The Patient Experience of Postoperative Delirium

Abstract

Background: Postoperative delirium (POD) is a common neurocognitive disorder in patients undergoing surgical procedures. Delirium is a disorder that is poorly understood, frequently unrecognized and associated with numerous adverse outcomes including longer hospital stays, significantly higher costs and increased morbidity and mortality. While there has been a great deal of research on proposed etiologies, risk factors and outcomes of delirium, few studies have explored the patient’s subjective experience of the phenomenon. Purpose: The purpose of this qualitative descriptive research was to investigate the patient experience of postoperative delirium and measure the distress associated with the experience. The Delirium Symptoms Experience Model (DSEM) provided the theoretical framework in which to understand the postoperative delirium experience. The three specific aims used to guide the investigation were: 1) Identify patient age, gender, race, type and length of surgery, past medical and surgical history, length of admission, delirium subtype (if known), and medications (including anesthetic agents) used in the perioperative period to better characterize the sample and provide context for the qualitative findings; 2) Describe the postoperative patients’ experience of being and feeling delirious; and, 3) Measure the distress associated with the recall of delirium using the Delirium Experience Questionnaire (DEQ) Methods: Ten participants ranging in age from 33-75 years (mean = 66.2 years of age) who experienced postoperative delirium were interviewed. Patients were screened for persistent delirium or cognitive impairment as assessed with the Confusion Assessment Method and the Mini-Cog™ Instruments. Results: Three organizing themes emerged from the content analysis: 1) Altered Perceptions of Reality; 2) Stuck in the Confusion; and, 3) Seeking Reality. The analysis of the quantitative measures and descriptive data demonstrated a high rate of psychological distress associated with delirium recall with 80% participants reporting it caused severe to very severe distress. The anesthetic drug propofol was the common medication prescribed in the perioperative period and given to all ten participants. Conclusion: Understanding this phenomenon from the patients’ perspective may provide a better understanding of the delirium experience and aid in the development of interventions and treatments to improve care and reduce suffering.