Post-operative delirium in older hip fracture patients: a new onset or was it already there?

PURPOSE: Hip fractures are a worldwide health issue primarily for older patients, conditioning major morbidity and mortality. An experienced multidisciplinary team is essential to manage surgery and peri-operative implications, to enable rapid functional and cognitive recovery. Delirium is a recognizable problem associated with negative outcomes. Our study aims to determine the influence of pre-operative delirium in the incidence of post-operative delirium, and to evaluate the association between other known peri-operative risk factors with both conditions. METHODS: A single-center, retrospective cohort study, conducted at a Level II trauma center over a 14-month period, included 241 patients with 65 years of age or older submitted to hip fracture surgery. Peri-operative data were gathered regarding baseline characteristics (sociodemographic, functional and cognitive status), intra-operative events (anesthesia technique, surgery duration, blood loss) and post-operative outcomes (delirium occurrence). RESULTS: Statistical analysis evidenced a female (75.5%) and elderly population (83.9 ± 7.8 years old) with significant comorbidities (cognitive impairment in 51.9%, ASA ≥ III in 79.7%, mean CIRS-G 8.83 ± 4.69) that underwent surgical fracture repair, mostly under 4 h (96.3%) and under regional anesthesia (63.1%). Pre- and post-operative delirium incidence was 18.3% and 12.9%, respectively, displaying increased presence according to cognitive impairment severity. CONCLUSION: Post-operative delirium was almost inexistent when it was absent pre-operatively. Moreover, pre-operative cognitive status was associated with the development of pre- and post-operative delirium. Careful cognitive assessment, implementation of preventive strategies and avoidance of peri-operative pro-delirium factors are crucial for comprehensive geriatric care.

[2017 Census: are there enough anaesthesiologists in Portugal?] / Censos 2017: Existe Número Suficiente de Anestesiologistas em Portugal?

INTRODUCTION: The objective of this study is to identify the number of anaesthesiologists working in Portugal and to monitor the national activity of this medical specialty by comparing it with a similar Census performed in 2014. MATERIAL AND METHODS: Observational cross-sectional study. Data related to the month of May 2017 was collected from Anaesthesiology departments of 53 Portuguese public institutions from a total of 86 hospitals. RESULTS: The Census registered 615 127 surgical procedures (3.4% more than in 2013), 84.1% of which on a non-emergent basis, and 49.6% day case surgery (6.1% more than in 2013). Moreover, 89 608 procedures were performed outside the operating rooms (19.0% less than in 2013), 282 944 were anaesthetic clinics (1.3% more than in 2013) and 112 183 were chronic pain evaluations (13.1% more than in 2013). In addition, 51 380 labour analgesia were performed for delivery (14.3% more than in 2013) corresponding to 70.5% of all deliveries occurring in the Obstetric department of Portuguese public hospitals in 2016 (5% more than in 2013). A total of 1280 Anaesthesiologists were identified (2.1% more than in May 2014), corresponding to a ratio of 12.4 per 100 000 inhabitants (it was 12.0 in May 2014). Together with the 262 anaesthesiologists that work exclusively in the private system, we found a total sum of 1542 anaesthesiologists indicating a ratio of 15.1 per 100 000 inhabitants (it was 13.9 in 2014). DISCUSSION: We predict that the identified deficit of 541 anaesthesiologists in the Portuguese National Health Service should be reduced by two thirds until 2023. The reduction of the shortage of anaesthesiologists will allow an increase in human resource capacity in Anaesthesiology. CONCLUSION: Even though there was a slight increase in the ratio of Anaesthesiologists per inhabitant in 2017 compared to 2014, Portugal maintains a shortage of Anaesthesiologists.

Introdução: O objectivo deste estudo é identificar o número de anestesiologistas e monitorizar a actividade da Anestesiologia em Portugal, comparando-a com idêntico Censos realizado em 2014. Material e Métodos: Estudo observacional transversal. Foram contactados, em maio de 2017, os diretores dos serviços de Anestesiologia das instituições hospitalares com actividade cirúrgica que compõem o Serviço Nacional de Saúde, num total de 53 instituições hospitalares, correspondendo a 86 hospitais. Resultados: O Censos registou um total de 615 127 intervenções cirúrgicas (mais 3,4% que em 2013), das quais 84,1% foram cirurgias programadas e destas 49,6% em regime de ambulatório (mais 6,1% que em 2013). Constatou-se ainda a realização de 89 608 procedimentos com apoio de anestesia fora do bloco operatório (menos 19,0% que em 2013), 282 944 consultas de anestesia (mais 1,3% que em 2013) e 112 183 consultas de dor crónica (mais 13,1% que em 2013). Identificaram-se 51 380 analgesias de parto (mais 14,3% que em 2013), que corresponderam a 70,5% dos partos ocorridos nos serviços de Obstetrícia dos hospitais do Serviço Nacional de Saúde (mais 5% de partos que em 2013). Foram identificados 1280 Anestesiologistas (mais 2,1% do que em maio de 2014), o que corresponde a um rácio de 12,4 por 100 000 habitantes (este valor era de 12,0 em maio de 2014). Com os 262 Anestesiologistas a trabalhar exclusivamente no sector privado, obtém-se um total nacional de 1542 Anestesiologistas, ou seja, um rácio de 15,1 por 100 000 habitantes (este valor era 13,9 em maio de 2014). Discussão: Prevê-se que o déficit de 541 Anestesiologistas identificados, possa ser reduzido em cerca de dois terços até 2023. A redução do déficit de Anestesiologistas permitirá aumentar a capacidade de resposta às crescentes solicitações dos serviços de anestesiologia Portugueses. Conclusão: Apesar de um ligeiro aumento do rácio de anestesiologistas por habitante em 2017 comparativamente a 2014, Portugal continua com um déficit de Anestesiologistas.