Delirium in the Orthopaedic Patient

Abstract

Published incidence of delirium in orthopaedic patients ranges from 5.1% to 61%. Delirium may present before or after the patient undergoes the surgical procedure and has demonstrated increased risk, including mortality. Yet, delirium goes unrecognized by both physicians and nurses. This article focuses on the literature on delirium in the orthopaedic patient, including incidence, how to identify those patients at risk, patient outcomes, nonpharmacological and pharmacological interventions, and provides an example of how one tertiary care hospital implemented a prevention and management program of delirium in orthopaedic patients.

Factors that contribute to underrecognition of delirium by registered nurses in acute care settings: a scoping review of the literature to explain this phenomenon

“…The authors stressed that it is not enough to provide nurses with the tools and teach them how to use them, but it is imperative to educate nurses on how to interpret the results of these tools so that they may intervene accordingly. Once again the findings of this study agree with the findings of similar studies that suggested that delirium detection increases when nurses receive comprehensive education on delirium and training in the use of a validated screening tool such as CAM (Neitzel et al 2007, Steis & Fick, 2012Waszynski & Petrovic 2008). Although the study contained a random sample of 800 nurses, only 181 responded (22Á62%).…”

“…Once again the findings of this study agree with the findings of similar studies that suggested that delirium detection increases when nurses receive comprehensive education on delirium and training in the use of a validated screening tool such as CAM (Neitzel et al . , Steis & Fick, ; Waszynski & Petrovic ). Although the study contained a random sample of 800 nurses, only 181 responded (22·62%).…”

“…Moreover, patients who were mistakenly perceived to have delirium by using subjective criteria were identified as nondelirious when they were assessed using CAM. Current literature supports Guenther's findings that delirium detection increases when nurses use validated screening tools such as CAM (Lemiengre et al 2006, Rigney 2006, Neitzel et al 2007, Steis & Fick, 2012, Waszynski & Petrovic 2008. However, Guenther et al (2012) failed to mention that the higher rate of delirium detection by the medical students could be related to the training sessions they received (a total of 75 minutes on how to use CAM) rather than the tool per se.…”

Developing a Strategy to Identify and Treat Older Patients With Postoperative Delirium

“…Antipsychotics have been studied extensively in the elderly patient population and should be administered at the lowest adequate dosages 65 . Haloperidol, the most widely studied antipsychotic, is the most frequently used antipsychotic medication for delirium because of its few anticholinergic side effects, few active metabolites, and small likelihood of causing sedation 65‐68 . Most studies have used doses of 0.25 to 0.50 mg haloperidol given every four hours for elderly or seriously medically compromised patients and doses of 2 to 3 mg per day in healthier patients 65,67‐69 .…”

Physical Activity and Risk of Postoperative Delirium

“…P ostoperative delirium (POD) affects between 9.9% and 67% 1 of older adults undergoing noncardiac surgery and 5.1% and 61% of older adults undergoing orthopedic surgery. 2 POD can have devastating long-term sequelae, such as cognitive dysfunction, decline in functional status, and increased morbidity and mortality. 3,4 Given that there are an estimated 13.6 million surgeries performed annually on patients aged 65 years and older in the United States alone, and approximately 5 million knee and hip replacements, the magnitude of this problem is staggering.…”