Letter to the Editor
The Occurrence of Post-Operative Delirium in Brazil
Pedro Vieira da Silva Magalhães, Cibele Vargas da Silva
Catholic University of Pelotas, School of Medicine and School of Psychology - Pelotas/RS, Brazil
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Alberto Cavallasca, María del Rosario Maliandi, Gustavo Guillermo Nasswetter" "autores" => array:4 [ 0 => array:2 [ "nombre" => "María José López" "apellidos" => "Meiller" ] 1 => array:2 [ "nombre" => "Javier Alberto" "apellidos" => "Cavallasca" ] 2 => array:2 [ "nombre" => "María del Rosario" "apellidos" => "Maliandi" ] 3 => array:2 [ "nombre" => "Gustavo Guillermo" "apellidos" => "Nasswetter" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222028289?idApp=UINPBA00004N" "url" => "/18075932/0000006300000002/v1_202212060806/S1807593222028289/v1_202212060806/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1807593222028265" "issn" => "18075932" "doi" => "10.1590/S1807-59322008000200016" "estado" => "S300" "fechaPublicacion" => "2008-04-01" "aid" => "2826" "copyright" => "CLINICS" "documento" => "simple-article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/" "subdocumento" => "cor" "cita" => "Clinics. 2008;63:267-70" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Necrolytic Migratory Erythema Associated with Glucagonoma: A Report of 2 Cases" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "267" "paginaFinal" => "270" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig3" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 792 "Ancho" => 534 "Tamanyo" => 85084 ] ] "descripcion" => array:1 [ "en" => "<p id="spara30" class="elsevierStyleSimplePara elsevierViewall">Erythematous scaling and crusted plaques, with exulceration on the edges of the lesions, involving the groin and genital areas</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Renata Câmara Teixeira, Marcello Menta Simonsen Nico, Anelise Casillo Ghideti" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Renata Câmara" "apellidos" => "Teixeira" ] 1 => array:2 [ "nombre" => "Marcello Menta Simonsen" "apellidos" => "Nico" ] 2 => array:2 [ "nombre" => "Anelise Casillo" "apellidos" => "Ghideti" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222028265?idApp=UINPBA00004N" "url" => "/18075932/0000006300000002/v1_202212060806/S1807593222028265/v1_202212060806/en/main.assets" ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "The Occurrence of Post-Operative Delirium in Brazil" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "271" "paginaFinal" => "272" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Pedro Vieira da Silva Magalhães, Cibele Vargas da Silva" "autores" => array:2 [ 0 => array:3 [ "nombre" => "Pedro Vieira da Silva" "apellidos" => "Magalhães" "email" => array:1 [ 0 => "maga@ufpel.tche.br" ] ] 1 => array:2 [ "nombre" => "Cibele Vargas da" "apellidos" => "Silva" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Catholic University of Pelotas, School of Medicine and School of Psychology - Pelotas/RS, Brazil" "identificador" => "af1" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="para10" class="elsevierStylePara elsevierViewall">Delirium, an acute neurobehavioral syndrome associated with disturbances in consciousness and attention, is a commonly presenting complication of the post-operative period in international studies. In a landmark review,<a class="elsevierStyleCrossRef" href="#bib1">1</a> the median incidence of postoperative delirium was 36.8%, with advancing age and pre-operative cognitive deficit being uniform findings. Recognition of delirium is vital, as it may be the first manifestation of an underlying condition or medication reaction; increase in hospitalization length, costs, mortality and the progression to dementia are possible outcomes of failing to diagnose this condition.<a class="elsevierStyleCrossRef" href="#bib2">2</a> Since pre-operative, intra-operative and postoperative circumstances may act in concert with personal predisposing characteristics<a class="elsevierStyleCrossRef" href="#bib3">3</a> to cause delirium, extrapolation of global figures to Brazil is questionable and the determination of local occurrence rates, of paramount importance for the preparation of health teams responsible for the care of such patients.</p><p id="para20" class="elsevierStylePara elsevierViewall">In an attempt to verify the occurrence of and factors associated with postoperative delirium in relevant Brazilian studies, we systematically searched, up to July 2007, Medline, PsychINFO, Biological Abstracts, Lilacs, Science Direct, ISI/Web of Science and Banco de Teses da CAPES. Search terms used were “post-operative delirium”, “delirium”, “surgery”, combined with “Brazil”, “Brasil”, and “Portuguese”. We followed Dyer et al<a class="elsevierStyleCrossRef" href="#bib1">1</a> regarding study selection, and studies could be included if they were primary data collection studies, the population included adults or elderly, delirium was evaluated prospectively and patients evaluated at least three times during the first postoperative week, patients were selected consecutively or randomly and a valid definition of delirium was employed.</p><p id="para30" class="elsevierStylePara elsevierViewall">Although we did locate 52 potentially relevant studies, only two fulfilled minimal inclusion criteria. The largest and most rigorous study to date<a class="elsevierStyleCrossRef" href="#bib4">4</a> assessed patients after cardiac surgery, which is consistent with international studies; using DSM-IV criteria, Santos et al. found an incidence of delirium of 33.6% among 220 elderly randomly selected after coronary artery bypass. In the other study, the incidence of delirium, evaluated by the Confusion Assessment Method, was 12.5% in elderly submitted to orthopedic surgery for hip fractures.<a class="elsevierStyleCrossRef" href="#bib5">5</a> Pre-surgical functional impairment was more commonly present in delirium patients. In both studies hospitalization was longer in those affected.</p><p id="para40" class="elsevierStylePara elsevierViewall">Identification of post-operative delirium is essential in clinical practice. With the exception of coronary artery bypass graft surgery and orthopedic fractures, which are likely to represent a minority of the surgeries performed in our country (6), reliable incidence rates for the commonest surgical interventions performed in Brazil are nonexistent. As such, training of health teams responsible for the detection of this major clinical event is likely to be inadequate, potentially leading to excessive patient morbidity and mortality, as well as increasing overall costs and hospital stays. Studies designed to detect the incidence of and risk factors for postoperative delirium, adequately powered to evaluate a number of variables of interest (e.g. age, pre-surgical cognitive status, type of intervention), with a valid definition of delirium in a population representative of those undergoing surgical procedures in Brazil are greatly needed.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec10" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postoperative delirium. A review of 80 primary data-collection studies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ CB Dyer \n \t\t\t\t\t\t\t\t """ 1 => """ CM Ashton \n \t\t\t\t\t\t\t\t """ 2 => """ TA Teasdale \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archinte.155.5.461" "Revista" => array:6 [ "tituloSerie" => "Arch Intern Med" "fecha" => "1995" "volumen" => "155" "paginaInicial" => "461" "paginaFinal" => "465" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7864702" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Post-operative delirium is associated with poor cognitive outcome and dementia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ P Wacker \n \t\t\t\t\t\t\t\t """ 1 => """ PV Nunes \n \t\t\t\t\t\t\t\t """ 2 => """ H Cabrita \n \t\t\t\t\t\t\t\t """ 3 => """ OV Forlenza \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000091022" "Revista" => array:6 [ "tituloSerie" => "Dement Geriatr Cogn Disord" "fecha" => "2006" "volumen" => "21" "paginaInicial" => "221" "paginaFinal" => "227" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16428883" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postoperative delirium" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ RC van der Mast \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000017178" "Revista" => array:6 [ "tituloSerie" => "Dement Geriatr Cogn Disord" "fecha" => "1999" "volumen" => "10" "paginaInicial" => "401" "paginaFinal" => "405" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10473947" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors for delirium in the elderly after coronary artery bypass graft surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ FS Santos \n \t\t\t\t\t\t\t\t """ 1 => """ IT Velasco \n \t\t\t\t\t\t\t\t """ 2 => """ R Fraguas Jr \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int Psychogeriatr" "fecha" => "2004" "volumen" => "16" "paginaInicial" => "175" "paginaFinal" => "193" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15318763" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delirium in elderly individuals with hip fracture: causes, incidence, prevalence, and risk factors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ ME Furlaneto \n \t\t\t\t\t\t\t\t """ 1 => """ LE Garcez-Leme \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/s1807-59322006000100007" "Revista" => array:6 [ "tituloSerie" => "Clinics" "fecha" => "2006" "volumen" => "61" "paginaInicial" => "35" "paginaFinal" => "40" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16532223" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A incidência de cirurgias na população de Ribeirão Preto, SP, Brasil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ MB Barros \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/s0034-89101982000500002" "Revista" => array:6 [ "tituloSerie" => "Rev Saude Publica" "fecha" => "1982" "volumen" => "16" "paginaInicial" => "268" "paginaFinal" => "281" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7167723" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/18075932/0000006300000002/v1_202212060806/S1807593222028277/v1_202212060806/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/18075932/0000006300000002/v1_202212060806/S1807593222028277/v1_202212060806/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222028277?idApp=UINPBA00004N" ]
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