Clinical Characteristics of Postoperative Delirium after Urological Surgery / 대한비뇨기과학회지

ABSTRACT

PURPOSE: Delirium in the elderly is common in the postoperative period but there are only few reports on detailed studies of this condition. Number of urologic patients with postoperative delirium was increas ed in our hospital for recent 24 months. The clinical characteristics of patients with postoperative delirium was analyzed retrospectively. MATERIALS AND METHODS: We selected the patients with postoperative delirium from 1010 patients who had undergone urological surgery under general or spinal anesthesia in the period from Jan. 1997 to Dec. 1999. Diagnosis of postoperative delirium was established with Diagnostic and Statistical Manual of Mental Disorders(DAM-III-R) by psychiatric clinicians. Onset and recovery of symptoms, risk factors, previous psychiatric clinicians. Onset and recovery of symptoms, risk factors, previous psychiatric disorder, relationship with anesthesia, drugs, and surgical procedures, concomittant medical conditions, and complications were retrospectively reviewed. RESULTS: Postoperative delirium was observed in 13 patients (1.3%). All patients were male and mean age was 70.4 years (46-86 years). Surgical procedures included TURP(8 patients), cystectomy (3 patients), nephroureterectomy (1 patient), and bladder rupture repair (1 patient). Delirium became apparent between one day and two days after the operation (mean 32.2 hours) and lasted for up to 7 days (mean 53 hours). Several factors such as older age (>65 years), male patient, longterm medication, past history of CVA, memory impairment, hearing difficulty, traumatic brain contusion, and obsessive personality were thought to be risk factors of postoperative delirium. Treatment with Haloperidol(R) intramuscular injection (2.5-5mg, every 30 minutes, 2-4 times until symptom resolution was achieved) with or without Ativan(R) intravenous injection (2mg) were effective. Complete symptom recovery was seen in 92.3% (12/13) of patients. One patient (7.7%) with previous history of dementia had persistent memory disturbance and disorientation during follow-up periods. CONCLUSIONS: Generally, postoperative delirium is an acute transient confusional state without considerable sequeles. Treatment is sedation and prevention of inadvertent accident associated with confusional state. Urologic surgeon must be attentive to the development of this illness especially when high risk factors were present.