Title

Postoperative Delirium in the Colorectal Surgical Population

Date of Award

4-2007

Embargo Period

4-2007

Degree Type

Thesis

Degree Name

Master of Nursing MNurs

First Advisor

Professor Jane Stein-Parbury

Second Advisor

Associate Professor Robyn Gallagher

Abstract

Delirium is the clinical diagnosis of an acute confusional state, characterised by impaired cognition, fluctuating levels of consciousness, altered psychomotor activity, and a disturbed sleep-wake cycle. Delirium is recognised as a common and serious problem for older hospitalised patients and is associated with longer, more costly hospitalisations, increased rates of nursing home placement, functional decline, rehabilitation needs, home healthcare, and caregiver burden. Surgery is a known risk factor for the development of delirium and with an aging, sicker population undergoing surgery, postoperative delirium (POD) is emerging as a frequent complication. POD is a potentially preventable and reversible condition, therefore early detection and identification of factors contributing to the development of POD, is one of the most important current issues in surgical nursing care. Because POD is not a naturally occurring illness, its study must occur within the context of specific populations. POD has not previously been investigated in the colorectal surgical population.

This study investigated the prevalence and incidence of POD in a colorectal surgical sample (n=118) using a validated delirium diagnostic instrument applied daily for three days postoperatively. Numerous other data were collected during the study period in order to characterise the sample and identify predictors for POD development in colorectal surgical patients.

The sample was about half women (54.2%) with a mean age of 71.81 years. Most participants (64.4%) were married or in de-facto relationships. Many of the participants had other conditions. Most frequently, these were hypertension (56.8%), arthritis (38.1%) and hypercholesterolemia (36.4%). One in five participants (21.1%) had five or more concomitant conditions. In addition to these concomitant conditions, many participants had impaired vision (48.3%). Few participants were current smokers (14.4%), but one in five (20.3%) exceeded daily alcohol intake guidelines.

These participants were assessed once daily for three days. The overall prevalence of POD was 34.7% with the incidence of POD within the first 24 hours 21.2%. Throughout the study, new cases of POD continued to be identified each day with a small number of participants (6.8%) having POD on all three postoperative days. Whilst the number of new cases of POD decreased each day, the daily POD incidence did not markedly decline throughout the study.

Several pre-existing characteristics were found to differentiate those who developed POD from those who did not. For POD that developed in the first 24 hours (POD One), these characteristics were being unmarried and, hospitalized and given intravenous (IV) hydration on the day prior to surgery and for POD at any time in the first 72 hours (POD Ever) they were older age, being male and requiring a HDU admission postoperatively.

Comments

Master of Nursing (MNurs) Thesis. University of Technology, Sydney

Staff and Students of Avondale College may access a print copy of this thesis from Avondale College Library (617.554701 MAN)

At the time of writing Linda Thomson Mangnall was affiliated with Avondale College

Recommended Citation

Thomson Mangnall, L. J. (2007). Postoperative delirium in the colorectal surgical population (Master's thesis). University of Technology, Sydney, Australia.

Please refer to publisher version or contact the library.

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