Parkinson’s patients at greater risk of delirium after surgery: US study

They also tend to have longer hospital stays and higher medical costs

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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People with Parkinson’s disease are nearly twice as likely to experience delirium — acute confusion and difficulty with attention — after surgery.

They also tend to have longer hospital stays and higher medical costs following surgery, according to a study, “Association of Postoperative Delirium and Parkinson Disease After Common United States Surgical Procedures,” which was published in the Journal of Surgical Research.

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Postoperative delirium is extreme confusion upon waking from surgery

Postoperative delirium is when a patient feels extremely confused and disoriented when they wake up after an operation. A team of U.S. researchers conducted a study to assess whether people diagnosed with Parkinson’s are more likely to experience postoperative delirium, compared to those without the disease.

“It is important to better understand the risks of postoperative delirium following common surgical procedures, so that appropriate preventive and management strategies can be employed to mitigate its effects,” the researchers wrote.

Using a large national database, the researchers examined outcomes following common surgeries for 35,743 people living with Parkinson’s and an equal number of people without the disease.

Both groups were matched according to factors like age, sex, co-occurring health problems, and the presence of dementia. About three-quarters of the patients were white, and over 90% were insured through Medicare. The most common surgeries were hip and knee replacements.

Postoperative delirium was documented for 4.2% of the Parkinson’s patients, compared to 2.3% of those without Parkinson’s. Statistical models showed that the risk of this complication was increased by 88% in people with Parkinson’s.

The researchers noted that, since delirium is not always recorded in medical databases, these rates are likely a “gross underestimation” — but this underestimation would be expected to apply equally for people with or without the disease, so the comparison between the two groups should be reasonably accurate.

The increased risk of postoperative delirium among Parkinson’s patients was similar regardless of the type of surgery, though the risk was highest with spinal fusion surgery — Parkinson’s patients undergoing spinal fusion were nearly three times more likely to experience delirium upon waking.

Spinal fusion surgery is a procedure where two or more vertebrae in the spine are joined together to stabilize the spine and alleviate certain back problems.

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Parkinson’s is an ‘independent risk factor for postoperative delirium’

“Our study found that [Parkinson’s] is an important independent risk factor for postoperative delirium across all of the ten most common operative procedures in the US, with a nearly twofold increased odds of delirium,” the scientists concluded.

They noted that further studies will be needed to understand exactly why this complication is more common among Parkinson’s patients, but they offered several potential explanations, including issues with getting medications that usually help control disease symptoms while in hospital for surgery. In a surgical setting, people with Parkinson’s are often managed by clinicians with limited expertise in the disease, according to the researchers.

“With increasing focus on patient satisfaction and patient-centered care, it is important to carefully consider the appropriate inpatient management of those [Parkinson’s], including advanced planning for medication regimens, consulting services, and early rehabilitative therapies,” the scientists wrote.

“A multidisciplinary team comprised of health professionals, including neurologists, geriatricians, and physical therapists, should be involved in postoperative management to reduce complications and maximize patient outcome.”

Mortality rates following surgery were similar in both groups but Parkinson’s patients tended to have longer hospital stays and higher medical costs associated with surgery (median $19,182 vs. $18,784).

The researchers noted that, due to limitations of the database used, they were able to examine only the frequency of postoperative delirium, and could not assess its timing or severity. They also were unable to specifically assess whether changes in medication may have contributed to delirium in some patients.