Delirium After Prolapse Surgery Increases Complications: National Cohort Study

INTRODUCTION AND HYPOTHESIS: Postoperative delirium (POD) is an acute state of altered mentation after surgery. The effect of POD on outcomes after prolapse surgery is not well-defined. We hypothesized that POD is associated with increased adverse events (AEs) after prolapse surgery in older adults. METHODS: This is a retrospective cohort study using the National Surgical Quality Improvement Program data registry of women ≥ 75 years who underwent prolapse surgery from 2021 to 2023. The primary outcome was a composite 30-day AE outcome. Multivariable logistic regression analyses were performed, controlling for clinically relevant variables with p < 0.05 on univariate analysis. RESULTS: Of 1766 older women screened for POD, 87 (4.9%) were diagnosed with POD. Patients with POD were older, less likely to be White, and more likely to have baseline dementia (p < 0.05). Although they underwent similar types of prolapse repair, women with POD were less likely to undergo concomitant hysterectomy. Reoperation (5.8% vs. 1.6%, p = 0.02) and discharge to skilled nursing facility (SNF) (4.6% vs. 0.9%, p = 0.01) were significantly associated with POD. On multivariable analysis, POD was associated with a 2.11 greater adjusted odds for composite AEs within 30 days of surgery (95% CI [1.23-3.61]), a 3.41 greater adjusted odds for reoperation (95% CI [1.21-9.61]), and a 3.71 greater adjusted odds for discharge to SNF (95% CI [1.09-12.58]). CONCLUSIONS: POD is associated with an increased odds of postoperative AEs in older women undergoing prolapse surgery. These findings support the incorporation of POD and associated risks into perioperative counseling for older adults undergoing reconstructive pelvic surgery.