Motor Subtypes of Postoperative Delirium in Older Adults | Geriatrics | JAMA Surgery | JAMA Network
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Original Article
March 2011March 21, 2011

Motor Subtypes of Postoperative Delirium in Older Adults

Author Affiliations

Author Affiliations: Departments of Surgery (Drs Robinson and Raeburn), Preventive Medicine and Biometrics (Dr Tran), Psychiatry (Dr Brenner), Physical Medicine and Rehabilitation (Dr Brenner), Neurology (Dr Brenner), and Pulmonary Sciences (Dr Moss), University of Colorado at Denver School of Medicine, and Department of Surgery (Drs Robinson and Raeburn) and Mental Illness Research, Education and Clinical Center (Dr Brenner), Denver Veterans Affairs (VA) Medical Center, VA Rocky Mountain Network, Denver.

Arch Surg. 2011;146(3):295-300. doi:10.1001/archsurg.2011.14

Hypothesis  Increased knowledge about motor subtypes of delirium may aid clinicians in the management of postoperative geriatric patients.

Design  Prospective cohort study defining preoperative risk factors, outcomes, and adverse events related to motor subtypes of postoperative delirium.

Setting  Referral medical center.

Patients  Persons 50 years and older with planned postoperative intensive care unit (ICU) admission following an elective operation were recruited.

Main Outcome Measures  Before surgery, a standardized frailty assessment was performed. After surgery, delirium and its motor subtypes were measured using the validated tools of the Confusion Assessment Method-ICU and the Richmond Agitation-Sedation Scale. Statistical analysis included the univariate t and χ2 tests and analysis of variance with post hoc analysis.

Results  Delirium occurred in 43.0% (74 of 172) of patients, representing 67.6% (50 of 74) hypoactive, 31.1% (23 of 74) mixed, and 1.4% (1 of 74) hyperactive motor subtypes. Compared with those having mixed delirium, patients having hypoactive delirium were older (mean [SD] age, 71 [9] vs 65 [9] years) and more anemic (mean [SD] hematocrit, 36% [8%] vs 41% [6%]) (P = .002 for both). Patients with hypoactive delirium had higher 6-month mortality (32.0% [16 of 50] vs 8.7% [2 of 23], P = .04). Delirium-related adverse events occurred in 24.3% (18 of 74) of patients with delirium; inadvertent tube or line removals occurred more frequently in the mixed group (P = .006), and sacral skin breakdown was more common in the hypoactive group (P = .002).

Conclusions  Motor subtypes of delirium alert clinicians to differing prognosis and adverse event profiles in postoperative geriatric patients. Hypoactive delirium is the most common motor subtype and is associated with worse prognosis (6-month mortality, 1 in 3 patients). Knowledge of differing adverse event profiles can modify clinicians' management of older patients with postoperative delirium.