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Presurgical thalamus volume in postoperative delirium: a longitudinal observational cohort study in older patients

Item Type:Article
Title:Presurgical thalamus volume in postoperative delirium: a longitudinal observational cohort study in older patients
Creators Name:Fislage, M. and Feinkohl, I. and Pischon, T. and Spies, C.D. and Borchers, F. and Winterer, G. and Zacharias, N.
Abstract:BACKGROUND: Previous studies suggest a role of the thalamus in cognitive function, while others implicate it as a central effect site of anesthetics. Yet, its role in postoperative neurocognition in the aging brain remains uncertain. We used presurgical thalamic volume as a functional indicator and determined its association with postoperative delirium (POD). METHODS: For this study, 301 older adults (aged ≥65) without dementia and scheduled for surgery were enrolled. Before surgery, participants underwent magnetic resonance imaging (MRI). Thalamus volume was segmented using Freesurfer (Version 5.3.). Participants were screened for POD twice a day until discharge or for a maximum of 7 days. POD was defined as a positive screening on ≥1 of 4 validated instruments: Richmond Agitation Sedation Scale (RASS), Nursing Delirium Screening Scale (Nu-DESC), Confusion Assessment Method (CAM), and Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) score. A logistic regression associated thalamus volume with POD with adjustment for age, global brain atrophy, and physical status according to the American Society of Anesthesiologists (ASA) classification. RESULTS: In this cohort, 44 participants (14.6%) were diagnosed with POD. Independently of age, global brain atrophy, and physical status score, a higher preoperative thalamus volume was associated with a reduced odds of POD (odds ratio per 1-cm3 increment; 0.73 [95% confidence interval (CI), 0.58-0.92]; P = .008). CONCLUSIONS: A larger thalamus volume was associated with reduced odds of POD. Thus, the thalamus marks a region of interest in POD in the aging brain. These findings may help to understand the neuronal basis of POD.
Keywords:Atrophy, Cohort Studies, Delirium, Intensive Care Units, Postoperative Complications, Thalamus / Diagnostic Imaging
Source:Anesthesia and Analgesia
ISSN:0003-2999
Publisher:International Anesthesia Research Society (IARS)
Volume:135
Number:1
Page Range:136-142
Date:July 2022
Official Publication:https://doi.org/10.1213/ane.0000000000005987
PubMed:View item in PubMed

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