Clin Orthop Surg.  2019 Sep;11(3):297-301. 10.4055/cios.2019.11.3.297.

Etiology and Related Factors of Postoperative Delirium in Orthopedic Surgery

• Song KJ
• Ko JH
• Kwon TY
• Choi BW

• KMID: 2462558
• DOI: http://doi.org/10.4055/cios.2019.11.3.297

Abstract

BACKGROUND
Delirium is a serious complication for elderly patients after orthopedic surgery. The purpose of this study was to assess the etiology and related factors of delirium after orthopedic surgery in Korea.
METHODS
We retrospectively reviewed the medical records of 3,611 patients over 50 years who had orthopedic surgery. The age of patients (50s, 60s, 70s, and > 80s), type of anesthesia (general, spinal, and local), operation time (more than 2 hours vs. less than 2 hours), surgical site (spine, hip, knee, or others), and etiology (trauma or disease) were compared to determine possible risk factors of delirium after orthopedic surgery.
RESULTS
Of 3,611 patients, 172 (4.76%) were diagnosed with delirium after orthopedic surgery. Postoperative delirium occurred in 1.18% in their 50s, 3.86% in their 60s, 8.49% in their 70s, and 13.04% in > 80s (p < 0.001). According to anesthesia type, 6.50% of postoperative delirium occurred after general anesthesia, 0.77% after spinal anesthesia, and 0.47% after local anesthesia (p < 0.001). More than 2 hours of operation was associated with higher occurrence of delirium than less than 2 hours was (5.88% vs. 4.13%, p = 0.017). For the etiology, 8.17% were trauma cases and 3.02% were disease (p < 0.001). Postoperative delirium occurred in 22 of 493 patients (4.46%) after spine surgery, 18 of 355 patients (5.07%) after hip surgery, 17 of 394 patients (4.31%) after knee surgery, and 15 of 1,145 patients (1.31%) after surgery at other sites (p < 0.001).
CONCLUSIONS
Postoperative delirium was more common in older patients who had surgery under general anesthesia, whose surgery took more than 2 hours, and who were hospitalized through the emergency room.

Keyword

Delirium; Orthopedic surgery; Etiology; Risk factor

MeSH Terms

Aged
Anesthesia
Anesthesia, General
Anesthesia, Local
Anesthesia, Spinal
Delirium*
Emergency Service, Hospital
Hip
Humans
Knee
Korea
Medical Records
Orthopedics*
Retrospective Studies
Risk Factors
Spine

Reference

1. Bruce AJ, Ritchie CW, Blizard R, Lai R, Raven P. The incidence of delirium associated with orthopedic surgery: a meta-analytic review. Int Psychogeriatr. 2007; 19(2):197–214.

2. Robinson TN, Eiseman B. Postoperative delirium in the elderly: diagnosis and management. Clin Interv Aging. 2008; 3(2):351–355.

3. Bilotta F, Doronzio A, Stazi E, et al. Early postoperative cognitive dysfunction and postoperative delirium after anaesthesia with various hypnotics: study protocol for a randomised controlled trial. The PINOCCHIO trial. Trials. 2011; 12:170.

4. Girard TD, Pandharipande PP, Ely EW. Delirium in the intensive care unit. Crit Care. 2008; 12:Suppl 3. S3.

5. 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(10):1658–1666.

6. Brauer C, Morrison RS, Silberzweig SB, Siu AL. The cause of delirium in patients with hip fracture. Arch Intern Med. 2000; 160(12):1856–1860.

7. Aziz KT, Best MJ, Naseer Z, et al. The association of delirium with perioperative complications in primary elective total hip arthroplasty. Clin Orthop Surg. 2018; 10(3):286–291.

8. Tabet N, Howard R. Pharmacological treatment for the prevention of delirium: review of current evidence. Int J Geriatr Psychiatry. 2009; 24(10):1037–1044.

9. Deiner S, Silverstein JH. Postoperative delirium and cognitive dysfunction. Br J Anaesth. 2009; 103:Suppl 1. i41–i46.

10. Wass S, Webster PJ, Nair BR. Delirium in the elderly: a review. Oman Med J. 2008; 23(3):150–157.

11. Freter SH, Dunbar MJ, MacLeod H, Morrison M, MacKnight C, Rockwood K. Predicting post-operative delirium in elective orthopaedic patients: the Delirium Elderly At-Risk (DEAR) instrument. Age Ageing. 2005; 34(2):169–171.

12. Flinn DR, Diehl KM, Seyfried LS, Malani PN. Prevention, diagnosis, and management of postoperative delirium in older adults. J Am Coll Surg. 2009; 209(2):261–268.

13. Kagansky N, Rimon E, Naor S, Dvornikov E, Cojocaru L, Levy S. Low incidence of delirium in very old patients after surgery for hip fractures. Am J Geriatr Psychiatry. 2004; 12(3):306–314.

14. Nazemi AK, Gowd AK, Carmouche JJ, Kates SL, Albert TJ, Behrend CJ. Prevention and management of postoperative delirium in elderly patients following elective spinal surgery. Clin Spine Surg. 2017; 30(3):112–119.

15. Kostas TR, Zimmerman KM, Rudolph JL. Improving delirium care: prevention, monitoring, and assessment. Neurohospitalist. 2013; 3(4):194–202.

16. Banh HL. Management of delirium in adult critically ill patients: an overview. J Pharm Pharm Sci. 2012; 15(4):499–509.

17. Martinez FT, Tobar C, Beddings CI, Vallejo G, Fuentes P. Preventing delirium in an acute hospital using a non-pharmacological intervention. Age Ageing. 2012; 41(5):629–634.

18. Wang J, Li Z, Yu Y, Li B, Shao G, Wang Q. Risk factors contributing to postoperative delirium in geriatric patients postorthopedic surgery. Asia Pac Psychiatry. 2015; 7(4):375–382.