Postoperative Delirium in Patients Undergoing Total Joint Arthroplasty: A Systematic Review

Razak, Hamid Rahmatullah Bin Abd; Yung, Wai Yin Ambrose

doi:10.1016/j.arth.2015.03.012

Cited by 83 publications

(124 citation statements)

References 23 publications

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“…The analyses were completed with adjusting for several confounders and risk factors; however, residual confounding could be present as the study was non-randomized. Known delirium risk factors such as dementia, decreased functional status, and psychiatric illness were not incorporated into the model (37). Hemodynamic data was not available for inclusion in our analysis, which may differ when comparing OPCAB to CABG patients and also deviations from optimal intraoperative blood pressure could be linked to delirium (38).…”

Section: Discussionmentioning

confidence: 99%

Risk factors for delirium after cardiac surgery: a historical cohort study outlining the influence of cardiopulmonary bypass

O’Neal

Billings

Liu

et al. 2017

Can J Anesth/J Can Anesth

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Purpose Cardiopulmonary bypass (CPB) induces a significant inflammatory response that may increase the risk for delirium. We hypothesized that exposure to CPB during coronary artery bypass grafting surgery would correlate with an increased risk of delirium and would be associated with several other outcomes. Methods We reviewed clinical data from two databases at our medical center, the Cardiac Surgery Perioperative Outcomes Database and the Society of Thoracic Surgeons Database. Patients undergoing elective coronary artery bypass grafting surgery (on-pump and off-pump) from November 1, 2009 to September 30, 2015 were included in the study. Delirium was defined as any positive CAM-ICU exam following surgery during the ICU course. We performed logistic regression to isolate the association between CPB exposure and delirium adjusted for predetermined risk factors and potential confounders. Results During the study period, a total of 2,280 patients underwent elective coronary artery bypass grafting surgery with 384 patients (16.9%) exposed to CPB. Delirium was diagnosed in 451 patients (19.8%). CPB exposure demonstrated a significant independent association with delirium (P = 0.002). The adjusted relative risk (RR) of delirium was 2.18 (95% CI, 1.39 to 3.07; P = 0.002) among patients exposed to CPB for 142 minutes (90th percentile of CPB duration), compared to a RR of only 1.51 (95% CI, 0.92 to 2.29; P = 0.10) for those on CPB for 54 minutes (10th percentile). Conclusions CPB use and duration of use were associated with an increased risk of delirium in patients undergoing coronary artery bypass grafting surgery.

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Section: Discussionmentioning

confidence: 99%

Risk factors for delirium after cardiac surgery: a historical cohort study outlining the influence of cardiopulmonary bypass

O’Neal

Billings

Liu

et al. 2017

Can J Anesth/J Can Anesth

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“…Known delirium risk factors such as dementia, decreased functional status, and psychiatric illness were not incorporated into the model. 17 Delirium was recorded by nurses in the ICU using the CAM-ICU method. Although using the CAM-ICU by nurses was previously validated, 18 the consistency in which delirium was measured may not have been similar across all patients.…”

Section: Discussionmentioning

confidence: 99%

Effect of Preoperative Beta-Blocker Use on Outcomes Following Cardiac Surgery

O’Neal

Billings

Liu

et al. 2017

The American Journal of Cardiology

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Recent studies suggest that the use of preoperative β blockers in cardiac surgery may not provide improved mortality rates and may even contribute to negative clinical outcomes. We therefore assessed the role of β blockers on several outcomes after cardiac surgery (delirium, acute kidney injury [AKI], stroke, atrial fibrillation (AF), mortality, and hospital length of stay) in 4,076 patients who underwent elective coronary artery bypass grafting, coronary artery bypass grafting + valve, or valve cardiac surgery from November 1, 2009, to September 30, 2015, at Vanderbilt Medical Center. Clinical data from 2 prospectively collected datasets at our institution were reviewed: the Cardiac Surgery Perioperative Outcomes Database and the Society of Thoracic Surgeons Database. Preoperative β-blocker use was defined by Society of Thoracic Surgeons guidelines as patients receiving a β blocker within 24 hours preceding surgery. Of the included patients, 2,648 (65.0%) were administered a β blocker within 24 hours before surgery. Adjusting for possible confounders, preoperative β-blocker use was associated with increased odds of AKI stage 2 (odds ratio 1.96, 95% confidence interval 1.19 to 3.24, p <0.01). There was no evidence that β-blocker use had an independent association with postoperative delirium, AKI stages 1 and 3, stroke, AF, mortality, or prolonged length of stay. A secondary propensity score analysis did not show a marginal association between β-blocker use and any outcome. In conclusion, we did not find significant evidence that preoperative β-blocker use was associated with postoperative delirium, AF, AKI, stroke, or mortality.

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“…3) It is necessary to control the various risk factors for POD in the 2 groups before conclusively attributing results of decreased incidence of delirium to statin therapy. 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].…”

Section: To the Editormentioning

confidence: 99%

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

Tiwari

Nagar

Behera

et al. 2019

The Journal of Arthroplasty

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Postoperative Delirium in Patients Undergoing Total Joint Arthroplasty: A Systematic Review

Cited by 83 publications

References 23 publications

Risk factors for delirium after cardiac surgery: a historical cohort study outlining the influence of cardiopulmonary bypass

Risk factors for delirium after cardiac surgery: a historical cohort study outlining the influence of cardiopulmonary bypass

Effect of Preoperative Beta-Blocker Use on Outcomes Following Cardiac Surgery

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

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