Postoperative Delirium in Elderly Patients after Elective Hip or Knee Arthroplasty Performed under Regional Anesthesia

Rade, Matthew C.; YaDeau, Jacques T.; Ford, Carey; Reid, M. Carrington

doi:10.1007/s11420-011-9195-2

Cited by 36 publications

(26 citation statements)

References 17 publications

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“…Radcliff et al (2012) reported the incidence of delirium as 10.4% after TKA, which is higher than that in the present study. However, Rade et al (2011) did not describe the diagnostic criteria or diagnostic process, and included ''confusion'' as delirium. Rade et al reported that the incidence of delirium after TKA was 5%, using the CAM; however, this study was limited to only 20 patients with average age of 78 years.…”

Section: Discussionmentioning

confidence: 99%

“…Although the incidence of delirium in that study is slightly higher compared with that in the present study, that study had a very small sample and a relatively older age of 78 years; in addition, an anesthesiologist confirmed the final diagnosis of delirium, not a psychiatrist. Even though the CAM has been widely used as a standardized delirium instrument for clinical and research purposes and was developed for non-psychiatrically trained personnel (Rade et al, 2011), it is not sensitive when used by individuals with minimal training, with sensitivities as low as 50% (Sands, Dantoc, Hartshorn, Ryan, & Lujic, 2010). Additionally, the status of the patients after the TKA procedures could be influenced by several factors, such as surgeon factors, the hospital environment, and patient factors.…”

Section: Discussionmentioning

confidence: 99%

“…Two research members (KSC, JKL) and the nursing staff were trained to focus on the symptoms of delirium and for assessing mental status using the observational guidelines based on the CAM and DSM IV. The symptoms included acute onset; fluctuating course; inattention; disorganized thinking; disturbance of consciousness; disorientation of patients to their own identity, time, and current situation; disturbances developing over a short period of time; and altered sleep/wake cycles (Andersson, Gustafson, & Hallberg, 2001;Rade, Yadeau, Ford, & Reid, 2011). Two research members checked the patient's mental status twice per day, in the morning and evening, and the nursing staff checked the patient's mental status during the day and night after the operation.…”

Section: Study Design and Participantsmentioning

confidence: 99%

See 2 more Smart Citations

Risk factors of delirium in patients undergoing total knee arthroplasty

Chung¹,

Lee²,

Park³

et al. 2015

Archives of Gerontology and Geriatrics

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Design and Participantsmentioning

confidence: 99%

See 1 more Smart Citation

Risk factors of delirium in patients undergoing total knee arthroplasty

Chung¹,

Lee²,

Park³

et al. 2015

Archives of Gerontology and Geriatrics

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“…Modern studies have evaluated the risk factors and incidence of postoperative delirium in post-TKA patients. A systematic review (3) investigating the incidence, risk factors, and prevention strategies for postoperative delirium analysed ten original articles, of which five original articles studied the incidence and risk factors of postoperative delirium in patients undergoing TJA-a total of three studies (4-6) done on its incidence as well as a total of two studies (5,6) done on its risk factors. The incidence ranged from 0% to 10%, whereas the independent predictors of postoperative delirium included age, history of psychiatric illness, decreased functional status, decreased verbal memory and the use of specific anaesthetic agents (benzodiazepines and opioids).…”

Section: Introductionmentioning

confidence: 99%

Incidence of postoperative delirium in patients undergoing total knee arthroplasty—an Asian perspective

Huang¹,

Razak²,

Yeo³

2017

Ann. Transl. Med.

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Background: Very little is known in the literature with regards to the incidence of postoperative delirium following total knee arthroplasty (TKA) in Asians and the associated surgical factors. We conducted a retrospective study on incidence of postoperative delirium following TKA in Asians. Methods:One thousand sixteen knees of 954 consecutive patients who underwent TKA by the senior author of this study in the year 2006 were included in this review. All written and electronic medical records for patients were screened. Delirium was recorded to be present based on clinical entry onto the patients' inpatient hospital notes and a diagnosis made by psychiatrist based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). All statistical analysis was performed using SPSS v.18.0 (IBM Corp., Armonk, NY, USA). Results:The incidence of postoperative delirium in our patients undergoing TKA was 0.59%. Six patients had a confirmed diagnosis of delirium postoperatively. We noted an association between a higher mean age (P<0.0001), a lower body mass index (P<0.0001), Chinese ethnicity (P=0.002), male gender (P=0.002) and chronic opioid use (P<0.0001) with incidence of post-operative delirium. We also noted a higher proportion of post-operative DVT (P<0.0001) and wound infection (P<0.0001) in the delirium group. Conclusions:The incidence of postoperative delirium in Asians undergoing TKA in our institution is very low at 0.59%. Advanced age, lower body mass index, Chinese ethnicity, male gender and preoperative chronic opioid use may be associated with developing postoperative delirium.

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“…[116][117][118] They may also bring enormous distress to the patients, family members, and care givers. 119 …”

Section: Postoperative Deliriummentioning

confidence: 99%

Dementia With Lew Body

Pervin

Edwards

Lippa

2015

Am J Alzheimers Dis Other Demen

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Patients who have dementia with Lewy bodies (DLB) and undergo surgery may develop aggravated postoperative cognitive dysfunction or postoperative delirium. Many patients with DLB respond poorly to surgery and anesthesia, and their conditions may worsen if they have other medical complications along with dementia. They may also face high risk of prolonged hospital stay, increased medical problems and/or mortality, causing significant physical, psychosocial, and financial burdens on individuals, family members, and society. Anesthesia, pain medications, old age, and surgery-related stresses are usually held responsible for the complications; however, the exact causes are still not fully understood. Literature on surgery-related complications for patients with DLB appears to be inadequate, and hence the topic merits detailed and systematic research. This article reviews postoperative complications and various surgery-related risk factors for DLB in light of other dementias such as Alzheimer's disease, as their neuropathologic features overlap with those of DLB.

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Postoperative Delirium in Elderly Patients after Elective Hip or Knee Arthroplasty Performed under Regional Anesthesia

Abstract: Delirium is a major adverse postoperative event in elderly patients.

Cited by 36 publications

References 17 publications

Risk factors of delirium in patients undergoing total knee arthroplasty

Risk factors of delirium in patients undergoing total knee arthroplasty

Incidence of postoperative delirium in patients undergoing total knee arthroplasty—an Asian perspective

Dementia With Lew Body

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