Take into Account Postoperative Cognitive Dysfunction
The article successfully combines the topic of hospital treatment with the risk of developing postoperative delirium (POD) (1). The authors point out that rather than being a transient disease (“Durchgangssyndrom”, transitory psychotic syndrome), POD is associated with increased mortality, prolonged hospitalization, and poorer outcome. The article advocates structured and consistent implementation of validated testing procedures as well as preventive and therapeutic approaches with non-pharmacological procedures. The authors conclude that adequate prevention of delirium, timely diagnosis, identification of precipitating factors, and rapid initiation of causal treatments are critical to the success of the treatment (1).
Our working group on the prevention of POD wishes to add that postoperative cognitive dysfunction (POCD) can also trigger persistent cognitive dysfunction after delirium (2). POCD can last up to two years postoperatively. POD is therefore an important risk factor for POCD. The preoperative presence of somatic diseases and subclinical delirious symptoms is an important risk factor for POD and POCD. Its prevention requires subclinical delirious symptoms and somatic diseases to be identified preoperatively, and then to implement compensatory measures. Our own investigations have shown this (3). For instance, one important somatic disease was preoperative urinary tract infection. However, prevention of delirium in the general hospital is only one aspect of adequately caring for people with cognitive impairment in the general hospital. Consistent gerontopsychiatric care for nursing home residents with dementia can reduce the risks of re-hospitalization and of delirium (4). In addition to delirium prevention in hospital, outpatient care for patients with dementia must also be strengthened as an interface to the hospital. The present work encourages this.
Prof. Dr. med. Torsten Kratz
Prof. Dr. med. Albert Diefenbacher, MBA
Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH,
Abteilung für Psychiatrie, Psychotherapie und Psychosomatik
Conflict of interest statement
The authors declare that no conflict of interest exists.
|1.||Zoremba N, Coburn M: Acute confusional states in hospital. Dtsch Arztebl Int 2019; 116: 101–6 VOLLTEXT|
|2.||Kratz T, Diefenbacher A: Kognitive Akut- und Langzeitfolgen intensivmedizinischer Behandlung. Nervenarzt 2016; 87: 246–52 CrossRef MEDLINE|
|3.||Kratz T, Heinrich M, Schlauß E, Diefenbachern A: The prevention of postoperative confusion—a prospective intervention with psychogeriatric liaison on surgical wards in a general hospital. Dtsch Arztebl Int 2015; 112: 289–96 VOLLTEXT|
|4.||Kirchen-Peters S, Diefenbacher A: Gerontopsychiatrische Konsiliar- und Liaisondienste – eine Antwort auf die Herausforderung Demenz? Z Gerontol Geriatr 2014; 47: 595–604 CrossRef MEDLINE|