Effect of anesthetic method on incidence of delirium after total hip replacement arthroplasty in South Korea: a population-based study using National Health Insurance claims data

Abstract

Background: There are various reports on the effects of the anesthetic method on neurologic complications. A population-based study was conducted to estimate the effect of anesthetic method on the incidence of postoperative delirium in patients that underwent total hip replacement arthroplasty in South Korea. Methods: The Korean National Health Insurance claims database was used to retrospectively identify and analyze 24,379 cases of total hip replacement arthroplasty, defined as patients having a claim record with the operation code 'N0711, ' from January 2008 to December 2017. Patients were divided into two groups, a general anesthesia group (n = 9,921) and a regional anesthesia group (n = 14,458). The incidence of delirium was assessed in cases when patients used medications for delirium, such as haloperidol, chlorpromazine, olanzapine, and risperidone. Results: Of the 9,921 patients receiving general anesthesia and 14,458 receiving regional anesthesia, 142 (1.43%) and 209 (0.86%) experienced postoperative delirium after total hip replacement arthroplasty, respectively. There was no significant difference between the groups (P = 0.92). In logistic regression analysis, sex (P = 0.038) and patients with acquired immune deficiency syndrome (P = 0.008) were predictors of postoperative delirium. Conclusions: Our results revealed that the anesthetic method was not associated with the incidence of postoperative delirium. In addition, the results suggest that male patients and patients with acquired immune deficiency syndrome undergoing total hip replacement arthroplasty carefully managed for postoperative delirium after surgery.

The Effect of General Anesthesia vs. Regional Anesthesia on Postoperative Delirium—A Systematic Review and Meta-Analysis

“…Tables 1 , 2 present the basic characteristics of the included studies. There were nine retrospective ( 17 , 18 , 22 , 25 , 28 – 31 , 35 ), and 12 prospective ( 19 – 24 , 26 , 27 , 32 – 34 , 36 , 37 ) articles, including seven randomized and non-randomized controlled trials, in the prospective studies ( 20 , 23 , 24 , 32 – 34 , 37 ). Male accounted for 50% or more of all patients in 4 trials ( 17 , 22 , 23 , 25 ).…”

“…There were nine retrospective ( 17 , 18 , 22 , 25 , 28 – 31 , 35 ), and 12 prospective ( 19 – 24 , 26 , 27 , 32 – 34 , 36 , 37 ) articles, including seven randomized and non-randomized controlled trials, in the prospective studies ( 20 , 23 , 24 , 32 – 34 , 37 ). Male accounted for 50% or more of all patients in 4 trials ( 17 , 22 , 23 , 25 ). The mean or median age of all included patients was 80 years or older in five trials ( 20 , 26 , 31 – 33 ), 70–80 years in seven trials ( 21 , 28 , 29 , 34 – 37 ), 60–70 years in seven trials ( 17 , 18 , 23 – 25 , 27 , 30 ), and younger than 60 years in two trials ( 19 , 22 ).…”

“…Male accounted for 50% or more of all patients in 4 trials ( 17 , 22 , 23 , 25 ). The mean or median age of all included patients was 80 years or older in five trials ( 20 , 26 , 31 – 33 ), 70–80 years in seven trials ( 21 , 28 , 29 , 34 – 37 ), 60–70 years in seven trials ( 17 , 18 , 23 – 25 , 27 , 30 ), and younger than 60 years in two trials ( 19 , 22 ). Except that the patients underwent lower limb vascular surgery in two articles ( 23 , 25 ) and uncertain surgeries in one article ( 19 ), the patients underwent orthopedic surgery in the other trials.…”

“…The patients in the RA group received the sole PNB in only two trials ( 17 , 29 ), and underwent PNB or neuraxial anesthesia in another two trials ( 25 , 35 ), while neuraxial anesthesia was the sole anesthesia in RA patients in the other 17 enrolled trials. The follow-up time was hospital stay after surgery in 13 trials ( 18 , 22 , 25 – 33 , 35 , 36 ), 1 year in one trial ( 23 ), 30 days in one trial ( 17 ), 1–7 days in one trial ( 20 ), 1–5 day in one trial ( 34 ), 1–4 days in one trial ( 37 ), 1–3 days in two trials ( 21 , 24 ), and 1 day in one trial ( 19 ). The methods of POD identification included antipsychotic drug use ( 17 , 18 , 22 , 30 ), Confusion Assessment Method for Intensive Care Unit (CAM-ICU) or CAM ( 19 , 21 , 36 , 37 ), DSM-IV criteria ( 24 , 27 ), NEECHAM confusion scale ( 25 ), change in mental state ( 23 ), and Pittsburgh Agitation Scale ( 26 ).…”

“…The follow-up time was hospital stay after surgery in 13 trials ( 18 , 22 , 25 – 33 , 35 , 36 ), 1 year in one trial ( 23 ), 30 days in one trial ( 17 ), 1–7 days in one trial ( 20 ), 1–5 day in one trial ( 34 ), 1–4 days in one trial ( 37 ), 1–3 days in two trials ( 21 , 24 ), and 1 day in one trial ( 19 ). The methods of POD identification included antipsychotic drug use ( 17 , 18 , 22 , 30 ), Confusion Assessment Method for Intensive Care Unit (CAM-ICU) or CAM ( 19 , 21 , 36 , 37 ), DSM-IV criteria ( 24 , 27 ), NEECHAM confusion scale ( 25 ), change in mental state ( 23 ), and Pittsburgh Agitation Scale ( 26 ). Seven articles did not provide a specific diagnostic method of POD ( 20 , 28 , 29 , 31 – 33 , 35 ), and a combination of CAM with DSM-IV criteria ( 34 ).…”