article · Scientific Reports
Postoperative delirium presents a critical challenge for elderly surgical patients, contributing to increased morbidity, higher mortality, and prolonged hospitalisation. An observational study conducted in hospitals within the South Gondar Zone examined the incidence and determinants of delirium diagnosed in the post-anaesthesia care unit using the Nursing Delirium Screening Scale. The observed incidence of postoperative delirium was 41 percent. Multivariable logistic regression revealed multiple significant risk factors, including an age of 75 years or older, severe functional impairment in daily activities, and an ASA physical status classification of IV. Furthermore, procedural and pharmacological factors such as premedication with benzodiazepines, intraoperative blood loss exceeding 1000 millilitres, and the use of ketamine during surgery substantially raised risk. The condition was also significantly linked to longer stays in recovery units and overall hospital admissions.
Delirium following surgery worsens clinical outcomes and places extra demand on healthcare institutions through extended patient recovery times. Identifying clear patient and medication risk factors allows clinical teams in low-resource settings to recognise vulnerable older patients prior to surgery, adjust anaesthetic protocols accordingly, and reduce preventable complications.
The findings provide observational evidence that could support the creation of risk-scoring protocols or decision-support algorithms for surgical and anaesthetic teams in hospital settings. The research represents early-stage clinical evidence, meaning any commercial or operational application would first require developing and validating structured screening tools or software solutions based on these identified factors.
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Postoperative delirium has the potential to impact individuals of all age groups, with a significant emphasis on the elderly population. Its presence leads to an increase in surgical morbidity and mortality rates, as well as a notable prolongation of hospital stays. However, there is a lack of research regarding the prevalence, risk factors, and implications of postoperative delirium in developing nations like Ethiopia, which affects both patients and healthcare institutions. An observational study was conducted at hospitals in the South Gondar Zone to diagnose postoperative delirium in the Post-Anesthesia Care Unit (PACU) using the Nursing Delirium Screening Scale. Both bivariable and multivariable logistic regression techniques were employed to analyze the association between independent factors and postoperative delirium. The strength of the association was indicated by the odds ratio with a 95% confidence interval (CI). Any p-values below 0.05 were considered statistically significant. The incidence of postoperative delirium was determined to be 41%. In the multivariate logistic regression analysis, several factors were identified as significantly associated with postoperative delirium. These factors include an age of 75 or older (AOR, 11.24; 95% CI, 4.74-26.65), ASA-PS IV (AOR, 3.25; 95% CI, 1.81-5.85), severe functional impairment of activities of daily living (AOR, 3.29; 95% CI, 1.06-10.20), premedication with benzodiazepine (AOR, 4.61; 95% CI, 2.48-8.57), intraoperative estimated blood loss exceeding 1000 ml (AOR, 2.74; 95% CI, 1.50-4.98), and intraoperative ketamine use (AOR, 3.84; 95% CI, 2.21-6.68). Additionally, postoperative delirium was found to significantly prolong the duration of stay in the post-anesthesia care unit (PACU) and the length of hospital stay (p-value < 0.05). Patients aged 75 or older, ASA-PS IV, experiencing severe functional impairment of ADL, patients premedicated with benzodiazepine, patients with intraoperative estimated blood loss exceeding 1000 ml, and intraoperative ketamine use were identified as risk factors for post-operative delirium.
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DOI: 10.1038/s41598-024-84554-2
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