Postoperative Delirium in a Urogynecologic and Gynecologic Population

Objectives: Delirium is a common postoperative complication. Limited data exists regarding the rates and predictors of postoperative delirium in urogynecologic and gynecologic populations. The objectives of this study are to determine the incidence and predictors of postoperative delirium following urogynecologic and benign gynecologic surgery.

Methods: This is a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. We selected patients from the 2021 dataset who have undergone benign gynecologic and urogynecologic outpatient surgeries and compared preoperative/operative factors and postoperative outcomes between those patients with and without postoperative delirium. We performed a subgroup analysis on the urogynecology and gynecology groups.

Results: Of 3,648 gynecologic or urogynecologic cases, 1,300 (35.6%) patients were screened for delirium, and 2,348 (64.4%) were not. Of the 1,300 patients screened for delirium, 79 (6.1%) screened positive for delirium. Patients in the combined urogynecologic and gynecologic populations with postoperative delirium were older (80 (IQR 77, 83) vs 78 (IQR 76, 82), p = 0.03) and less likely to come from home prior to surgery (94% vs 99%, p< 0.001). Patients with delirium are less likely to be independent prior to surgery (86% vs 97%, p< 0.001), and more likely to have a history of dementia (19% vs 4%, p< 0.001). Patients with delirium had longer hospital stays (37% vs 15% with 3+ days, p< 0.001), were less likely to be independent at discharge (69% vs 91%, p< 0.001) and more likely to go home with healthcare services (21% vs 11%, p=0.02). Patients with postoperative dementia had higher rates of unplanned reoperations (6.3% vs 1.2%, p= < 0.01) and readmission (10% vs 5%, p< 0.001). See Table 1 for details.
The rate of delirium was 6.5% in urogynecologic patients screened for delirium and 5.7% in the screened gynecologic population. Compared to screened gynecologic patients, screened urogynecologic patients had fewer pre-operative risk factors and were more likely to be independent on discharge.
Table 1 Legend: Number (%) or median (Interquartile Range)

Conclusions: Our study shows that of those urogynecologic or gynecologic patients screened for delirium, 6.1% screened positive. A positive delirium screen is associated with older patients with more pre-operative risk factors. Patients with delirium were also less likely to be discharged home and more likely to have unplanned readmission or re-operations.