Substance Use Related Postoperative Delirium: A Classification, Clinical and Comparative Analysis

Advances in medical science and technology enable more Veterans of all ages to choose surgical interventions to treat diseases, relieve pain, regain physical functionality, and to enrich their quality of life. Surgery, however, brings the risk of postoperative delirium, a common complication of surgery. Postoperative delirium is a multifactorial syndrome that appears to be transient but sustains deleterious effects long after its resolution. Much work has been done to understand the pathophysiology of this syndrome and to find efficacious means of prevention and management. This dissertation presents a compendium of three manuscripts related to the recognition, documentation and the association of postoperative delirium with poor outcomes among Veterans, with a particular interest in those with a substance use disorder and the use of psychotropic medications. The first manuscript is a review of systematic reviews, seeking consensus on the prevention of postoperative delirium. A consensus message is challenging for a syndrome with an unresolved pathophysiology. The second manuscript is a qualitative study, exploring the perspectives of stakeholder providers, regarding the documentation of postoperative delirium in the electronic medical records. The non-recognition and under-documentation of POD present a significant barrier to establishing a baseline for the at-risk population. The third manuscript reports the results of a classification and clinical analysis of substance use related postoperative delirium. Using chart reviews to establish a baseline of incidence for postoperative delirium in our local VA, and explored the associations that might be contributory to the poor outcomes attendant to this syndrome. These investigations are preliminary to proposing hypotheses for future research to investigate interventions for the prevention, management, and treatment of postoperative delirium