J Knee Surg 2017; 30(06): 600-605
DOI: 10.1055/s-0036-1593872
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Risk Factors of Postoperative Delirium after Total Knee Arthroplasty

Lih Wang
1   Department of Orthopedic Surgery, Dong-A University Medical Center, Busan, The Republic of Korea
,
Sangyun Seok
1   Department of Orthopedic Surgery, Dong-A University Medical Center, Busan, The Republic of Korea
,
Sungsoo Kim
1   Department of Orthopedic Surgery, Dong-A University Medical Center, Busan, The Republic of Korea
,
Kyungtaek Kim
2   Department of Orthopedic Surgery, Dong Eui Medical Center, Busan, The Republic of Korea
,
Seunghyun Lee
1   Department of Orthopedic Surgery, Dong-A University Medical Center, Busan, The Republic of Korea
,
Kyungho Lee
1   Department of Orthopedic Surgery, Dong-A University Medical Center, Busan, The Republic of Korea
› Author Affiliations
Further Information

Publication History

01 June 2016

18 September 2016

Publication Date:
23 November 2016 (online)

Abstract

We investigated the results of delirium which developed after total knee arthroplasty (TKA) and the risk factors for delirium in the patients who are older than 65 years. From March 2008 to March 2012, we performed a retrospective study on 296 knees of 265 patients who were treated with TKA. They were divided into two groups: 216 patients without delirium and 49 patients diagnosed with delirium by psychiatry. We analyzed the risk factors into three categories: First, the preoperative factors including gender, age, body mass index (BMI), clinical and functional knee joint score (Knee Society Knee Score and Knee Society Function Score) and the number of underlying diseases and associations with each disease; Second, the operative factors including the anesthesia method, amount of blood loss, operating time, laboratory factors, and transfusion count; Third, the postoperative factors such as start time of walking and duration of hospital stay were analyzed. There were significant statistical difference between two groups just in age, history of dementia, cerebrovascular disease, difference of hemoglobin and albumin, start time of walking, and duration of hospital stay. The delirium after TKA delays the postoperative ambulation and extends the hospital stay, which causes functional and socioeconomic loss of patients. Therefore, the risk factors for delirium should be assessed and proper prevention and management should be conducted.

 
  • References

  • 1 Francis J, Martin D, Kapoor WN. A prospective study of delirium in hospitalized elderly. JAMA 1990; 263 (08) 1097-1101
  • 2 Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA 1996; 275 (11) 852-857
  • 3 Inouye SK, Rushing JT, Foreman MD, Palmer RM, Pompei P. Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. J Gen Intern Med 1998; 13 (04) 234-242
  • 4 Levkoff SE, Evans DA, Liptzin B. , et al. Delirium. The occurrence and persistence of symptoms among elderly hospitalized patients. Arch Intern Med 1992; 152 (02) 334-340
  • 5 Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc 2001; 49 (05) 516-522
  • 6 Bekker AY, Weeks EJ. Cognitive function after anaesthesia in the elderly. Best Pract Res Clin Anaesthesiol 2003; 17 (02) 259-272
  • 7 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 (04) 378-389
  • 8 Sockalingam S, Parekh N, Bogoch II. , et al. Delirium in the postoperative cardiac patient: a review. J Card Surg 2005; 20 (06) 560-567
  • 9 Rogers MP, Liang MH, Daltroy LH. , et al. Delirium after elective orthopedic surgery: risk factors and natural history. Int J Psychiatry Med 1989; 19 (02) 109-121
  • 10 Williams-Russo P, Urquhart BL, Sharrock NE, Charlson ME. Post-operative delirium: predictors and prognosis in elderly orthopedic patients. J Am Geriatr Soc 1992; 40 (08) 759-767
  • 11 Flink BJ, Rivelli SK, Cox EA. , et al. Obstructive sleep apnea and incidence of postoperative delirium after elective knee replacement in the nondemented elderly. Anesthesiology 2012; 116 (04) 788-796
  • 12 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 (01) 173-178
  • 13 Postler A, Neidel J, Günther K-P, Kirschner S. Incidence of early postoperative cognitive dysfunction and other adverse events in elderly patients undergoing elective total hip replacement (THR). Arch Gerontol Geriatr 2011; 53 (03) 328-333
  • 14 Rade MC, YaDeau JT, Ford C, Reid MC. Postoperative delirium in elderly patients after elective hip or knee arthroplasty performed under regional anesthesia. HSS J 2011; 7 (02) 151-156
  • 15 Hwang SK, Lee CH. Postoperative delirium after hip arthroplasty in the elderly. HSS J 2010; 22: 151-158
  • 16 Yoon HK, Cho DY, Shin DE, Kim JH, Lee JS, Kim JH. Bipolar hemiarthroplasty for the femur neck fractures in patients aged around ninety. J Korean Fract Soc 2004; 17: 209-213
  • 17 Kim YS, Yoo RH, Ko SH, Kim DC, Han YJ. Cardiac arrest during hip arthroplasty and postoperative delirium in the elderly patient: a case report. Korean J Anesthesiol 1999; 36: 365-369
  • 18 Chung KS, Lee JK, Park JS, Choi CH. Risk factors of delirium in patients undergoing total knee arthroplasty. Arch Gerontol Geriatr 2015; 60 (03) 443-447
  • 19 Cole MG, Primeau FJ. Prognosis of delirium in elderly hospital patients. CMAJ 1993; 149 (01) 41-46
  • 20 George J, Bleasdale S, Singleton SJ. Causes and prognosis of delirium in elderly patients admitted to a district general hospital. Age Ageing 1997; 26 (06) 423-427
  • 21 Saxena S, Lawley D. Delirium in the elderly: a clinical review. Postgrad Med J 2009; 85 (1006): 405-413
  • 22 Trzepacz PT. Delirium. Advances in diagnosis, pathophysiology, and treatment. Psychiatr Clin North Am 1996; 19 (03) 429-448
  • 23 van der Mast RC. Pathophysiology of delirium. J Geriatr Psychiatry Neurol 1998; 11 (03) 138-145 , discussion 157–158
  • 24 Morrison RS, Magaziner J, Gilbert M. , et al. Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol A Biol Sci Med Sci 2003; 58 (01) 76-81
  • 25 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 (01) 51-56
  • 26 Rockwood K, Cosway S, Carver D, Jarrett P, Stadnyk K, Fisk J. The risk of dementia and death after delirium. Age Ageing 1999; 28 (06) 551-556
  • 27 Bedford PD. Adverse cerebral effects of anaesthesia on old people. Lancet 1955; 269 (6884): 259-263
  • 28 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 (07) 655-662
  • 29 Robertson BD, Robertson TJ. Postoperative delirium after hip fracture. J Bone Joint Surg Am 2006; 88 (09) 2060-2068