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Acute Postoperative Confusion and Hallucinations in Parkinson Disease

William E. Golden, MD; Robert C. Lavender, MD; and W. Steven Metzer, MD
[+] Article, Author, and Disclosure Information

Requests for Reprints: William E. Golden, MD, Division of General Internal Medicine, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 641, Little Rock, AR 72205.

Current Author Addresses: Drs. Golden and Lavender: Division of General Internal Medicine, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 641, Little Rock, AR 72205.

Dr. Metzer: John L. McClellan Memorial Veterans Administration Hospital, Department of Neurology, 4300 West 7th Street, Little Rock, AR 72205.

Ann Intern Med. 1989;111(3):218-222. doi:10.7326/0003-4819-111-3-218
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Study Objective: To determine whether patients with Parkinson disease are at an increased risk for postoperative confusion.

Design: Retrospective chart review of patients with Parkinson disease who remained in the hospital at least 48 hours after their surgery. Current data were compared with published historical controls.

Setting: Recent medical records of a university-affiliated hospital, Veterans Administration hospital, and community hospital.

Patients: Available charts of patients with Parkinson disease who had had surgery in the last 2 years. Patients were excluded if they were disoriented at admission or had serious metabolic disturbances.

Measurements and Main Results: Fifteen of twenty-five postoperative patients with Parkinson disease (60%; CI, 39% to 78%) suffered significant acute confusion, and 9 of these patients had documented hallucinations. Neuropsychiatric changes were frequently delayed after surgery. The acute confusional state lasted an average 2.5 days; several patients, however, were discharged before resolution. These disturbances did not appear to be related to type of antiparkinsonian medication or anesthetic.

Conclusion: In comparison with historical controls, the relative risk of patients with Parkinson disease having an acute postoperative confusional state is between 2. 8 and 8.1. These patients may need environmental supports during the postoperative period.





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