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Trajectory of Functional Recovery After Postoperative Delirium in Elective Surgery

Hshieh, Tammy T. MD; Saczynski, Jane PhD; Gou, Ray Yun MA; Marcantonio, Edward MD; Jones, Richard N. ScD; Schmitt, Eva PhD; Cooper, Zara MD; Ayres, Douglas MD; Wright, John MD; Travison, Thomas G. PhD; Inouye, Sharon K. MDon behalf of the SAGES Study Group

doi: 10.1097/SLA.0000000000001952

Objective: To describe functional recovery after elective surgery and to determine whether improvements differ among individuals who develop delirium.

Background: No large studies of older adults have investigated whether delirium influences the trajectory of functional recovery after elective surgery. The prospective observational study assessed this association among 566 individuals aged 70 years and older.

Methods: Patients undergoing major elective surgery were assessed daily while in hospital for presence and severity of delirium using the Confusion Assessment Method, and their functional recovery was followed for 18 months thereafter. The Activities of Daily Living and Instrumental Activities of Daily Living Scales and the Physical Component Summary of the Short Form-12 were obtained before surgery and at 1, 2, 6, 12, and 18 months. A composite index (standard deviation 10, minimally clinically significant difference 2) derived from these scales was then analyzed using mixed-effects regression.

Results: Mean age was 77 years; 58% of participants were women and 24% developed postoperative delirium. Participants with delirium demonstrated lesser functional recovery than their counterparts without delirium; at 1 month, the covariate-adjusted mean difference on the physical function composite was −1.5 (95% confidence interval −3.3, −0.2). From 2 to 18 months, the corresponding difference was −1.8 (95% confidence interval −3.2, −0.3), an effect comparable with the minimally clinically significant difference.

Conclusions: Delirium was associated with persistent and clinically meaningful impairment of functional recovery, to 18 months. Use of multifactorial preventive interventions for patients at high risk for delirium and tailored transitional care planning may help to maximize the functional benefits of elective surgery.

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*Division of Aging, Brigham and Women's Hospital, Boston, MA

Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA

Harvard Medical School, Boston, MA

§Department of Pharmacy and Health Systems Sciences, Northeastern University, Boston, MA

Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

||Department of Psychiatry and Human Behavior, Department of Neurology, Warren Alpert Medical School, Brown University, Providence, RI

**Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA

††Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA.

Reprints: Jane Saczynski, PhD, Northeastern University, 360 Huntington Avenue, R218 TF, Boston, MA 02115. E-mail:

D.A. is an associate surgeon and assistant professor; Z.C. is an associate surgeon, assistant professor, and the deputy director of strategy and partnerships at the Harvard Chan School of Public Health; R.J.W. is an associate surgeon and assistant professor; J.S. is an associate professor; T.H. is an associate professor and instructor in medicine; S.K.I., is a professor of medicine and director of the Aging Brain Center at Hebrew SeniorLife; R.N.J. is an associate professor; E.R.M. is a professor of medicine and the director of the Aging Research Program; T.T. is an assistant professor and the director of biostatistics and co-director of Interventional Studies in Aging Center at the Institute For Aging Research; E.S. is an associate director at the Aging Brain Center; and R.G. is a program analyst.

The authors and all staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

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