Skip to main content

Advertisement

SpringerLink
Log in

A Systematic Review of Postoperative Delirium in the Urologic Patient

  • Lower Urinary Tract Symptoms and Voiding Dysfunction (J Sandhu, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Postoperative delirium (POD) is a common phenomenon among general surgery patients, but it is not well described in urologic surgical patients. We sought to define the incidence and predictive risk factors for POD in patients undergoing urologic surgery.

Recent Findings

Eighteen articles were included for review. The pooled incidence rate of postoperative delirium after urologic surgery was 1.69% (0.69–46.97%). Longer intraoperative time, male sex, unmarried status, and age were shown to be risk factors for POD.

Summary

POD is common after many urologic surgeries and leads to worse postoperative outcomes and higher healthcare utilization. Future studies are needed to better assess for and prevent POD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

Data supporting this study are available from corresponding author upon request. All figures and tables are original.

References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: Author; 2013.

    Book  Google Scholar 

  2. Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. J Alzheimers Dis. 2018;66:1–10.

    Article  CAS  Google Scholar 

  3. Martin BJ, Buth KJ, Arora RC, Baskett RJF. Delirium as a predictor of sepsis in post-coronary artery bypass grafting patients: a retrospective cohort study. Crit Care. 2010;14:R171.

    Article  Google Scholar 

  4. Koster S, Hensens AG, van der Palen J. The long-term cognitive and functional outcomes of postoperative delirium after cardiac surgery. Ann Thorac Surg. 2009;87:1469–74. [Internet]. The Society of Thoracic Surgeons; Available from. https://doi.org/10.1016/j.athoracsur.2009.02.080.

    Article  PubMed  Google Scholar 

  5. Gottesman RF, Grega MA, Bailey MM, Pham LD, Zeger SL, Baumgartner WA, et al. Delirium after coronary artery bypass graft surgery and late mortality. Ann Neurol. 2010;67:338–44.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Sprung J, Roberts RO, Weingarten TN, Nunes Cavalcante A, Knopman DS, Petersen RC, et al. Postoperative delirium in elderly patients is associated with subsequent cognitive impairment. Br J Anaesth. 2017;119:316–23. [Internet]. The Author(s); Available from. https://doi.org/10.1093/bja/aex130.

    Article  CAS  PubMed  Google Scholar 

  7. Robinson TN, Raeburn CD, Tran ZV, Angles EM, Brenner LA, Moss M. Postoperative delirium in the elderly: risk factors and outcomes. Ann Surg. 2009;249:173–8.

    Article  Google Scholar 

  8. Leslie DL, Marcantonio ER, Zhang Y, Leo-Summers L, Inouye SK. One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008;168:27–32.

    Article  Google Scholar 

  9. Franco K, Litaker D, Locala J, Bronson D. The cost of delirium in the surgical patient. Psychosomatics. 2001;42:68–73.

    Article  CAS  Google Scholar 

  10. Rudolph JL, Marcantonio ER. Postoperative delirium: acute change with long-term implications. Anesth Analg. 2011;112:1202–11.

    Article  Google Scholar 

  11. Patel HD, Ball MW, Cohen JE, Kates M, Pierorazio PM, Allaf ME. Morbidity of urologic surgical procedures: an analysis of rates, risk factors, and outcomes. Urology. 2015;85:552–60. [internet]. Elsevier Inc. Available from. https://doi.org/10.1016/j.urology.2014.11.034.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6:e1000100.

    Article  Google Scholar 

  13. Sterne J, Savović J, Page M, Elbers R, Blencowe N, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. Br Med J. 2019;366:i4898.

    Article  Google Scholar 

  14. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.

    Article  Google Scholar 

  15. Clayton D, Hills M. Statistical methods in epidemiology. Oxford: Oxford University Press; 1993.

    Google Scholar 

  16. Larsen RJ, Marx ML. A introduction to mathematical statistics and its applications. Fifth. Boston: Prentice Hall; 1981.

    Google Scholar 

  17. Braga ILS, Castelo-Filho J, de Sousa Bezerra Pinheiro R, de Azevedo RB, Ponte AT, da Silveira RA, et al. Functional capacity as a predictor of postoperative delirium in transurethral resection of prostate patients in Northeast Brazil. Neuropsychiatr Dis Treat. 2019;15:2395–401.

    Article  Google Scholar 

  18. Dai YT, Lou MF, Yip PK, Huang GS. Risk factors and incidence of postoperative delirium elderly Chinese patients. Gerontology. 2000;46:28–35.

    Article  CAS  Google Scholar 

  19. Gani H, Domi R, Kodra N, Prifti P, Naco M, Beqiri V, et al. The incidence of postoperative delirium in elderly patients after urologic surgery. Med Arh. 2013;67:45–7.

    Article  Google Scholar 

  20. Hamann J, Bickel H, Schwaibold H, Hartung R, Förstl H. Postoperative acute confusional state in typical urologic population: incidence, risk factors, and strategies for prevention. Urology. 2005;65:449–53.

    Article  Google Scholar 

  21. Large MC, Reichard C, Williams JTB, Chang C, Prasad S, Leung Y, et al. Incidence, risk factors, and complications of postoperative delirium in elderly patients undergoing radical cystectomy. Urology. 2013;81:123–9. [Internet]. Elsevier Inc.; Available from. https://doi.org/10.1016/j.urology.2012.07.086.

    Article  PubMed  Google Scholar 

  22. Matsuki M, Tanaka T, Takahashi A, Inoue R, Hotta H, Itoh N, et al. Incidence and risk factors of postoperative delirium in elderly patients undergoing urological surgery: A multi-institutional prospective study. Int J Urol. 2020;27(3):219–225. https://doi.org/10.1111/iju.14172.

  23. Munjupong S, Sripon T, Siripoonyothai S, Jesadapatarakul N, Poojinya T, Chernsirikasem N. Incidence and risk factors of emergence delirium after general and regional anesthesia in elective non-cardiac surgery patients. J Med Assoc Thail. 2018;101:1653–8.

    Google Scholar 

  24. Sato T, Hatakeyama S, Okamoto T, Yamamoto H, Hosogoe S, Tobisawa Y, et al. Slow gait speed and rapid renal function decline are risk factors for postoperative delirium after urological surgery. PLoS One. 2016;11:e0153961.

    Article  Google Scholar 

  25. Tai S, Xu L, Zhang L, Fan S, Liang C. Preoperative risk factors of postoperative delirium after transurethral prostatectomy for benign prostatic hyperplasia. Int J Clin Exp Med. 2015;8:4569–74.

    PubMed  PubMed Central  Google Scholar 

  26. Tognoni P, Simonato A, Robutti N, Pisani M, Cataldi A, Monacelli F, et al. Preoperative risk factors for postoperative delirium (POD) after urological surgery in the elderly. Arch Gerontol Geriatr. 2011;52:e166–9. [internet]. Elsevier Ireland Ltd; Available from. https://doi.org/10.1016/j.archger.2010.10.021.

    Article  CAS  PubMed  Google Scholar 

  27. Xue P, Wu Z, Wang K, Tu C, Wang X. Incidence and risk factors of postoperative delirium in elderly patients undergoing transurethral resection of prostate: a prospective cohort study. Neuropsychiatr Dis Treat. 2016;12:137–42.

    Article  Google Scholar 

  28. Kim HC, Kim E, Jeon YT, Hwang JW, Lim YJ, Seo JH, et al. Postanaesthetic emergence agitation in adult patients after general anaesthesia for urological surgery. J Int Med Res. 2015;43:226–35.

    Article  CAS  Google Scholar 

  29. Haugen CE, Mountford A, Warsame F, Berkowitz R, Bae S, Thomas AG, et al. Incidence, risk factors, and sequelae of post-kidney transplant delirium. J Am Soc Nephrol. 2018;29:1752–9.

    Article  Google Scholar 

  30. Bandini M, Marchioni M, Preisser F, Nazzani S, Tian Z, Graefen M, et al. Comprehensive analysis of in-hospital delirium after major surgical oncology procedures: A population-based study. Can Urol Assoc J. 2020;14(3):E84–93. https://doi.org/10.5489/cuaj.6030.

  31. Berian JR, Zhou L, Russell MM, Hornor MA, Cohen ME, Finlayson E, et al. Postoperative delirium as a target for surgical quality improvement. Ann Surg. 2018;268:93–9.

    Article  Google Scholar 

  32. Dhakharia V, Sinha S, Bhaumik J. Postoperative delirium in Indian patients following major abdominal surgery for cancer: risk factors and associations. Indian J Surg Oncol. 2017;8:567–72.

    Article  Google Scholar 

  33. Ha A, Krasnow RE, Mossanen M, Nagle R, Hshieh TT, Rudolph JL, et al. A contemporary population-based analysis of the incidence, cost, and outcomes of postoperative delirium following major urologic cancer surgeries. Urol Oncol Semin Orig Investig. 2018;36:341.e15–22.

    Google Scholar 

  34. Cotoia A, Mirabella L, Beck R, Matrella P, Assenzo V, Hazot TC, et al. Effects of closed-loop intravenous anesthesia guided by bispectral index in adult patients on emergence delirium: a randomized controlled study. Minerva Anestesiol. 2018;84:437–46.

    PubMed  Google Scholar 

  35. Ravi B, Pincus D, Choi S, Jenkinson R, Wasserstein DN, Redelmeier DA. Association of duration of surgery with postoperative delirium among patients receiving hip fracture repair. JAMA Netw Open. 2019;2(2):e190111. https://doi.org/10.1001/jamanetworkopen.2019.0111.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Wong CL, Holroyd-Leduc J, Simel DL, Straus SE. Does this patient have delirium? value of bedside instruments. JAMA. 2010;304(7):779–86. https://doi.org/10.1001/jama.2010.1182.

  37. Inouye S, Leo-Summer L, Zhang Y, Bogardus S, Leslie D, Agostini J. A chart-based method for identification of delirium: validation compared with interviewer ratings using the confusion assessment method. J Am Geriatr Soc. 2005;53:312–8.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Department of Obstetrics and Gynecology, Weill Cornell Medical College/New York Presbyterian, 425 East 61st Street, 12th Floor, New York, NY, 10065, USA

    Michelina D. Stoddard, Ahra Cho, Stephanie A. Chen & Bilal Chughtai

  2. Fordham University, 441 East Fordham Road, Bronx, NY, 10458, USA

    Claire Dunphy

  3. Samuel J. Wood Library and C.V. Starr Biomedical Information Center, 1300 York Avenue, New York, NY, 10065, USA

    Drew N. Wright

Authors
  1. Michelina D. Stoddard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahra Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephanie A. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Claire Dunphy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Drew N. Wright
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bilal Chughtai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bilal Chughtai.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Ethics Approval

This article is a systematic review of literature and, therefore, there was no direct patient involvement.

Consent to Participate

Not applicable.

Consent for Publication

Not applicable.

Code Availability

All calculations are available in a supplementary Excel file.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Lower Urinary Tract Symptoms and Voiding Dysfunction

Supplementary Information

ESM 1

(PDF 142 kb).

Supplementary Table 1

(DOCX 15 kb).

Supplementary Table 2

(DOCX 16 kb).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stoddard, M.D., Cho, A., Chen, S.A. et al. A Systematic Review of Postoperative Delirium in the Urologic Patient. Curr Urol Rep 21, 60 (2020). https://doi.org/10.1007/s11934-020-01010-0

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11934-020-01010-0

Keywords

Search

Navigation