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Studies on delirium and associated cognitive and functional decline in older surgical patients

The time is now to improve perioperative care and outcomes
PhD ceremony:S.J.E. Beishuizen
When:October 28, 2020
Supervisors:prof. dr. B.C. van Munster, prof. dr. S.E.J.A. (Sophia) de Rooij
Where:Academy building RUG
Faculty:Medical Sciences / UMCG

Delirium is a syndrome that is frequently encountered by older hospitalized patients. The acute symptoms of confusion, agitation and drowsiness often subdue within days, but it is also known to negatively impact cognitive and functional performance over a longer period of time. As delirium is often observed after surgery, this might be an important factor to consider when deciding whether or not to perform surgery on an older patient. In this thesis we investigated several factors that show a temporal relation with delirium in the perioperative period, and the long term effects of delirium on cognitive and functional performance after surgery. We studied cohorts of older patients undergoing surgery for hip fracture or aortic stenosis. We found that it was difficult to learn more about the hypothesis of brain damage occurring during delirium by studying a biomarker, because of the heterogeneity of delirium itself, and the many factors that can both precipitate delirium and are of influence on the level of the biomarker we studied. Secondly, it appeared that a blood transfusion might serve as a preventive measure for delirium in patients with anemia after surgery. Lastly our findings underline that delirium occurring in the perioperative period has long lasting effects on cognitive and functional performance, and that this effect is partly predictable before surgery. Our findings can aid in the process of shared decision making that is conducted by clinicians and patients to establish the need for surgery, and might aid in improving outcomes for patients.