Delirium Bibliography

**The Delirium Bibliography is moving!**

 

We're excited to announce that the Delirium Bibliography has been moved to the Network for Investigation of Delirium: Unifying Scientists (NIDUS) website! The new bibliography includes well over 3,000 references on delirium and acute care for elders in addition to new references on pediatric delirium, as well. Articles in the new bibliography are still indexed by keywords taken from MEDLINE and other relevant databases, and they can be easily browsed with a search function. Questions? Email margaretwebb@hsl.harvard.edu

The searchable delirium bibliography page is one of our most popular features, allowing you to quickly gain access to the literature on delirium and acute care of older persons.  The HELP team keeps it updated for you on a monthly basis!  Feel free to search by author, title, keywords. It is primarily intended for clinicians and researchers interested in exploring these topics.

Each article is indexed by keywords taken from MEDLINE and other relevant databases.

You may base your search on as many search terms as you like. A search term can be a keyword, an author's name, all or part of an article's title, or any word or phrase that you might expect to find in an article's abstract. You may then indicate whether you would like to limit the search to one or more options.

The results are prioritized so that entries including all search terms will be listed first, but you can indicate whether to then sort by title (the default), by author, by journal name or by publication year.

You may further restrict to a topic category. Note: If you do not enter any search terms, the results will include all of the entries for the selected topic category.

More information about each entry on this page is available by moving the mouse over the green information symbols.

Please note that Pub Med Central (PMC) full text links are provided wherever available.  However, due to copyright restrictions, only abstracts can be provided for articles not available in PMC.

Total Results: 3263

  • The Healthy Heart-Mind Trial: Randomized Controlled Trial of Melatonin for Prevention of Delirium. 2019 Ford, A. H. Flicker, L. Kelly, R. Patel, H. Passage, J. Wibrow, B. Anstey, M. Edwards, M. Almeida, O. P.. J Am Geriatr Soc,
    • Title

      The Healthy Heart-Mind Trial: Randomized Controlled Trial of Melatonin for Prevention of Delirium.

    • Authors
      Ford, A. H. Flicker, L. Kelly, R. Patel, H. Passage, J. Wibrow, B. Anstey, M. Edwards, M. Almeida, O. P.
    • Year
      2019
    • Journal
      J Am Geriatr Soc
    • URL
    • Abstract
      OBJECTIVES: Delirium is a serious medical condition with increased incidence in at-risk surgical populations. We sought to determine if melatonin use reduces the incidence of delirium in individuals undergoing major cardiac surgery. DESIGN: Randomized double-blind placebo-controlled clinical trial (two arms, 1:1 allocation, parallel design). SETTING: The trial took place in two metropolitan hospitals (public tertiary and private) in Perth, Western Australia. PARTICIPANTS: We recruited 210 adults aged 50 years or older who were due to undergo coronary artery bypass grafting or valve replacement surgery. INTERVENTION: Participants were randomly assigned (1:1) to 7 days of treatment with melatonin 3 mg at night or matching placebo, starting 2 days before the surgery. MEASUREMENTS: The primary outcome of interest was incident delirium within 7 days of surgery as assessed via daily clinical assessment that included the Confusion Assessment Method. Secondary outcomes of interest included duration and severity of delirium, length of hospital stay, cognitive function, and mood and anxiety symptoms at discharge and 3 months after the surgery. RESULTS: The groups were well balanced for demographic and clinical parameters. Forty-two participants developed delirium, but it was evenly distributed between the groups (melatonin 21/98, 21.4%; placebo 21/104, 20.2%; adjusted odds ratio [OR] = .78; 95% confidence interval [CI] = .35-1.75). The median duration of delirium was 3 (interquartile range [IQR] = 2-4) and 2 (IQR = 1-3) days for people treated with melatonin and placebo, respectively (z = -1.03; P = .304). A similar proportion of participants experienced severe episodes of delirium in each group (melatonin 9/21, 42.9% vs placebo 6/21, 28.6%; chi(2) = .93; P = .334; adjusted OR = 1.98; 95% CI = .40-9.78). The groups did not differ in terms of length of stay, mood, anxiety, and cognitive performance. CONCLUSION: The findings of this randomized double-blind placebo-controlled trial do not support the prophylactic use of melatonin to prevent delirium after major cardiac surgery.
    • PubMed ID
  • The Caregiver Burden of Delirium in Older Adults With Alzheimer Disease and Related Disorders. 2019 Fong, T. G. Racine, A. M. Fick, D. M. Tabloski, P. Gou, Y. Schmitt, E. M. Hshieh, T. T. Metzger, E. Bertrand, S. E. Marcantonio, E. R. Jones, R. N. Inouye, S. K.. J Am Geriatr Soc,
    • Title

      The Caregiver Burden of Delirium in Older Adults With Alzheimer Disease and Related Disorders.

    • Authors
      Fong, T. G. Racine, A. M. Fick, D. M. Tabloski, P. Gou, Y. Schmitt, E. M. Hshieh, T. T. Metzger, E. Bertrand, S. E. Marcantonio, E. R. Jones, R. N. Inouye, S. K.
    • Year
      2019
    • Journal
      J Am Geriatr Soc
    • URL
    • Abstract
      OBJECTIVES: To measure the burden of delirium in older adults with or without Alzheimer disease or related disorders (ADRDs). DESIGN: Prospective, observational cohort. SETTING: Inpatient hospital and study participants' homes. PARTICIPANTS: A subset (n = 267) of older medical and surgical patients and their caregivers enrolled in the Better Assessment of Illness study. MEASUREMENTS: Delirium burden was measured using the DEL-B instrument (range = 0-40, with higher scores indicating greater burden) in caregivers (DEL-B-C) and patients 1 month after hospitalization. Severity of cognitive impairment (Montreal Cognitive Assessment [MoCA]), delirium presence (Confusion Assessment Method [CAM]), and delirium severity (CAM-Severity [CAM-S]) were measured during hospitalization and at 1-month follow-up. ADRD diagnosis was determined by a clinical consensus process. RESULTS: For patients with (n = 56) and without (n = 211) ADRD, both DEL-B instruments had good internal consistency. DEL-B-C scores had a median (interquartile range) among caregivers of patients with and without ADRD of 9 (5-15) and 5 (1-11), respectively (P < .05). If the patient developed delirium, caregivers experienced greater burden (beta[delirium x ADRD] = -.29; P = .42), regardless of ADRD status. Further, caregiver burden was modestly correlated with patient MoCA scores (Spearman correlation coefficient, rho = -0.18; P = .01). Patients with ADRD who developed delirium self-reported less burden than those without ADRD (beta[delirium x ADRD] = -.67; P = .044). As with caregivers, delirium burden was modestly correlated with patient MoCA score (rho = -0.18; P = .005) and correlated with the CAM-S in patients without ADRD (rho = 0.38; P < .001) but not for patients with ADRD (rho = -0.07; P = .61). CONCLUSIONS: Delirium resulted in the same degree of increased caregiver burden regardless of whether a patient had ADRD, signifying delirium is equally stressful to caregivers, even among those with experience caring for someone with a chronic cognitive disorder. Delirium burden is only modestly associated with degree of cognitive impairment, suggesting that other aspects of delirium contribute to burden.
    • PubMed ID
  • Geriatric Events Among Older Adults Undergoing Nonelective Surgery Are Associated with Poor Outcomes. 2019 Dworsky, J. Q. Childers, C. P. Copeland, T. Maggard-Gibbons, M. Tan, H. J. Saliba, D. Russell, M. M.. Am Surg, 85:10 (1089-1093)
    • Title

      Geriatric Events Among Older Adults Undergoing Nonelective Surgery Are Associated with Poor Outcomes.

    • Authors
      Dworsky, J. Q. Childers, C. P. Copeland, T. Maggard-Gibbons, M. Tan, H. J. Saliba, D. Russell, M. M.
    • Year
      2019
    • Journal
      Am Surg
    • URL
    • Abstract
      Older adults undergoing nonelective surgery are at risk for geriatric events (GEs: delirium, dehydration, falls/fractures, failure to thrive, and pressure ulcers), but the impact of GEs on postoperative outcomes is unclear. Using the 2013 to 2014 National Inpatient Sample, we analyzed nonelective hospital admissions for five common operations (laparoscopic cholecystectomy, colectomy, soft tissue debridement, small bowel resection, and laparoscopic appendectomy) in older adults (aged >/=65 years) and a younger referent group (aged 55-64 years). Nationally weighted descriptive statistics were generated for GEs. Logistic regression controlling for patient, procedure, and hospital characteristics estimated the association of 1) age with GEs and 2) GEs with outcomes. Of 471,325 overall admissions, 64.7 per cent were aged >/=65 years. The rate of any GE in older adults was 26.9 per cent; GEs varied by age and procedure (P < 0.001). After adjustment, the probability of any GE increased with age category (P < 0.001); having any GE was associated with higher probability of all outcomes (P < 0.001): mortality (4.5% vs 0.8%), postoperative complications (61.7% vs 24.9%), prolonged length of stay (24.3% vs 7.9%), and skilled nursing facility discharge (46.6% vs 10.3%). In addition, there was a dose-response relationship between GEs and negative outcomes. GEs are prevalent in the nonelective surgery setting and associated with worse clinical outcomes. Quality improvement efforts should focus on addressing GEs.
    • PubMed ID
  • Shifting the focus: A QI project to improve the management of delirium in patients with hip fracture. 2019 Dormandy, L. Mufti, S. Higgins, E. Bailey, C. Dixon, M.. Future Healthc J, 6:3 (215-219)
    • Title

      Shifting the focus: A QI project to improve the management of delirium in patients with hip fracture.

    • Authors
      Dormandy, L. Mufti, S. Higgins, E. Bailey, C. Dixon, M.
    • Year
      2019
    • Journal
      Future Healthc J
    • URL
    • Abstract
      Introduction: Delirium is common in the perioperative setting, particularly in those admitted with a neck of femur fracture. It is associated with poorer outcomes, including increasing mortality, morbidity and prolonged hospital stay. It is often poorly recognised and under diagnosed. Setting: An urban district general hospital. Intervention: A steering group was set up and used 'plan, do, study, act' methodology to develop a diagnostic pathway and educational programme for all staff working with patients admitted with neck of femur fracture. Results: There was an increase in the multidisciplinary teams use of the 4AT delirium screening tool by 26% (p=0.0008). Staff surveys indicated an increase in the knowledge of delirium and confidence at explaining it to patients. Discussion: By increasing staff confidence and use of recognised screening tools it is hoped that accurate diagnosis of this perioperative complication is improved, leading to improved management of these complex patients.
    • PubMed ID
  • Impact of a delirium prevention project among older hospitalized patients who underwent orthopedic surgery: a retrospective cohort study. 2019 Choi, J. Y. Kim, K. I. Kang, M. G. Lee, Y. K. Koo, K. H. Oh, J. H. Park, Y. H. Suh, J. Kim, N. H. Yoo, H. J. Koo, J. Moon, H. M. Kim, E. H. Park, K. Kim, C. H.. BMC Geriatr, 19:1 (289)
    • Title

      Impact of a delirium prevention project among older hospitalized patients who underwent orthopedic surgery: a retrospective cohort study.

    • Authors
      Choi, J. Y. Kim, K. I. Kang, M. G. Lee, Y. K. Koo, K. H. Oh, J. H. Park, Y. H. Suh, J. Kim, N. H. Yoo, H. J. Koo, J. Moon, H. M. Kim, E. H. Park, K. Kim, C. H.
    • Year
      2019
    • Journal
      BMC Geriatr
    • URL
    • Abstract
      BACKGROUND: Postoperative delirium (POD) is a common clinical syndrome with significant negative outcomes. Thus, we aimed to evaluate the feasibility and effectiveness of a delirium screening tool and multidisciplinary delirium prevention project. METHODS: A retrospective cohort study was conducted at a single teaching center in Korea. A cohort of patients who underwent a delirium prevention program using a simple delirium screening tool from December 2018 to February 2019 (intervention group, N = 275) was compared with the cohort from the year before implementation of the delirium prevention program (December 2017 to February 2018) (control group, N = 274). Patients aged >/=65 years who were admitted to orthopedic wards and underwent surgery were included. The incidence rates of delirium before and after implementation of the delirium prevention program, effectiveness of the delirium screening tool, change in the knowledge score of nurses, and length of hospital stay were assessed. RESULTS: The sensitivity and specificity of the screening tool for the incidence of POD were 94.1 and 72.7%, respectively. The incidence rates of POD were 10.2% (control group) and 6.2% (intervention group). The odds ratio for the risk reduction effect of the project related to the incidence of POD was 0.316 (95% confidence interval: 0.125-0.800, p = 0.015) after adjustment for possible confounders. The delirium knowledge test score increased from 40.52 to 43.24 out of 49 total points (p < 0.001). The median length of hospital stay in the intervention and control groups was 6.0 (interquartile range, 4-9) and 7.0 (interquartile range, 4-10) days, respectively (p = 0.062). CONCLUSION: The screening tool successfully identified patients at a high risk of POD at admission. The POD prevention project was feasible to implement, effective in preventing delirium, and improved knowledge regarding delirium among the medical staff. TRIAL REGISTRATION: None.
    • PubMed ID
  • Melatonin for the prevention of postoperative delirium in older adults: a systematic review and meta-analysis. 2019 Campbell, A. M. Axon, D. R. Martin, J. R. Slack, M. K. Mollon, L. Lee, J. K.. BMC Geriatr, 19:1 (272)
    • Title

      Melatonin for the prevention of postoperative delirium in older adults: a systematic review and meta-analysis.

    • Authors
      Campbell, A. M. Axon, D. R. Martin, J. R. Slack, M. K. Mollon, L. Lee, J. K.
    • Year
      2019
    • Journal
      BMC Geriatr
    • URL
    • Abstract
      BACKGROUND: Older surgical patients are at high risk of developing postoperative delirium. Non-pharmacological strategies are recommended for delirium prevention, but no pharmacological agents have compelling evidence to decrease the incidence of delirium. The purpose of this study was to assess whether perioperative melatonin decreases the incidence of delirium in older adults undergoing surgical procedures. METHODS: A systematic search using PubMed/Medline, Embase, PsycINFO, CINAHL, and references of identified articles published in English between January 1990 and October 2017 was performed. Two independent reviewers screened titles and abstracts, and then extracted data following a full-text review of included articles with consensus generation and bias assessment. Studies reporting outcomes for melatonin or ramelteon use to prevent delirium in postoperative hospitalized patients (mean age >/= 50 years) were eligible for inclusion. Data were pooled using a fixed-effects model to generate a forest plot and obtain a summary odds ratio for the outcome of interest (delirium incidence). Cochran's Q and I(2) values were used to investigate heterogeneity. RESULTS: Of 335 records screened, 6 studies were selected for the qualitative analysis and 6 were included in the meta-analysis (n = 1155). The mean age of patients in included studies ranged from 59 to 84 years. Patients in intervention groups typically received melatonin or ramelteon at daily doses of two to eight milligrams around cardiothoracic, orthopedic, or hepatic surgeries for one to nine days, starting on the evening before or the day of surgery. The incidence of delirium ranged from 0 to 30% in the intervention groups versus 4-33% in the comparator groups, and was significantly reduced in the melatonin group, with a summary effect of the meta-analysis yielding an odds ratio of 0.63 (95% CI 0.46 to 0.87; 0.006; I(2) = 72.1%). A one study removed analysis reduced overall odds ratio to 0.310 (95% CI 0.19 to 0.50), while reducing heterogeneity (Cochran's Q = 0.798, I(2) = 0.000). CONCLUSION: Perioperative melatonin reduced the incidence of delirium in older adults in the included studies. While optimal dosing remains an unanswered question, the potential benefit of melatonin and melatonin receptor agonists may make them a reasonable option to use for delirium prevention in older adults undergoing surgical procedures.
    • PubMed ID
  • Assessment of a Geriatric Hip Fracture Program: Analysis of Harmful Adverse Events Using the Global Trigger Tool. 2019 Blood, T. D. Deren, M. E. Goodman, A. D. Hayda, R. A. Trafton, P. G.. Journal of Bone and Joint Surgery, 101:8 (704-709)
    • Title

      Assessment of a Geriatric Hip Fracture Program: Analysis of Harmful Adverse Events Using the Global Trigger Tool.

    • Authors
      Blood, T. D. Deren, M. E. Goodman, A. D. Hayda, R. A. Trafton, P. G.
    • Year
      2019
    • Journal
      Journal of Bone and Joint Surgery
    • URL
    • Abstract
      Background:The purpose of this study was to assess the impact of adding a geriatric comanagement program to the care of geriatric patients with a hip fracture at our hospital. The Institute for Healthcare Improvement (IHI) Global Trigger Tool (GTT) was used to follow the frequency and severity of adverse events occurring in hospitalized patients and to examine the effectiveness of a comanagement program (the Geriatric Hip Fracture Program [GHFP]).Methods:Data were collected for patients treated for a hip fracture from 2010 to 2014, which was 1 year prior to (October 2010 to September 2011) and 2 years after the implementation of the GHFP, and were grouped into 3-month intervals for analysis. The patients treated prior to the implementation of the GHFP were compared with those treated following the implementation of the program. The frequency and severity of adverse events were collected using the GTT.Results:There were 75.9 patients with an adverse event and 160.7 adverse events per 100 admissions. After the institution of the GHFP, there was a significant decrease in the number of patients with adverse events and the number of adverse events per 100 admissions over time. The rate of adverse events decreased by 12% per year when acute blood loss anemia was excluded. Similarly, the number of adverse events (excluding blood loss anemia) decreased significantly over time, from 128.7 per 100 admissions before the GHFP to 34.2 in the last quarter. Multivariable analysis (excluding acute blood loss anemia) demonstrated a trend toward a decreased likelihood of a patient experiencing an adverse event after the institution of the GHFP as well as a trend toward a decrease in the number of adverse events per patient. The length of the hospital stay was significantly shorter after the implementation of the GHFP.Conclusions:The implementation of the GHFP reduced the number of adverse events over time. Increasing age and the Carlson Comorbidity Index (CCI) were predictors of adverse events, while only age was a predictor of readmissions and CCI was a predictor of death in our study. The implementation of the GHFP has played an important role at our institution in quantifying the decrease in adverse events over a 2-year period, and we believe that it is essential for improving care of geriatric patients with a hip fracture.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
    • PubMed ID
  • Clinical management of delirium: The response depends on the subtypes. An observational cohort study in 602 patients. 2019 Zipser, C. M. Knoepfel, S. Hayoz, P. Schubert, M. Ernst, J. von Kanel, R. Boettger, S.. Palliat Support Care, (1-8)
    • Title

      Clinical management of delirium: The response depends on the subtypes. An observational cohort study in 602 patients.

    • Authors
      Zipser, C. M. Knoepfel, S. Hayoz, P. Schubert, M. Ernst, J. von Kanel, R. Boettger, S.
    • Year
      2019
    • Journal
      Palliat Support Care
    • URL
    • Abstract
      OBJECTIVE: The hypoactive, hyperactive, and mixed subtypes of delirium differently impact patient management and prognosis, yet the evidence remains sparse. Therefore, we examined the outcome of varying management strategies in the subtypes of delirium. METHODS: In this observational cohort study, 602 patients were managed for delirium over 20 days with the following strategies: supportive care alone or in combination with psychotropics, single, dual, or triple+ psychotropic regimens. Cox regression models were calculated for time to remission and benefit rates (BRs) of management strategies. RESULTS: Generally, the mixed subtype of delirium caused more severe and persistent delirium, and the hypoactive subtype was more persistent than the hyperactive subtype. The subtypes of delirium were similarly predictive for mortality (P = 0.697) and transfer to inpatient psychiatric care (P = 0.320). In the mixed subtype, overall, psychotropic drugs were administered more often (P = 0.016), and particularly triple+ regimens were administered more commonly compared to hypoactive delirium (P = 0.007). Patients on supportive care benefited most, whereas those on triple+ regimens did worst in terms of remission in all groups of hypoactive, hyperactive, and mixed subtypes (BR: 4.59, CI 2.01-10.48; BR: 4.59, CI 1.76-31.66; BR: 3.36, CI 1.73-6.52; all P < 0.05). SIGNIFICANCE OF RESULTS: The mixed subtype was more persistent to management than the hypoactive and hyperactive subtypes. Delirium management remains controversial and, generally, supportive care benefited patients most. Psychopharmacological management for delirium requires careful choosing of and limiting the number of psychotropics.
    • PubMed ID
  • Predisposing and precipitating factors for delirium in neurology: a prospective cohort study of 1487 patients. 2019 Zipser, C. M. Deuel, J. Ernst, J. Schubert, M. Weller, M. von Kanel, R. Boettger, S.. J Neurol,
    • Title

      Predisposing and precipitating factors for delirium in neurology: a prospective cohort study of 1487 patients.

    • Authors
      Zipser, C. M. Deuel, J. Ernst, J. Schubert, M. Weller, M. von Kanel, R. Boettger, S.
    • Year
      2019
    • Journal
      J Neurol
    • URL
    • Abstract
      INTRODUCTION: Predisposing and precipitating factors for delirium are well known; however, their interaction and impact on delirium in neurological patients remains largely unknown. Therefore, those factors were evaluated in hospitalized patients with neurological disorders. METHODS: In this prospective cohort study, 1487 neurological patients were included, 356 patients with delirium and 1131 without delirium. Relevant neurological- and medical-related clusters were assessed with multiple regression analyses, prediction models, and cluster analysis evaluating their association with delirium. RESULTS: The 1-year incidence of delirium in this cohort was 23.9%. Delirium developed in 31% of patients with stroke, in 39.5% with epilepsy, and in 58.4% with ICH. The most relevant predisposing factors were substance-use disorders (OR 4.24, 2.28-7.78, p < 0.001), advanced age (OR 3.44, CI 2.40-4.92, p < 0.001), and neurodegenerative disorders (OR 2.58, CI 1.47-4.54, p = 0.001). The most relevant precipitating factors were meningitis (OR 21.52, CI 1.22-379.83, p = 0.036), acute renal failure (OR 10.01, CI 1.13-88.73, p = 0.039), and intracranial hemorrhage (OR 3.62, CI 2.08-6.30, p < 0.001). Delirious patients were hospitalized 6 days longer, had higher in-hospital mortality, and were discharged more often to nursing homes and rehabilitation. Best predictor for delirium was the coexistence of advanced age with epilepsy (58.3%, p < 0.001), while patients aged < 65 years without epilepsy and stroke rarely developed delirium (5.1%, p < 0.001). CONCLUSIONS: Delirium is common in elder neurological patients and associated with worse outcome. Primary cerebral conditions most frequently precipitate delirium in neurology. Neurologists are advised to monitor symptoms of delirium in the presence of risk factors to enable both timely diagnostic work-up and management of delirium.
    • PubMed ID
  • Risk factors for postoperative delirium after spinal surgery: a systematic review and meta-analysis. 2019 Zhu, C. Wang, B. Yin, J. Xue, Q. Gao, S. Xing, L. Wang, H. Liu, W. Liu, X.. Aging Clin Exp Res,
    • Title

      Risk factors for postoperative delirium after spinal surgery: a systematic review and meta-analysis.

    • Authors
      Zhu, C. Wang, B. Yin, J. Xue, Q. Gao, S. Xing, L. Wang, H. Liu, W. Liu, X.
    • Year
      2019
    • Journal
      Aging Clin Exp Res
    • URL
    • Abstract
      BACKGROUND: Postoperative delirium is common in older patients after spinal surgery. Many reports investigating the risk factors for delirium after spinal surgery have been published recently. METHODS: A literature search was performed using the Cochrane Library, Web of Science, PubMed, Embase, and Springer databases from inception to February 2019. Relevant studies involving patients with delirium who underwent spinal surgery were included if the studies contained data about blood transfusion or other related factors, such as haemoglobin, haematocrit, and blood loss levels. The Newcastle-Ottawa Scale was used for the study-quality evaluation. The pooled odds ratios or (standard) mean differences of the individual risk factors were estimated using the Mantel-Haenszel or inverse-variance methods. RESULTS: Fifteen observational studies met the inclusion criteria; the studies included a total of 583,290 patients (5431 patients with delirium and 577,859 patients without delirium). In addition to an advanced age, the results of the meta-analyses showed that living in an institution, diabetes, cerebral vascular diseases, pulmonary diseases, opioid use, length of surgery, intraoperative blood loss, blood transfusions, intraoperative infusion, preoperative albumin, postoperative albumin, preoperative haematocrit, postoperative haematocrit, preoperative haemoglobin, postoperative haemoglobin, preoperative sodium, postoperative sodium, Mini-Mental State Examination score, inability to ambulate, depression, number of medications, and treatment with multiple drugs (> three types) were significantly associated with delirium. CONCLUSION: The above-mentioned risk factors can be used to identify high-risk patients, and the appropriate prophylaxis strategies should be implemented to prevent delirium after spinal surgery.
    • PubMed ID
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