Incidence of delirium following total joint replacement in older adults: a meta-analysis

Scott, Julia S.; Mathias, Jane L.; Kneebone, Anthony C.

doi:10.1016/j.genhosppsych.2015.02.004

Cited by 78 publications

(96 citation statements)

References 67 publications

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“…The incidence of POD following total joint replacement in our study (27.5%) was within the reported range of 3.6–41% (Rudolph and Marcantonio, 2011; Xie et al, 2014; Scott et al, 2015). For example, Xie et al (2014) reported that POD occurred in 20% of patients (≥63 years old) who underwent total hip and knee replacement under spinal anesthesia.…”

Section: Discussionsupporting

confidence: 84%

NeurimmiRs and Postoperative Delirium in Elderly Patients Undergoing Total Hip/Knee Replacement: A Pilot Study

Dong

Sun

et al. 2017

Front. Aging Neurosci.

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Objective: Postoperative delirium (POD) is a frequent complication after surgery and its occurrence is associated with poor outcomes. The pathophysiology of this complication is not clear, but identification of risk factors is important for positive postoperative outcomes. The purpose of this study was to investigate the associations between the preoperative expression levels of microRNA (miR)-146a, miR-125b, and miR-181c in cerebrospinal fluid (CSF) and serum and the development and severity of POD.Methods: Forty elderly patients aged 65 years old and older admitted for elective total hip/knee replacement under spinal anesthesia. Preoperatively, baseline cognitive function was assessed using the Mini-Mental State Examination. Each patient was interviewed daily on the first and second postoperative days. Delirium was diagnosed using the Confusion Assessment Method, and delirium severity was measured using the Memorial Delirium Assessment Scale (MDAS). Preoperative serum and CSF miR levels were determined by quantitative real-time PCR (qRT-PCR).Results: POD was detected in 27.5% (11/40) of patients. Up-regulation of miR-146a and miR-181c in CSF and down-regulation of miR-146a in serum were observed preoperatively in patients who developed POD, while patients with and without POD did not differ in serum or CSF levels of miR-125b. Delirious patients had higher CSF/serum ratios of miR-146a and miR-181c levels than non-delirious patients. The lower CSF miR-146a and CSF/serum miR-146a ratios were significantly associated with milder POD severity, represented by a lower MDAS score.Conclusion: The dysregulation of preoperative miR-146a and miR-181c in CSF and serum was associated with the development and severity of POD. These NeurimmiRs might participate in the neuropathogenesis of POD, pending further investigations.Clinical trial registration: this study was registered at ClinicalTrials.gov (NCT02817386).

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Section: Discussionsupporting

confidence: 84%

NeurimmiRs and Postoperative Delirium in Elderly Patients Undergoing Total Hip/Knee Replacement: A Pilot Study

Dong

Sun

et al. 2017

Front. Aging Neurosci.

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“…Our results suggest that such a failure to undergo anteriorization, or to show significant frontal alpha power, under general anesthesia is an intraoperative, electrophysiological marker of poorer preoperative cognitive status. Since poor preoperative cognitive status is itself a risk factor for POCD (Bekker et al, 2010; Silbert et al, 2015; reviewed in Berger et al, 2015) and may be a risk factor for postoperative delirium (Greene et al, 2009; but also see Scott et al, 2015), this finding raises the possibility that a failure of the brain to manifest strong frontal alpha power under general anesthesia may also be a predictor of POCD and postoperative delirium. If future studies provide evidence for such associations between lower intraoperative frontal alpha power and postoperative delirium and/or POCD, then these results would suggest that lower intraoperative frontal alpha power (and deficient anteriorization) could be used as a real-time and relatively inexpensive intraoperative electrophysiological marker to identify patients at potential increased risk of postoperative delirium and/or POCD, and could be used to target these at-risk patients for potential therapeutic intervention and/or for increased postoperative follow-up care and monitoring.…”

Section: Discussionmentioning

confidence: 99%

“…Although POCD and delirium are distinct syndromes assessed by different instruments, each is associated with decreased quality of life (Phillips-Bute et al, 2006; Basinski et al, 2010; Naidech et al, 2013), increased 1-year mortality, long-term cognitive decline, and possible increased risk of developing dementia (Inouye et al, 2014, 2016; Berger et al, 2015). Further, poor preoperative cognitive function is a risk factor for developing POCD (Bekker et al, 2010; Silbert et al, 2015; reviewed in Berger et al, 2015) and may be a risk factor for postoperative delirium (Greene et al, 2009; but also see Scott et al, 2015). Thus, identifying patients with poor preoperative cognitive function could be used to risk-stratify patients at high risk of POCD and delirium, and to direct resources toward prevention, treatment, and management efforts for these high-risk patients.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Frontal Alpha-Band Power Correlates with Preoperative Neurocognitive Function in Older Adults

Giattino

Gardner

Sbahi

et al. 2017

Front. Syst. Neurosci.

106

107

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Each year over 16 million older Americans undergo general anesthesia for surgery, and up to 40% develop postoperative delirium and/or cognitive dysfunction (POCD). Delirium and POCD are each associated with decreased quality of life, early retirement, increased 1-year mortality, and long-term cognitive decline. Multiple investigators have thus suggested that anesthesia and surgery place severe stress on the aging brain, and that patients with less ability to withstand this stress will be at increased risk for developing postoperative delirium and POCD. Delirium and POCD risk are increased in patients with lower preoperative cognitive function, yet preoperative cognitive function is not routinely assessed, and no intraoperative physiological predictors have been found that correlate with lower preoperative cognitive function. Since general anesthesia causes alpha-band (8–12 Hz) electroencephalogram (EEG) power to decrease occipitally and increase frontally (known as “anteriorization”), and anesthetic-induced frontal alpha power is reduced in older adults, we hypothesized that lower intraoperative frontal alpha power might correlate with lower preoperative cognitive function. Here, we provide evidence that such a correlation exists, suggesting that lower intraoperative frontal alpha power could be used as a physiological marker to identify older adults with lower preoperative cognitive function. Lower intraoperative frontal alpha power could thus be used to target these at-risk patients for possible therapeutic interventions to help prevent postoperative delirium and POCD, or for increased postoperative monitoring and follow-up. More generally, these results suggest that understanding interindividual differences in how the brain responds to anesthetic drugs can be used as a probe of neurocognitive function (and dysfunction), and might be a useful measure of neurocognitive function in older adults.

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“…In addition, the differences in patients' values, cultural beliefs, expectations, and experiences across their lifespans influence quality of life. Hence, using only the care map may be problematic to predict older adults' health outcomes (Schrijvers et al, 2012;Scott, Mathias, & Kneebone, 2015).…”

Section: Is the Care Map A True Predictor Of Health Outcomes?mentioning

confidence: 99%

When a Care Map is Not a True Predictor of Clinical Outcomes

Roopsawang

Belza

2015

J Gerontol Nurs

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Incidence of delirium following total joint replacement in older adults: a meta-analysis

Cited by 78 publications

References 67 publications

NeurimmiRs and Postoperative Delirium in Elderly Patients Undergoing Total Hip/Knee Replacement: A Pilot Study

NeurimmiRs and Postoperative Delirium in Elderly Patients Undergoing Total Hip/Knee Replacement: A Pilot Study

Intraoperative Frontal Alpha-Band Power Correlates with Preoperative Neurocognitive Function in Older Adults

When a Care Map is Not a True Predictor of Clinical Outcomes

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