Postoperative delirium in ophthalmic surgery: Single-center cohort comparative study

Abstract

Objective. To study risk factors in the development of postoperative delirium in ophthalmic patients and to develop pre-operative preventive measures. Materials and methods. A non-randomized cohort prospective observational study was carried out. The control was a retrospective group of patients (medical records) with a diagnosis of senile cataract treated at the Vladivostok Clinical Hospital No 2. from 2020 to 2024. Results. 9304 cataract operations were performed between 2020 and 2024. Of this number, 41 (0.44%) cases of postoperative delirium (PD) were identified. Among them, 8 (0.09%) patients were transferred to an intensive care unit, taking into account the hypertensive type of PD. The patient age ranged from 68.95 ± 11.85 to 70.7 ± 8.85 years. The Charlson Comorbidity Index ranged from 7.5 ± 2.15 to 8.3 ± 1.85, with a prevalence of chronic heart failure, acute cerebral circulation disorder in the anamnesis, chronic obstructive pulmonary disease, smoking, and alcohol abuse. Following the comparison with the control group, an algorithm for managing ophthalmic surgery patients was developed. This algorithm optimizes premedication measures and excludes the use of drugs that may trigger PD. Conclusion. The research has identified demographic (age), anamnestic (comorbidities and harmful habits), clinical (use of narcotic analgesic, benzodiazepine, and anticholinergic drugs) risk factors in PD development. Optimization of the preparation of ophthalmic surgery patients and exclusion of PD trigger drugs at the anaesthetization stage reduce the frequency of PD by 8.7 times.