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The predisposing and precipitating risk factors for delirium in neurosurgery: a prospective cohort study of 949 patients

  • Original Article - Neurosurgery general
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Delirium is the most common neuropsychiatric presentation during hospitalization. In neurosurgery, studies on predisposing and precipitating risk factors for the development of delirium are rare but required for the individual risk estimation.

Methods

Prospective cohort study in a tertiary university center. In total, 949 neurosurgical patients, 307 with and 642 without delirium, were included. Demographic factors, neurosurgery-related, neurological, and medical clusters were tested as predictors of delirium in multiple logistic regression analyses.

Results

The incidence of delirium in this cohort of neurosurgical patients was 32.4%. Compared to patients without delirium, those with delirium were significantly older, more cognitively and neurologically impaired, transferred from hospitals and nursing homes, admitted as emergencies, longer hospitalized (16.2 vs. 9.5 days; p < 0.001), in greater need of intensive care management, and more frequently transferred to rehabilitation. Predisposing factors of delirium were stroke (OR 5.45, CI 2.12–14.0, p < 0.001), cardiac insufficiency (OR 4.59, CI 1.09–19.26, p = 0.038), cerebral neoplasm (OR 1.53, CI 0.92–2.54, p = 0.019), and age ≥ 65 years (OR 1.47, CI 1.03–2.09, p = 0.030). Precipitating factors of delirium were acute cerebral injury (OR 3.91, CI 2.24–6.83, p < 0.001), hydrocephalus (OR 3.10, CI 1.98–4.87, p < 0.001), and intracranial hemorrhage (OR 1.90, CI 1.23–2.94, p = 0.004).

Conclusions

Delirium in acute neurosurgical patients was associated with longer hospitalization. Whereas common etiologies of delirium like infections and dementia, did not predict delirium, pre-existing neurovascular and traumatic diseases, as well as surgery-related events seem important risk factors contributing to delirium in neurosurgery.

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Abbreviations

OR:

Odds ratio

CI:

Confidence interval

ICU:

Intensive care unit

DOS:

Delirium Observation Screening Scale

LOS:

Length of stay

CCI:

Charlson Comorbidity index

ICD:

International Classification of Diseases

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Authors and Affiliations

  1. Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland

    Carl Moritz Zipser, Roland von Känel & Sönke Böttger

  2. Department of Neurology and Neurophysiology, University of Zurich, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland

    Carl Moritz Zipser

  3. Department of Hematology, University of Zurich, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland

    Jeremy Deuel

  4. Institute of Nursing Science, University of Zurich, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland

    Jutta Ernst

  5. School of Health Professions, Zurich University of Applied Science, Technikumstrasse 81, 8401, Winterthur, Switzerland

    Maria Schubert

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Zipser, C.M., Deuel, J., Ernst, J. et al. The predisposing and precipitating risk factors for delirium in neurosurgery: a prospective cohort study of 949 patients. Acta Neurochir 161, 1307–1315 (2019). https://doi.org/10.1007/s00701-019-03927-z

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