The influence of orthopedic surgery on the incidence of post-operative delirium in geriatric patients: results of a prospective observational study |
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| Institution: | 1. Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Kerpener-Strasse 62, 50937 Cologne, Germany;2. Department of Anesthesiology and Intensive Care Medicine, Krankenhaus Köln-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany;3. Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Urbacher Weg 19, 51149 Cologne, Germany;4. Department of Orthopedics and Trauma Surgery, University Hospital of Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany;1. Hoy Spirit Hospital, Andheri, India;2. Criticare Superspeciality Hospital, Andheri, Mumbai, India;1. University of Texas Southwestern, Dallas, TX, USA;2. University of Texas Southwestern, Staff Orthopedic Surgeon, Dallas VAMC, Dallas, TX, USA;3. Department of Orthopaedics, University of Texas Southwestern, Dallas, TX, USA;1. Allegheny Health Network, Department of Orthopaedic Surgery, Pittsburgh, PA, 15212, USA;2. University of Pittsburgh, Department of Mechanical Engineering and Materials Science, Pittsburgh, PA, 15213, USA;1. Department of Orthopaedic Surgery, Ogori Daiichi General Hospital, Ogori Daiichi General Hospital, 839-1 Ogori-shimogo, Yamaguchi, 754-0002, Japan;2. Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan;1. Denver Health Medical Center, Department of Orthopaedic Surgery, USA;2. Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO, USA;1. Neelam Superspeciality Hospital, Rajpura, India;2. Punjab Cancer Care Hospital, Bathinda, India;3. Amar Hospital, Fatehpur Shekawati, India |
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| Abstract: | BackgroundPostoperative delirium (PD) is a major concern in geriatric patients undergoing orthopedic surgery. This prospective observational study aims to examine the incidence of PD, to identify intervention-specific risk factors and to investigate the influence of orthopedic surgery on delirium.MethodsFrom 2019 to 2020, 132 patients ≥70 years of age with endoprosthetic (Group E) or spinal surgery (Group S) were included. Upon admission, the ISAR score, the Nursing Delirium Screening Scale, potential risk factors, the ASA score, duration of surgery, type of anesthesia, blood loss, and hemoglobin drop were recorded. For risk factor analysis patients were grouped into Group D (delirium) and Group ND (no delirium). Primary endpoint was the occurrence of PD.ResultsOf 132 patients, 50 were included in Group E and 82 in Group S. Mean age and ISAR score were not significantly different between groups. Delirium rate in Group E and S was 12% vs. 18% (p = 0.3). Differences could be observed between Group D and ND in duration of surgery (173 min vs. 112 min, p = 0.02), postoperative hemoglobin drop (3.2 g/dl vs. 2.3 g/dl; p = 0.026), history of PD (23% vs. 11%, p = 0.039) and use of isoflurane (6 vs. 2). Type of surgery was not an independent risk factor (p = 0.26).ConclusionSpecific type of orthopedic surgery is not an independent risk factor for PD. Prevention of PD should focus on duration of surgery and blood loss, particularly in patients with a history of PD. A possible delirogenic potential of isoflurane should be further studied. |
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| Keywords: | Spinesurgery Arthroplasty Isoflurane Prevention Perioperative management |
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