Older Patients With Greater Postoperative Pain More Likely to Have Delirium

In older adults undergoing spine surgery, postoperative delirium (POD) is associated with pain levels but not with opioid consumption, according to secondary analysis findings published in the Journal of Pain Research.

Age is the most notable risk factor for POD, which is associated with postoperative neurocognitive decline, loss of independence, and increased mortality. Previous research has suggested a link between preoperative opioid use and POD in those undergoing spine surgery. Investigators therefore examined the association between POD development and postoperative pain and opioid use, taking into account the patients’ preoperative opioid use status.

Investigators conducted a secondary analysis of a prospective, observational study of patients 70 years of age and older undergoing elective spine surgery at Brigham and Women’s Hospital in Boston between 2017 and 2018. The secondary analysis evaluated predictors for POD, which were determined by daily in-person interviews using the Confusion Assessment Method instrument. Pain was quantified using a 10-point Numerical Rating Scale (NRS). Among the 219 patients studied (mean age, 76 years),  57% were men, 27% took preoperative opioids, and 25% exhibited POD in the first 3 days following surgery.

The analysis found that patients taking opioids before surgery had higher maximum daily pain scores during the first 3 days after surgery (mean range, 6.8-7.2 points) than patients without preoperative opioid use (mean range, 5.6-6.1 points; all P <.01). Notably, the preoperative opioid users consumed around twice as many opioids than those without preoperative opioid use (mean range, 2.5-3.0 vs 1.3-1.5 morphine milligram equivalents (MME)/hr; all P <.001), respectively.

Patients with POD vs those without had higher maximum postoperative pain scores on day 1 (mean, 7.1 vs 6.1 points; P <.01), day 2 (mean, 6.8 vs 5.9 points; P =.02), and day 3 (mean, 6.6 vs 5.7 points; P =.01). No difference in opioid consumption was observed on the basis of POD status.

This study is limited by the fact that preoperative opioid doses and duration of postoperative opioid therapy were not evaluated.

The study authors concluded, “This study showed that POD was not significantly associated with postoperative opioid consumption, but instead was associated with greater postoperative pain, especially in patients who were taking opioids preoperatively.” Based on these findings, clinicians should consider older patients’ preoperative opioid use in determining perioperative analgesic management, the researchers added.

This article originally appeared on Clinical Pain Advisor