Postoperative delirium in spine surgery

Background Context: Postoperative delirium is a great concern in the treatment of hip fracture. However, there have been no reports regarding the postoperative delirium in spine surgery. Purpose: To determine the incidence and risk factors for postoperative delirium in the patients who have had spine surgery. Study Design/Setting: The incidence and intraoperative risk factors of postoperative delirium were retrospectively examined in patients who had spine surgery during a 3-year period. Patient Sample: Three hundred forty-one patients who underwent spine surgery from 2000 to 2002 were included. Methods: The presence of delirium was determened by the Confusion Assessment Method. Laboratory data were checked preoperatively, at 1 day and 1 week postoperatively. The prognosis of postoperative delirium was evaluated. Results: Postoperative delirium was found in 13 patients; all of them were in their 70's or 80's. The incidence of delirium was 12.5% in the patients over 70 years old. Hemoglobin and hematocrit levels at 1 day after surgery in the delirium group were significantly lower than those in the control group. One patient had persistent cognitive dysfunction after surgery. Two patients who developed postoperative delirium died during the follow-up period. Conclusion: Low concentrations of hemoglob in and hematocrit 1 day after surgery were risk factors for postoperative delirium. As delirium is thought to represent not only brain dysfunction, but also impaired general physical condition, careful observation is necessary for the management of patients with postoperative delirium.