The effects of elective aortic repair, colorectal cancer surgery and subsequent postoperative delirium on long-term quality of life, cognitive functioning and depressive symptoms in older patients

Abstract

Objectives: This study aimed to demonstrate the impact of elective major abdominal surgery and subsequent postoperative delirium on quality of life (QOL; primary outcome), cognitive functioning and depressive symptoms (secondary outcomes) in older surgical patients.

Method: A single-centre, longitudinal prospective cohort study was conducted between November 2015 and June 2018, including patients ≥70 years old who underwent surgery for colorectal cancer or an abdominal aortic aneurysm. They were followed-up at discharge and at 6 and 12 months postoperatively until June 2019. QOL was assessed with the World Health Organization Quality of Life-BREF questionnaire (WHOQOL-BREF). Cognitive functioning was measured with the Mini-Mental State Examination and depressive symptoms with the CES-D 16.

Results: In all patients (n = 265), physical and psychological health were significantly lower at discharge compared to baseline (p < 0.001 for both domains). Physical health restored after 6 months, but psychological health remained decreased for the complete study period. Psychological, social and environmental QOL were significantly worse in patients with delirium compared to patients without (p = 0.001, p = 0.006 and p = 0.001 respectively). The cognitive functioning score was significantly lower at baseline in patients with delirium compared to those without (p = 0.006). Patients with delirium had a significantly higher CES-D 16 score compared to those without after 12 months (p = 0.027).

Conclusion: Physical and psychological QOL were decreased in the early postoperative period. While physical health was restored after 6 and 12 months, psychological health remained decreased. After 12 months, postoperative delirium resulted in worse psychological, social and environmental QOL and more depressive symptoms. Decreased cognitive functioning may be a risk factor for delirium.

Keywords:

• quality of life
• postoperative delirium
• older patients
• elective surgery
• cognitive functioning

Disclosure statement

The PhD program of the corresponding author (T. L. Janssen) is funded by an ‘unrestricted grant’ by Amphia Fund for innovation. All other authors declare that they have no competing interests.

Authors’ contributions

All authors made a substantial contribution to the design and set-up of this study, to collection of data and to the writing or revising of this manuscript. All authors read and approved the final manuscript.

Ethics approval and consent to participate

The Medical Ethical Research Committee of Rotterdam, Maasstad Hospital (TWOR) approved the research protocol, ID number NL55694.101.15, in June 2016. Additionally, the Local Research and Development Committee at the Amphia Hospital approved the protocol (Local ID number 1473.16).

Availability of data and material

Data for this manuscript are part of a larger data file, which will be used for future publications. Data will therefore not be made publicly available.

Additional information

Funding

This research is funded by an “unrestricted grant” by Amphia Fund for Innovation. Limited financial support has been provided by Vifor Pharma Nederland B.V. Both funds did not interfere in the decision making for the formation of this bundle of care nor for this manuscript.