Increased Risk, Complicated Recovery Associated With Postoperative Delirium and Parkinson Disease

A recent study aimed to investigate the relationship between Parkinson disease (PD) and postoperative delirium after common surgical procedures. The researchers conducted a retrospective analysis using the National Inpatient Sample database, focusing on patients who underwent 10 prevalent surgical procedures in the US between 2005 and 2014. 

The main objective was to compare the occurrence of postoperative delirium in patients with PD to those without PD, alongside secondary measures like patient disposition, length of hospital stay, and associated costs.

The study encompassed a vast dataset of 3,235,866 patients who underwent the specified surgical procedures during the designated timeframe. The research methodology involved matching 35,743 patients with PD to an equal number of patients without PD based on factors such as age, sex, elective admission, Charlson Comorbidity index, and dementia presence. The median age of participants was 77 years, with a median Charlson Comorbidity index of 1. Nearly half were female, and an equivalent proportion were admitted as elective cases. The 3 most frequent surgical procedures were hip arthroplasty (28.5%), knee arthroplasty (16.1%), and percutaneous coronary angioplasty (14.9%).

Findings revealed that postoperative delirium was significantly more prevalent in patients with PD compared to matched individuals without PD (4.2% vs 2.3%, P <0.001). After adjusting for relevant factors, the odds of experiencing postoperative delirium were 1.88 times higher in the PD group compared to the non-PD group, with a confidence interval of 95% (1.73-2.05). The study further identified that patients undergoing spinal fusion had the highest odds of developing delirium, with an adjusted odds ratio of 2.99 (95% confidence interval 2.06-4.38).

In addition to a higher incidence of postoperative delirium, patients with PD faced a more complex postoperative course. Their hospital stays were prolonged, incurring greater costs compared to their non-PD counterparts. Moreover, the likelihood of being discharged to a post-acute care facility was notably higher for PD patients compared to those without PD.

In conclusion, this study underscores a significant association between PD and an increased risk of postoperative delirium following common surgical procedures. 

The findings emphasize the importance of recognizing and addressing this heightened risk in PD patients to potentially mitigate the occurrence of postoperative delirium and optimize the overall postoperative care experience.

Reference:
Newman JM, Sodhi N, Dalton SE, et al. Does parkinson disease increase the risk of perioperative complications after total hip arthroplasty? A nationwide database study. J Arthroplasty. 2018;33(7S):S162-S166. doi:10.1016/j.arth.2018.01.006