J Korean Hip Soc.  2010 Jun;22(2):151-158. 10.5371/jkhs.2010.22.2.151.

Postoperative Delirium after Hip Arthroplasty in the Elderly

Affiliations
  • 1Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju, Korea. hwtonlka@yonsei.ac.kr

Abstract

PURPOSE
Our study was done to evaluate the influence of postoperative delirium on the prognosis of hip arthroplasty, and risk factors for postoperative delirium in individuals older than 65.
MATERIALS AND METHODS
Among patients who received hip arthroplasty in our hospital (WCH) between March 2004 and March 2008, we chose 193 patients for our study after excluding patients who had preoperative delirium and who had a history of dementia and cognitive dysfunction. We divided our cohort of 193 patients into two groups, 131 patients with postoperative delirium and 62 patients without delirium. We checked for clinical results for hip arthroplasty. We checked for multiple factors related to delirium.
RESULTS
The mean hospital stay was 42.4+/-14.0 in the delirium group and 20.4+/-4.3 in the control group; the difference was significant. The mean preoperative cumulative ambulation score was 1.9+/-1.2 in the delirium group and 3.1+/-1.7 in the control group; the difference was significant. In 2 individuals of the control group and 4 of the delirium group, dislocation developed;and there was significant difference. There was a high prevalence of delirium among patients with hip fractures, and of histories of psychiatric diseases, alcohol abuse, liver cirrhosis and cerebral vascular disease. The delirium group had a significantly longer stay in the intensive care unit. On admission, the delirium group had significantly lower sodium and albumin compared to controls.
CONCLUSION
Because postoperative delirium after hip arthroplasty makes the prognosis worse, preoperative evaluation and management of risk factors is necessary.

Keyword

Hip arthroplasty; Delirium; Elderly

MeSH Terms

Aged
Alcoholism
Arthroplasty
Cohort Studies
Delirium
Dementia
Dislocations
Hip
Hip Fractures
Humans
Intensive Care Units
Length of Stay
Liver Cirrhosis
Prevalence
Prognosis
Risk Factors
Sodium
Vascular Diseases
Walking
Sodium

Cited by  2 articles

Comparison of Simultaneous Bilateral Cementless Total Hip Replacement with Staged Bilateral Cementless Total Hip Replacement in High Risk Anesthesia Group
Sung Kwan Hwang, Sung Min Kwon, Hoi Jeong Chung
J Korean Hip Soc. 2011;23(3):200-205.    doi: 10.5371/jkhs.2011.23.3.200.

Incidence and Associated Factors of Delirium after Orthopedic Surgery
Si-Wook Lee, Chul-Hyun Cho, Ki-Cheor Bae, Kyung-Jae Lee, Eun-Seok Son, Sang-Hyun Um
J Korean Orthop Assoc. 2019;54(2):157-163.    doi: 10.4055/jkoa.2019.54.2.157.


Reference

1. American Psychiatric Association. Diagnostic criteria from DSM-IV-TR. 2000. Washington, DC: ; : American Psychiatric Association.
2. Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc. 2001. 49:516–522.
Article
3. Robinson TN, Raeburn CD, Tran ZV, Angles EM, Brenner LA, Moss M. Postoperative delirium in the elderly: risk factors and outcomes. Ann Surg. 2009. 249:173–178.
4. Brauer C, Morrison RS, Silberzweig SB, Siu AL. The cause of delirium in patients with hip fracture. Arch Intern Med. 2000. 160:1856–1860.
Article
5. Flinn DR, Diehl KM, Seyfried LS, Malani PN. Prevention, diagnosis, and management of postoperative delirium in older adults. J Am Coll Surg. 2009. 209:261–268. quiz 94.
Article
6. Francis J, Martin D, Kapoor WN. A prospective study of delirium in hospitalized elderly. JAMA. 1990. 263:1097–1101.
Article
7. Inouye SK. Prevention of delirium in hospitalized older patients: risk factors and targeted intervention strategies. Ann Med. 2000. 32:257–263.
Article
8. Bitsch M, Foss N, Kristensen B, Kehlet H. Pathogenesis of and management strategies for postoperative delirium after hip fracture: a review. Acta Orthop Scand. 2004. 75:378–389.
Article
9. Marcantonio ER, Goldman L, Mangione CM, et al. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA. 1994. 271:134–139.
Article
10. Park CT, Yang HI, Sung KB, Shin HG, Park HK. Analysis of risk factors related to delirium tremens in alcohol withdrawal seizure patients. J Korean Neurol Assoc. 1996. 14:543–547.
11. Kat MG, Vreeswijk R, de Jonghe JF, et al. Long-term cognitive outcome of delirium in elderly hip surgery patients. A prospective matched controlled study over two and a half years. Dement Geriatr Cogn Disord. 2008. 26:1–8.
Article
12. Kalisvaart KJ, de Jonghe JF, Bogaards MJ, et al. Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study. J Am Geriatr Soc. 2005. 53:1658–1666.
Article
13. Warshaw G, Mechlin M. Prevention and management of postoperative delirium. Int Anesthesiol Clin. 2009. 47:137–149.
Article
14. Gustafson Y, Brännström B, Berggren D, et al. A geriatric-anesthesiologic program to reduce acute confusional states in elderly patients treated for femoral neck fractures. J Am Geriatr Soc. 1991. 39:655–662.
Article
15. Edlund A, Lundström M, Lundström G, Hedqvist B, Gustafson Y. Clinical profile of delirium in patients treated for femoral neck fractures. Dement Geriatr Cogn Disord. 1999. 10:325–329.
Article
16. Schuurmans MJ, Duursma SA, Shortridge-Baggett LM, Clevers GJ, Pel-Littel R. Elderly patients with a hip fracture: the risk for delirium. Appl Nurs Res. 2003. 16:75–84.
Article
17. Beloosesky Y, Hendel D, Weiss A, et al. Cytokines and Creactive protein production in hip-fracture-operated elderly patients. J Gerontol A Biol Sci Med Sci. 2007. 62:420–426.
Article
18. Litaker D, Locala J, Franco K, Bronson DL, Tannous Z. Preoperative risk factors for postoperative delirium. Gen Hosp Psychiatry. 2001. 23:84–89.
Article
19. Morimoto Y, Yoshimura M, Utada K, Setoyama K, Matsumoto M, Sakabe T. Prediction of postoperative delirium after abdominal surgery in the elderly. J Anesth. 2009. 23:51–56.
Article
20. Kim KH, Kho DH, Shin JY, Choi JY, Kim ES, Kim DH. Risk factors of postoperative delirium in elderly patients with hip fractures. J Korean Soc Fractures. 2008. 21:189–194.
Article
21. Lundström M, Olofsson B , Stenvall M , et al. Postoperative delirium in old patients with femoral neck fracture: a randomized intervention study. Aging Clin Exp Res. 2007. 19:178–186.
Article
Full Text Links
  • JKHS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr