Delirium in the post-operative setting is common and is associated with significant morbidity, mortality, and cost. Elderly patients are at a particulary high risk for postoperative delirium, and as the US population ages, more elderly patients will present for surgery. Long-term sequelae of postoperative delirium include increased mortality, decreased cognitive function, decreased functional outcomes, and increased hospital costs. Although many factors may contribute to post-operative delirium, inadequate intraoperative cerebral blood flow (CBF) may be an important modifiable cause. Elderly patients, with high rates of hypertension and cerebral vascular disease, may require higher than expected blood pressures to maintain adequate CBF. Currently, anesthesiologists maintain blood pressure above empiric targets, with the assumption that CBF is adequate. However, no routine clinical monitor is currently used to directly measure CBF, and so elderly patients are at high risk of cerebral hypoperfusion. Recently, novel technology has been developed to assess the adequacy of CBF in real time, in individual patients. By monitoring individual patients at high ris for postoperative delirium, a potential association could be identified between inadequate CBF and postoperative delirium. This observational study will enroll 100 patients greater than 70 years old undergoing spine surgery at Johns Hopkins Hospital. Each patient will undergo rigorous preoperative cognitive testing. Intraoperatively, the adequacy of CBF will be assessed in real time. Postoperatively, the incidence of delirium and long-term cognitive dysfunction will be evaluated.
The specific aims of this project are: 1. To assess whether the duration of time during surgery that a patient's blood pressures is outside the limits of CBF autoregulation is associated with postoperative delirium. 2. To assess whether the development of postoperative delirium is associated with cognitive dysfunction 3 to 6 weeks after spine surgery. The long-term objectives of this project are to reduce the incidence of postoperative delirium through monitoring of CBF, to predict the development of postoperative delirium, and to prevent cognitive decline that may result from delirium. If successful, this project will identify an important risk factor for postoperative delirium, that could be modified intraoperatively.
Postoperative delirium in the elderly is common and is associated with significant mortality and morbidity, including cognitive decline. This project will seek to identify a potentially modifiable risk factor for postoperative delirium. If successful, boh postoperative delirium and its long term sequelae in the elderly, including cognitive decline, could be prevented.
| Brown 4th, Charles H; LaFlam, Andrew; Max, Laura et al. (2016) Delirium After Spine Surgery in Older Adults: Incidence, Risk Factors, and Outcomes. J Am Geriatr Soc 64:2101-2108 |
| Brown 4th, Charles H; Max, Laura; LaFlam, Andrew et al. (2016) The Association Between Preoperative Frailty and Postoperative Delirium After Cardiac Surgery. Anesth Analg 123:430-5 |
| Brown 4th, Charles H; Laflam, Andrew; Max, Laura et al. (2016) The Impact of Delirium After Cardiac Surgical Procedures on Postoperative Resource Use. Ann Thorac Surg 101:1663-9 |
| Brown 4th, Charles H; Sharrett, A Richey; Coresh, Josef et al. (2015) Association of hospitalization with long-term cognitive and brain MRI changes in the ARIC cohort. Neurology 84:1443-53 |
| Brown 4th, Charles H; Morrissey, Candice; Ono, Masahiro et al. (2015) Impaired olfaction and risk of delirium or cognitive decline after cardiac surgery. J Am Geriatr Soc 63:16-23 |
| Brown 4th, Charles H; Faigle, Roland; Klinker, Lauren et al. (2015) The Association of Brain MRI Characteristics and Postoperative Delirium in Cardiac Surgery Patients. Clin Ther 37:2686-2699.e9 |
| Khan, Abid; Giri, Sumanprava; Wang, Yating et al. (2015) BEND3 represses rDNA transcription by stabilizing a NoRC component via USP21 deubiquitinase. Proc Natl Acad Sci U S A 112:8338-43 |
| Brown 4th, Charles H; Dowdy, David (2015) Risk factors for delirium: are systematic reviews enough?. Crit Care Med 43:232-3 |
| Brown 4th, Charles H; Grega, Maura; Selnes, Ola A et al. (2014) Length of red cell unit storage and risk for delirium after cardiac surgery. Anesth Analg 119:242-50 |
| Brown 4th, Charles H; Savage, William J; Masear, Courtney G et al. (2014) Odds of transfusion for older adults compared to younger adults undergoing surgery. Anesth Analg 118:1168-78 |
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