The effects of elective aortic repair, colorectal cancer surgery and subsequent postoperative delirium on long-term quality of life, cognitive functioning and depressive symptoms in older patients

Ties L Janssen*, Jolanda de Vries, Paul Lodder, Miriam C Faes, Gwan H Ho, Paul D Gobardhan, Lijckle van der Laan

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Objectives: 

This study aimed to demonstrate the impact of elective major abdominal surgery and subsequent postoperative delirium on quality of life (QOL; primary outcome), cognitive functioning and depressive symptoms (secondary outcomes) in older surgical patients.

Method: 

A single-centre, longitudinal prospective cohort study was conducted between November 2015 and June 2018, including patients ≥70 years old who underwent surgery for colorectal cancer or an abdominal aortic aneurysm. They were followed-up at discharge and at 6 and 12 months postoperatively until June 2019. QOL was assessed with the World Health Organization Quality of Life-BREF questionnaire (WHOQOL-BREF). Cognitive functioning was measured with the Mini-Mental State Examination and depressive symptoms with the CES-D 16.

Results: 

In all patients (n = 265), physical and psychological health were significantly lower at discharge compared to baseline (p < 0.001 for both domains). Physical health restored after 6 months, but psychological health remained decreased for the complete study period. Psychological, social and environmental QOL were significantly worse in patients with delirium compared to patients without (p = 0.001, p = 0.006 and p = 0.001 respectively). The cognitive functioning score was significantly lower at baseline in patients with delirium compared to those without (p = 0.006). Patients with delirium had a significantly higher CES-D 16 score compared to those without after 12 months (p = 0.027).

Conclusion: 

Physical and psychological QOL were decreased in the early postoperative period. While physical health was restored after 6 and 12 months, psychological health remained decreased. After 12 months, postoperative delirium resulted in worse psychological, social and environmental QOL and more depressive symptoms. Decreased cognitive functioning may be a risk factor for delirium.

Original languageEnglish
Number of pages10
JournalAging & Mental Health
DOIs
Publication statusE-pub ahead of print - 2020

Keywords

  • ANEURYSMS
  • DEMENTIA
  • DISTRESS
  • ELDERLY-PATIENTS
  • MORTALITY
  • OUTCOMES
  • RECALL
  • RISK
  • SYMPTOMATOLOGY
  • cognitive functioning
  • elective surgery
  • older patients
  • postoperative delirium
  • quality of life

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