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Background Postoperative delirium (POD) is a common complication after major surgery, resulting in various adverse reactions. However, incidence and risk factors associated with POD after shoulder arthroplasty (SA) have not been well studied using a large-scale national database. Methods A retrospective database analysis was performed based on the Nationwide Inpatient Sample (NIS) from 2005 to 2014, the largest fully paid hospital care database in the United States. Patients undergoing SA were included. The patient’s demographics, comorbidities, length of stay (LOS), total costs, type of insurance, type of hospital, in-hospital mortality, and medical and surgical perioperative complications were assessed. Results A total of 115,147 SA patients were obtained from the NIS database. The general incidence of delirium after SA was 0.89%, peaking in 2010. Patients with delirium after SA had more comorbidities, prolonged LOS, increased hospitalization costs, and higher in-hospital mortality (P < 0.0001). These patients were associated with medical complications during hospitalization, including acute renal failure, acute myocardial infarction, pneumonia, pulmonary embolism, stroke, urinary tract infection, sepsis, continuous invasive mechanical ventilation, blood transfusion, and overall perioperative complications. Risk factors associated with POD include advanced age, neurological disease, depression, psychosis, fluid and electrolyte disturbances, and renal failure. Protective factors include elective hospital admissions and private insurance. Conclusion The incidence of delirium after SA is relatively low. Delirium after SA was associated with increased comorbidities, LOS, overall costs, Medicare coverage, mortality, and perioperative complications. Studying risk factors for POD can help ensure appropriate management and mitigate its consequences. Meanwhile, we found some limitations of this type of research and the need to establish a country-based POD database, including further clearly defining the diagnostic criteria for POD, investigating risk factors and continuing to collect data after discharge (30 days or more), so as to further improve patient preoperative optimization and management.

Background Women reported significantly poorer health and poorer outcomes in some surgeries than men. As the patients with frailty got more and more attention in joint placement. It is necessary to find whether frail women also need to be paid more attention after TKA or THA. Further, it is also needed to discuss specifically the different impacts of sex in the perioperative period for frail patients undergoing TKA or THA. Method We used the frailty-defining diagnosis cluster and the discharge data from the National Inpatient Sample database of patients who underwent THA and TKA. Bivariate and multivariate analysis methods were performed to find the association between sex and patient characteristics and postoperative complications of these patients. Result Frail patients undergoing TKA comprised 34.6% male and 65.4% female. In the multivariate analysis, the female sex was found to be a protective factor for mortality, acute cardiac events, acute renal failure, pneumonia, DVT_PE, and postoperative delirium. Frail patients undergoing THA were 39.5% male and 60.4% female. In the multivariate analysis, the female sex was found to be a protective factor for acute cardiac events, acute pulmonary edema, acute renal failure, and pneumonia. Moreover, whether in TKA or THA, the male sex rather than the female sex is closely associated with serious comorbidities. Lower hospital costs were also associated with the female sex. Conclusion Female sex acts as a protective factor for postoperative complications of THA or TKA. Therefore, frail men rather than frail women need more attention from clinicians, although the proportion of frail women is far greater than that of men.