Delirium following total joint replacement surgery

Authors

  • Jeffrey Huang Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
  • Juraj Sprung Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
  • Toby N. Weingarten Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA

DOI:

https://doi.org/10.17305/bjbms.2018.3653

Keywords:

Delirium, surgery, outcomes, total joint arthroplasty

Abstract

Postoperative delirium (POD) is a common complication associated with increased resource utilization, morbidity and mortality. Our institution screens all postsurgical patients for postoperative delirium. The study aim was to perform an automated interrogation of the electronic health records to estimate the incidence of and identify associated risk factors for POD following total joint arthroplasty (TJA). Adult patients who underwent TJA with a multimodal analgesia protocol, including peripheral nerve blockade, from 2008 through 2012, underwent automated chart review. POD was identified by routine nursing assessment and administrative billing codes. Of 11,970 patients, 181 (1.5%) were identified to have POD. Older age (odds ratio, 95% CI 2.20, 1.80–2.71 per decade, p < 0.001), dementia (7.44, 3.54–14.60, p < 0.001), diabetes mellitus (1.70, 1.1.5–2.47, p = 0.009), renal disease (1.68, 1.03–2.65, p = 0.039), blood transfusions (2.04, 1.14–3.52, p = 0.017), and sedation during anesthesia recovery (1.76, 1.23–2.51, p = 0.002) were associated with POD. Anesthetic management was not associated with POD risk. Patients who developed POD required greater healthcare resources. Dementia is strongly associated with POD. The association between POD and transfusions may reflect higher acuity patients or detrimental effect of blood. Postoperative sedation should be recognized as a warning sign of increased risk.

Author Biographies

  • Jeffrey Huang, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
    Department of Anesthesiology and Perioperative Medicine
  • Juraj Sprung, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
    Department of Anesthesiology and Perioperative Medicine
  • Toby N. Weingarten, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
    Department of Anesthesiology and Perioperative Medicine
Delirium following total joint replacement surgery

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Published

12-02-2019

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Section

Translational and Clinical Research

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How to Cite

1.
Delirium following total joint replacement surgery. Biomol Biomed [Internet]. 2019 Feb. 12 [cited 2024 Mar. 28];19(1):81-5. Available from: https://www.bjbms.org/ojs/index.php/bjbms/article/view/3653