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Comment & Response
January 16, 2019

Postoperative Delirium—Amplifying the Confusion—Reply

Author Affiliations
  • 1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
  • 2The Johns Hopkins University, Baltimore, Maryland
JAMA Surg. 2019;154(4):366. doi:10.1001/jamasurg.2018.5245

In Reply We appreciate the comments by Pal and understand the quandary in trying to generalize our study.1 Pal’s comments concerning age, surgery risk, type of anesthetic drug, or phenotype certainly point to the evidence that postoperative delirium is a complicated geriatric syndrome and that many factors weigh into its causation. Many of the factors mentioned should be the focus of future studies in this area to help enhance our understanding and improve management. From our study design, we cannot comment on surgical risk or other anesthetic drugs. However, in this randomized clinical trial, in an older population undergoing hip fracture repair, lighter propofol sedation was not found to decrease the incidence of postoperative delirium except in a subgroup of patients with lower comorbidity.1 All of the modeling approaches for delirium analysis accounted for age. The data suggest, as does Pal, that patient phenotype, particularly underlying comorbid state, and clinical factors, such as depth of sedation, may play more complex roles in the risk of postoperative delirium than simply instilling their individual direct effects toward this complicated geriatric syndrome.

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