Postoperative delirium after major orthopedic surgery

doi:10.5312/wjo.v11.i2.90

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World Journal of Orthopedics

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2218-5836

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Orthop. Feb 18, 2020; 11(2): 90-106
Published online Feb 18, 2020. doi: 10.5312/wjo.v11.i2.90

Table 6 Perioperative risk factors and adjusted association with postoperative delirium by procedure

	THAOR (95%CI), n = 18276	THA P value	TKAOR (95%CI), n = 19987	TKA P value	SFOR (95%CI), n = 4183	SF P value
Age, yr
≥ 70 vs < 70	4.9 (3.0, 7.9)	< 0.001^a	2.16 (1.58, 2.94)	< 0.001^a	-	-
≥ 65 vs < 65	-	-	-	-	2.76 (1.79, 4.25)	< 0.001^a
Male	0.90 (0.60, 1.35)	0.62	0.82 (0.60, 1.12)	0.21	0.73 (0.48, 1.10)	0.13
BMI	0.94 (0.90, 0.98)	0.004^a	0.99 (0.96, 1.02)	0.37	0.99 (0.95, 1.02)	0.46
Latest creatinine value before surgery
1.2-2.0 mg/dL vs < 1.2 mg/dL	1.77 (1.05, 3.00)	0.03^a	0.79 (0.49, 1.27)	0.32	1.40 (0.73, 2.68)	0.31
> 2.0 mg/dL vs < 1.2 mg/dL	4.08 (1.06, 15.66)	0.04^a	1.39 (0.46, 4.20)	0.56	2.26 (0.20, 26.24)	0.51
Preoperative hyponatremia	2.36 (1.54, 3.64)	< 0.001^a	1.25 (0.87, 1.79)	0.23	1.24 (0.82, 1.88)	0.31
PCA route
IV vs Epidural	1.98 (1.19, 3.28)	0.008^a	1.26 (0.83, 1.92)	0.27	-	-
Peripheral nerve infusion vs Epidural	-	-	0.93 (0.47, 1.86)	0.85	-	-
Postoperative thiamine order	5.05 (2.72, 9.37)	< 0.001^a	6.40 (4.00, 10.26)	<0.001^a	6.64 (3.72, 11.85)	<0.001^a
ASA Score
2 vs 1	-	-	1.91 (0.26, 13.88)	0.52	1.90 (0.25, 14.19)	0.53
> 3 vs 1	-	-	3.63 (0.49, 26.74)	0.21	2.38 (0.31, 18.46)	0.41
≥ 3 vs 2	2.01 (1.33, 3.05)	< 0.001^a	-	-	-	-
Anesthesia type
Other vs general	2.92 (0.66, 12.85)	0.16	0.89 (0.43, 1.82)	0.74	-	-
Surgery length	1.00 (1.00, 1.01)	0.10	1.00 (0.99, 1.01)	0.55	1.00 (1.00, 1.00)	<0.001^a
Atrial fibrillation, present on admission	0.97 (0.53, 1.77)	0.91	1.93 (1.32, 2.81)	<0.001^a	2.19 (1.09, 4.41)	0.03^a
Pressure ulcers, present on admission	0.65 (0.08, 5.05)	0.68	-	-	7.56 (1.89, 30.24)	0.004^a
Opioid dependence or long-term use	7.11 (3.26, 15.51)	< 0.001^a	2.98 (1.38, 6.41)	0.005^a	1.88 (0.91, 3.90)	0.09
Parenteral diazepam	5.05 (1.5, 16.97)	0.009^a	4.40 (1.52, 12.75)	0.007^a	2.17 (1.19, 3.97)	0.01^a
Elixhauser comorbidity
Deficiency anemias	1.64 (0.74, 3.63)	0.22	1.10 (0.57, 2.11)	0.78	1.11 (0.42, 2.93)	0.83
Congestive heart failure	2.35 (0.93, 5.96)	0.07	1.59 (0.74, 3.38)	0.23	1.54 (0.39, 6.11)	0.54
Rheumatoid arthritis/collagen vascular diseases	1.06 (0.45, 2.51)	0.900	0.35 (0.13, 0.94)	0.04^a	1.02 (0.49, 2.13)	0.95
Chronic pulmonary disease	1.13 (0.67, 1.92)	0.64	0.84 (0.55, 1.28)	0.41	1.06 (0.65, 1.73)	0.82
Coagulopathy	1.32 (0.39, 4.53)	0.66	1.60 (0.70, 3.62)	0.26	2.80 (1.05, 7.50)	0.04^a
Depression	1.70 (1.05, 2.75)	0.03^a	1.47 (1.02, 2.11)	0.04^a	2.61 (1.73, 3.92)	<0.001^a
Diabetes w/o chronic complications	1.54 (0.90, 2.64)	0.12	1.90 (1.36, 2.66)	< 0.001^a	1.54 (0.92, 2.58)	0.10
Diabetes w chronic complications	2.05 (0.45, 9.23)	0.35	1.77 (0.68, 4.58)	0.24	3.34 (1.02, 10.91)	0.046^a
Hypertension	1.62 (1.06, 2.48)	0.03^a	1.21 (0.59, 1.64)	0.23	1.00 (0.66, 1.51)	0.99
Hypothyroidism	1.01 (0.61, 1.66)	0.98	1.46 (1.06, 2.02)	0.02^a	1.07 (0.65, 1.76)	0.80
Liver disease	0.41 (0.05, 3.22)	0.40	0.70 (0.16, 3.07)	0.63	0.71 (0.15, 3.30)	0.66
Lymphoma	1.33 (0.25, 7.20)	0.74	-	-	-	-
Fluid and electrolyte disorders	0.31 (0.04, 2.43)	0.26	1.41 (0.44, 4.56)	0.57	1.14 (0.36, 3.63)	0.82
Other neurological disorders	2.04 (0.98. 4.27)	0.06	2.79 (1.69, 4.60)	< 0.001^a	2.14 (1.10, 4.14)	0.02^a
Obesity	1.06 (0.53, 2.12)	0.88	0.79 (0.53, 1.19)	0.27	1.56 (0.90, 2.69)	0.11
Peripheral vascular disorders	1.20 (0.47, 3.10)	0.70	1.40 (0.62, 3.16)	0.42	1.68 (0.64, 4.42)	0.30
Psychoses	2.52 (0.81, 7.90)	0.11	6.39 (3.51, 11.62)	< 0.001^a	4.95 (2.38, 10.28)	<0.001^a
Pulmonary circulation disorders	1.20 (0.47, 3.10)	0.70	1.69 (0.89, 3.23)	0.11	1.57 (0.51, 4.88)	0.44
Renal failure	0.94 (0.41, 2.15)	0.88	2.32 (1.31, 4.11)	0.004^a	0.97 (0.39, 2.45)	0.95
Solid tumor w/o metastasis	-	-	1.42 (0.31, 6.45)	0.65	-	-
Valvular disease	1.08 (0.59, 1.97)	0.80	1.23 (0.79, 1.92)	0.37	1.17 (0.61, 2.26)	0.63
Weight loss	0.61 (0.05, 7.46)	0.70	7.14 (0.62, 82.11)	0.11	-	-

^aP < 0.05. POD: Postoperative delirium; THA: Total hip arthroplasty; TKA: Total knee arthroplasty; ASA: American society of anesthesiologists; PCA: Patient-controlled analgesia; SF: Spine fusion surgery; CI: Confidence interval; BMI: Body mass index; OR: Odds ratio.

Citation: Urban MK, Sasaki M, Schmucker AM, Magid SK. Postoperative delirium after major orthopedic surgery. World J Orthop 2020; 11(2): 90-106
URL: https://www.wjgnet.com/2218-5836/full/v11/i2/90.htm
DOI: https://dx.doi.org/10.5312/wjo.v11.i2.90