Surgery, which can improve and save lives, can also cause harm.  Examples of serious complications include infections, blood clots, heart attacks, strokes, pneumonia, and breathing problems.  But one study recently found that the complication that resulted in the biggest problems for older surgical patients overall was delirium.

 Researchers studied 566 patients over the age of 70 who underwent specific types of elective surgery such as total hip or knee replacement.  They excluded everyone who had dementia and/or who had experienced delirium or been hospitalized in the three months before they went into the hospital. 

They tracked serious complications, those they termed life-altering and/or life-threatening. 

They also tracked the impact of those complications on three results.  First, did the patient have to stay in the hospital more than five days?  Second, when they left the hospital, did they go to an institutional setting such as another hospital or a skilled nursing facility?  Third, were they readmitted to the hospital within 30 days?

Each patient fell into one of four buckets based on whether they experienced any complications and what type they were:  no complications, complications excluding delirium, delirium only, and both delirium and other complications.

The researchers wrote, “Delirium occurred more frequently than all other major complications combined.”  It affected 23.9 percent of the patients, while all other complications affected 8.3 percent.  That is, it was about three times as likely that a patient would experience delirium than that they would experience another complication.

Patients who developed delirium were 90 percent more likely than people with no complications to have to stay in the hospital for more than 5 days.  They were 50 percent more likely to be discharged to a nursing facility or other institution than people with no complications. And their chances of being readmitted to the hospital within 30 days were 130 percent higher than were those of people with no complications.

In fact, the only group that fared worse on these indicators was the one consisting of people who experienced both delirium and at least one other serious complication.

The study, reported in the American Medical Association’s journal JAMA Surgery, indicated both that delirium is often preventable, and that delirium often isn’t seen as a major complication of surgery.  However, in terms of its impact on a group of patients overall, the study showed that it is the most common and most serious one.

The researchers concluded, “Given its high prevalence and negative effect, delirium should be considered as the leading postoperative complication contributing to adverse outcomes.”

The Hospital Elder Life Program (hospitalelderlifeprogram.org) offers some suggestions for preventing delirium.  But what if the patient develops delirium anyway?   Next week’s column describes challenges in getting intensive cognitive rehabilitation to reduce the damage.