• Pablo R Kappen, Hilbert J Kappen, DirvenClemens M FCMFDepartment of Neurosurgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands., Markus Klimek, Johannes Jeekel, Elrozy R Andrinopoulou, Robert J Osse, and VincentArnaud J P EAJPEDepartment of Neurosurgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands..
• Department of Neurosurgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands. Electronic address: p.kappen@erasmusmc.nl.
• World Neurosurg. 2023 Apr 1; 172: e212e219e212-e219.

BackgroundThe clinical relevance of postoperative delirium (POD) in neurosurgery remains unclear and should be investigated because these patients are vulnerable. Hence, we investigated the impact of POD, by means of incidence and health outcomes, and identified independent risk factors.MethodsAdult patients undergoing an intracranial surgical procedure in the Erasmus Medical Center Rotterdam between June 2017 and September 2020 were retrospectively included. POD incidence, defined by a Delirium Observation Screening Scale (DOSS) ≥3 or antipsychotic treatment for delirium within 5 days after surgery, was calculated. Logistic regression analysis on the full data set was conducted for the multivariable risk factor and health outcome analyses.ResultsAfter including 2901 intracranial surgical procedures, POD was present in 19.4% with a mean onset in days of 2.62 (standard deviation, 1.22) and associated with more intensive care unit admissions and more discharge toward residential care. Onset of POD was not associated with increased length of hospitalization or mortality. We identified several independent nonmodifiable risk factors such as age, preexisting memory problems, emergency operations, craniotomy compared with burr-hole surgery, and severe blood loss. Moreover, we identified modifiable risk factors such as low preoperative potassium and opioid and dexamethasone administration.ConclusionsOur POD incidence rates and correlation with more intensive care unit admission and discharge toward residential care suggest a significant impact of POD on neurosurgical patients. We identified several modifiable and nonmodifiable risk factors, which shed light on the pathophysiologic mechanisms of POD in this cohort and could be targeted for future intervention studies.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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