Electrolyte disorders and aging: risk factors for delirium in patients undergoing orthopedic surgeries

Abstract

BackgroundAt present, the exact mechanism of postoperative delirium has not been elucidated. The purpose of this study was to analyze the incidence of delirium in patients undergoing orthopedic surgeries and to explore possible related factors.MethodsThis is a retrospective study. We used 582 patients who had undergone orthopedic surgery between January 2011 and December 2014. The surgeries consisted of 155 cases of internal fixation for intertrochanteric fracture (IFIF), 128 cases of femoral head replacement (FHR), 169 cases of total hip arthroplasty (THA) and 130 cases of total knee arthroplasty (TKA). Among the 582 patients, 75 developed postoperative delirium (an incidence of 12.9%). The demographics of the patients, which included age, gender, operation duration and blood loss, were statistically analyzed with univariate logistic regression analysis and then multivariate logistic regression. To investigate the influences of different electrolytes disorders for postoperative delirium, the Chi-square test was used.ResultsMultivariate logistic regression analysis indicated that postoperative delirium incidence in patients aged 70–79 years and in patients aged ≥80 years was higher than that in patients aged <70 years, odds ratio (OR) values were 6.33 and 26.37, respectively. In addition, the incidence of postoperative delirium in the group of patients with electrolyte disorders was higher than that in the normal group (OR, 2.38). There were statistically significant differences between the delirium group and the non-delirium group in the incidences of the sodium and calcium disorders.ConclusionsAging and postoperative electrolyte disorders (hyponatremia and hypocalcemia) are risk factors for postoperative delirium in patients undergoing orthopedic surgeries.

Incidence and Risk Factors of Postoperative Delirium Following Primary Elective Total Hip Arthroplasty: A Retrospective Nationwide Inpatient Sample Database Study

“…In terms of demographics, patients suffered from postoperative delirium were significantly older than those without. This was highly consistent with previous studies which had identified advanced age as a common independent predictor of postoperative delirium [1,9,20,21,22,23,24,25].Interestingly, there was significant difference of race distribution between the two groups, indicating a racial difference in occurrence of postoperative delirium. Our study found that the Whites occupying a larger proportion in the postoperative delirium group.…”

“…In order to optimize postoperative outcomes and prevent complications, it is critical to identify preoperatively whether patients are at high risk of postoperative delirium [1,19,20,21]. Several risk factors of postoperative delirium had been reported in previous literatures, among which advanced age is the most frequently acknowledged [1,9,19,20,21,22,23,24,25]. Other risk factors, including a history of dementia or psychiatric illness, cognitive impairment, polypharmacy, postoperative electrolyte disorders, and diabetes, had also been identified [1,9,20,21,22,23,24,25].…”

“…Several risk factors of postoperative delirium had been reported in previous literatures, among which advanced age is the most frequently acknowledged [1,9,19,20,21,22,23,24,25]. Other risk factors, including a history of dementia or psychiatric illness, cognitive impairment, polypharmacy, postoperative electrolyte disorders, and diabetes, had also been identified [1,9,20,21,22,23,24,25]. However, currently there is a paucity of studies about the incidence and risk factors of postoperative delirium associated with primary elective THA based on large-scale national database analysis [7,9,20,21,22,23,24,25].…”

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

“…Intravenous zoledronic acid and subcutaneous denosumab and romosozumab are associated with hypocalcemia, (20,73,74) for example, which is a significant risk factor for postoperative delirium in patients undergoing hip fracture repair. (75) These drugs are contraindicated in patients with hypocalcemia, (74,76,77) and many surgical patients are hypocalcemic in the postoperative period. (78)(79)(80) In the key HORIZON Recurrent Fracture Trial, patients with osteoporosis who had recently fractured a hip did not receive their first zoledronic acid infusion until after they had taken calcium and vitamin D supplements for at least 2 weeks.…”

Letter to the Editor on “The Role of Perioperative Statin Use in the Prevention of Delirium After Total Knee Replacement Under Spinal Anesthesia”

“…There is no mention about the preoperative functional status of patients and history of any psychiatric disorder including depression, 2 independent predictors of POD reported in a systematic review of patients undergoing total joint arthroplasty [3]. Moreover, there is no information about postoperative laboratory parameters including postoperative day 3 blood urea nitrogen, serum electrolytes, and fluid balance, which could have potentially influenced the delirium incidence in the 2 groups [4,5]. Also, postoperative rehabilitation protocol, including the mobility status of the patients, which could have affected the development of delirium, should have been discussed in the 2 groups.…”