Frailty and Postoperative Delirium in Elderly patients Undergoing Elective Surgery: An Analytical Study

Abstract

Introduction
Postoperative delirium (POD) in geriatric patients significantly increases morbidity and mortality. Frailty predisposes patients to significant adverse postoperative outcomes. This study evaluates the occurrence of preoperative frailty using Edmonton Frail Scale (EFS) and its association with postoperative delirium in elderly patients.

Methods
An analytical cohort study was conducted among patients aged ≥ 65 undergoing elective non-cardiac surgery. Preoperative frailty, cognitive reserve and comorbidities were assessed with validated tools. Intraoperative variables including anesthesia type, surgery, surgical duration, intraoperative complications including hypotension were recorded. Postoperative delirium was assessed twice daily for 72 hours postoperatively using confusion assessment method (CAM). Unadjusted and multivariable logistic regression analyses were performed to identify independent risk factor and evaluate the association between frailty and delirium after adjusting for relevant covariates.

Results
The occurrence of delirium was 9.70%(16/165). Preoperative frailty was present in 55(33.33%) participants. Postoperative delirium was seen in 43.33% of moderate to severe frail group compared to 0.91% in the non-frail group (p <0.001). In the multivariable analysis, after adjustment for age and intraoperative hypotension, the odds of postoperative delirium increased about twofold for every one-point increase in Edmonton Frail Scale score (aOR 2.20; 95% CI 1.57-3.50, p <0.001). Intraoperative hypotension was another significant factor (aOR 12.88; 95% CI 2.66-77.58 p <0.002).

Conclusions
The preoperative frailty score and intraoperative hypotension were significant predictors of postoperative delirium. Implementing routine frailty screening and hemodynamic stability in frail elderly population are essential strategies to decrease the risk of postoperative delirium.