Up to 40% of older surgery patients develop postoperative delirium, a syndrome of confusion that typically occurs in the first few days after surgery. Postoperative delirium is associated with longer hospitalizations, significant distress, and major postoperative complications, but its underlying causes have been elusive.
"These findings are significant because we now have a roadmap to tackle a problem that impacts millions ofin the U.S. every year," said Michael Devinney, M.D., Ph.D., corresponding author of the study, and assistant professor in the Department of Anesthesiology at Duke University School of Medicine.
To arrive at these findings, scientists examined more than 200 patients, ages 60 or older, before and after non-cardiac and non-neurological surgeries. To understand changes in the blood-brain barrier's permeability, they collected spinal fluid andbefore surgery and 24 hours after, measuring the ratio of a protein called albumin as an indicator of the barrier's fluidity.
They found increased blood-brain barrier permeability is associated with greater delirium rates and longer hospital stays among all patients, suggesting that the permeability increase is a response to surgery. They also found that those with lower cognitive abilities experienced increased delirium rates. However, the lower performance on cognitive testing affected delirium risk separate from postoperative blood-brain barrier opening.
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