Postoperative delirium: cognitive prehabilitation lowers risk

  • Humeidan ML & al.
  • JAMA Surg
  • 11 Nov 2020

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • Older adults undergoing major surgery were less likely to develop postoperative delirium if they performed brain exercises in the weeks leading up to surgery.

Why this matters

  • Postoperative delirium is common in this age group, and it slows recovery and increases morbidity and mortality.

Key results

  • 97% of intervention patients completed some brain exercise (median, 4.6 hours out of goal of 10 hours).
  • Postoperative delirium intervention group vs control group:
    • Intention-to-treat analysis:
      • Incidence, 14.4% vs 23.0% (P=.08).
      • Multivariate relative risk, 0.58 (P=.047).
    • On-treatment analysis:
      • Incidence, 13.2% vs 23.0% (P=.04).
  • Among patients with delirium, groups were similar for:
    • Onset day.
    • Delirium duration.
    • Total delirium-positive days.

Study design

  • US randomized controlled trial (Neurobics trial) among 268 adults aged ≥60 (median, 67) years:
    • Normal baseline cognition.
    • Undergoing major, noncardiac, nonneurological surgery with general anesthesia.
    • Expected hospital stay of ≥72 hours.
  • Randomization: normal daily activity (control group) vs electronic, tablet-based preoperative cognitive exercise targeting memory, speed, attention, flexibility, problem-solving functions (intervention).
  • Main outcome: delirium between postoperative day 0 to day 7 or discharge.
  • Funding: Ohio State University Department of Anesthesiology and Neuroscience Research Institute.

Limitations

  • Completed hours of brain exercise estimated from number of games played.
  • Unmeasured and residual confounding.
  • Unknown generalizability.