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Acta Neurochirurgica

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01-07-2019 | Hydrocephalus | Original Article - Neurosurgery general

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

Authors: Carl Moritz Zipser, Jeremy Deuel, Jutta Ernst, Maria Schubert, Roland von Känel, Sönke Böttger

Published in: Acta Neurochirurgica | Issue 7/2019

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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Title: The predisposing and precipitating risk factors for delirium in neurosurgery: a prospective cohort study of 949 patients
Authors: Carl Moritz Zipser
Jeremy Deuel
Jutta Ernst
Maria Schubert
Roland von Känel
Sönke Böttger
Publication date: 01-07-2019
Publisher: Springer Vienna
Keywords: Hydrocephalus
Hydrocephalus
Hydrocephalus
Dementia
Dementia
Published in: Acta Neurochirurgica / Issue 7/2019
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-019-03927-z

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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