiology. 2007; 107(3):406-11. DOI: 10.1097/01.anes.0000278905.07899.df. View