Why should you stay one night? Prospective observational study of enhanced recovery in elderly patients
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ORIGINAL ARTICLE
Why should you stay one night? Prospective observational study of enhanced recovery in elderly patients Gabriele Melegari1 · Giovanna Albertini1 · Andrea Romani2 · Silvio Malaguti3 · Francesca Traccitto2 · Enrico Giuliani4 · Gian Maria Cavallini5 · Elisabetta Bertellini1 · Alberto Barbieri3 Received: 24 May 2020 / Accepted: 19 August 2020 © Springer Nature Switzerland AG 2020
Abstract Background Delirium is a severe condition that can arise in many contexts during hospitalization. The aim of this research was to measure the incidence of postoperative delirium in patients aged 75 years or older, with the exclusion of those with preexisting neurocognitive disorders (NCD), who underwent fast-track, moderate surgery. Methods We conducted a prospective cohort study with patients ≥ 75 years of age who were eligible for fast-track, moderate surgery, without severe dementia, with a planned hospitalization of 24 h and with a physical status varying from very fit to vulnerable. The 4-item confusion assessment method (CAM4) was used to measure delirium. Results Of the 209 eligible patients, 195 subjects were enrolled in the study. The percentage of the population with a CAM4 score above 0 before surgery was 2.56%; after surgery, the percentage was 10.25%; and on the following day, the percentage was 4.61%. There was a statistically significant difference in the CAM4 scores between immediately after surgery and at 24 h after surgery (p = 0.0172). Conclusion The data from this study support an enhanced recovery approach for elderly patients, in which after a minor surgical procedure with anaesthesia, a recovery period of one night in the hospital can contribute to normalizing the CAM4 score and reducing the incidence of delirium. Keywords Delirium · Perioperative management · Surgery · Elderly patients
Introduction The Italian Institute of Statistics (ISTAT) has periodically estimated the risk and cause of death in the Italian population, led economic forecasts, and measured population changes; the ISTAT recently reported a life expectancy of * Gabriele Melegari [email protected] 1
Anaesthesia and Intensive Care, Policlinico Teaching Hospital, Azienda Ospedaliero-Universitaria di Modena, via del Pozzo 71, 41124 Modena, MO, Italy
2
MD Lt, Italian Army, Rome, Italy
3
School of Anaesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy
4
Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
5
Department of Head‑Neck Surgery, Policlinico Teaching Hospital, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
80.5 years for males and 85 for females [1, 2], placing Italy in the second position in terms of longevity worldwide, preceded only by Japan. Although the quality of life in older people suggests that the cutoff age for the definition of the elderly population should change from 65 to 75 years, the rate of hospitalization in the elderly population is increasing, as demonstrated in sev
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