Longitudinal Trends In The Incidence Of Hyperactive Delirium And Its Causes Of Change After Surgery For Degenerative Lumbar Disease

Background:Postoperative delirium(POD)is a common postoperative complication in elderly patients.Although POD can have a number of serious adverse consequences when it occurs,it can be prevented.However,the current studies on POD are mostly small sample studies and only report the incidence over a small range of time,which is not conducive to observing the longitudinal trend of POD.In addition,the incidence of POD reported in different studies varies considerably,which is related to the recognition rate of different delirium subtypes.Hyperactive postoperative delirium(Hyper-POD)is more likely to be recognized and documented by health care professionals than hypoactive or mixed POD.Therefore,it is clinically important to clarify the incidence and longitudinal trends of Hyper-POD and to analyze the possible causes of the changes so as to reduce the incidence of POD.Objective:The purpose of this study was to investigate the longitudinal changes in the incidence of Hyper-POD of lumbar degenerative disease at our institution over the past 11 years and to identify the potential causes of the changes.Methods:This retrospective study used a sizable sample.The Linear-by-Linear Association test was used to investigate temporal trends in the incidence of Hyper-POD in the medical records of all enrolled patients.Depending on the kind of variable and its distribution,differences between groups were assessed using the one-way ANOVA test,the Kruskal-Wallis H test,or the Chi-Square test.The aforementioned tests were corrected for P values using the Bonferroni method,and P< 0.05 was considered a statistically significant difference.Results:The pooled incidence of Hyper-POD over the last 11 years was 1.79%(130/7250).There were three periods of increasing incidence of Hyper-POD,with a particularly strong trend in the third period.Compared to the first period,the second period saw an increase in patients ≥60 years of age,more comorbidities,more difficult procedures,and increased use of postoperative central analgesics.The third period saw an increase in the use of intraoperative benzodiazepines and an increase in the use of postoperative central analgesics(pentazocine)in patients compared to the second period.Conclusion:Inherent risk factors(increasing age of the surgical patient,increased comorbidities,and increased difficulty of the procedure)and modifiable risk factors(intraoperative benzodiazepine sedation,increased use of central analgesia in the postoperative period)may have combined to contribute to the increased incidence of Hyper-POD.Modifiable risk factors(benzodiazepines and pentazocine)may be the main reason for the dramatic increase in the incidence of Hyper-POD in the third period.The intervention of modifiable risk factors may be a crucial step in lowering the prevalence of Hyper-POD.