Abstract

Objective: The aim of this study is to assess the incidence of postoperative delirium (POD) in patients over 60 years undergoing neurosurgery at our institution. The secondary objectives are to identify risk factors for POD, focusing on preoperative, intraoperative, and postoperative data.

Background: POD is one of the most common postoperative complications. Recent meta-analyses indicate that the incidence of POD following neurosurgery is highly variable, particularly for spinal procedures. Accurate risk estimation and the identification of key risk factors are crucial for implementing preventive measures for patients who are most at risk of this complication.

Methods: This prospective observational study included 113 patients over 60 years of age undergoing spinal and cranial neurosurgery between May 2023 and September 2023. The incidence of postoperative delirium was assessed using the Nursing Delirium Screening scale (Nu-DESC). Data was collected from preoperative, intraoperative, and postoperative assessments.

Results: The incidence of postoperative delirium was approximately 1.8%, which was insufficient to identify significant predictors of delirium. Consequently, post hoc exploratory analyses were conducted. Focusing specifically on lumbar surgery, the findings indicated that psychological factors related to pain, particularly high scores on the Pain Catastrophizing Scale, were strongly associated with postoperative pain (NRS >7). Additionally, longer surgery durations were correlated with a prolonged hospital stay, and redo surgery was a predictor of delayed first mobilization.

Conclusions: POD seems to be underrecognized at our institution. Raising awareness among patients and healthcare professionals about the importance of identifying and addressing this complication is essential to improve patient outcomes. Future research should focus on exploring interventions, to further enhance patient outcomes, particularly for those undergoing high-risk surgeries like intracranial procedures.