2023 FSA Podium and Poster Abstracts
P013: THE IMPACT OF PREOPERATIVE RENAL IMPAIRMENT ON THE INCIDENCE OF POSTOPERATIVE DELIRIUM
Will S Roberts1; Evan Maroun, MS1; Alexander Knight1; Shawn Price1; Thomas M Austin, MD, MS2; F. Cole Dooley, MD2; 1Nova Southeastern University Kiran C. Patel College of Osteopathic Medicine; 2University of Florida College of Medicine - Department of Anesthesiology
Introduction/Background: Postoperative Delirium (POD) is debatably the most common neurologic complication of major surgery with an estimated incidence of approximately 15% to 50% depending on the delirium screening criteria utilized.1,2 The incidence of POD has been linked to various preoperative patient demographics as well as the severity of the surgery performed.1 The preoperative patient characteristics most commonly associated with POD are age, male sex, pre-existing dementia, anxiety, depression, and various cardiovascular pathologies.1 However, there is very limited research analyzing the potential of renal function to influence incidence rates of POD. Due to the increased rates of POD following major surgery as well as the high cost of treatment and possible mortality, additional methods of predicting and subsequently preventing POD are needed.
Methods: Three databases (Embase, Web of Science, OVID-Medline) were searched for articles that contained keywords relating a quantitative assessment of preoperative renal function to POD. Once removed from the databases, the abstracts were manually de-duplicated and screened based on standardized inclusion/exclusion criteria via blind format using Rayyan. Adjusted odds ratios with 95% confidence intervals for associations between preoperative renal function and POD were then tabulated. Two-sided p-values < 0.05 were considered statistically significant.
Results: The initial search identified 397 articles which were then de-duplicated to 240 results. Further screening based on abstract-title and full-text review yielded 14 articles that investigated the effects of preoperative renal function and POD incidence (Figure 1 & Table 1). Out of the 23,384 patients analyzed, 2,785 patients developed POD, indicating an overall incidence of 11.9%. Moreover, elevated serum creatinine, history of chronic kidney disease (CKD), and elevated urinary albumin/creatinine ratio (UACR) were significantly associated with POD in each study that analyzed them in this review (Table 2). Preoperative GFR was found significant in three out of the five studies (Table 2).
Discussion/Conclusion: The results of this study reveal that preoperative renal function correlates with the incidence rate of POD. With many anesthetic agents and medications being excreted renally, the association with POD is likely due at least in part to delayed excretion of the potent pharmacologic agents or their metabolites used during surgery or sedation. Further research needs to be conducted analyzing the incidence rates of POD in more types of operations including the specific anesthetics utilized. Overall, renal impairment is a proven predictor of POD, affords very little cost to physicians, and its consideration in the development of an anesthetic plan may prove to reduce healthcare costs and mortality if able to reduce the incidence of POD.