Pre-operative hemoglobin level and use of sedative-hypnotics are independent risk factors for post-operative delirium following total knee arthroplasty

Abstract

Background: Delirium is a well-known complication following surgery, especially with the increasing age of patients undergoing surgery. The increasing demands resulting from a prolonged healthy life expectancy has resulted in more arthroplasties despite their age and existing comorbidities. The purpose of this study is to explore the various risk factors that may contribute to delirium in unilateral and bilateral total knee arthroplasties in the elderly population. Methods: 170 patients who underwent unilateral or bilateral total knee arthroplasties were analyzed retrospectively for delirium. Age, sex, comorbidities, use of sedative-hypnotics, peri-operative blood loss, pre- and post-operative laboratory blood test results were investigated and analyzed. Results: The incidence of post-operative delirium was 6.5% (11 out of 170 patients) with a mean age of 79.5 (± 6.9) years, compared to 73.0 (± 9.0) years in the non-delirium group. Higher age, use of sedative-hypnotics, low pre-operative Hb and Ht, low post-operative Hb, Ht and BUN were observed in the delirium group. Multivariate logistic regression analysis identified that the use of sedative-hypnotics and pre-operative Hb level were independent risk factors for post-operative delirium after TKA. The odds ratios for the use of sedative-hypnotics and pre-operative Hb level were 4.6 and 0.53, respectively. Receiver operating characteristic curve analysis showed that pre-operative Hb of less than 11.1 g/dL was a predictor for the development of delirium, with a sensitivity of 54.6% and a specificity of 91.6%. Conclusion: Patients with a pre-operative Hb level of <11.1 g/dL or those using sedative-hypnotics are associated with post-operative delirium. Peri-operative management and preventative measures are therefore needed to reduce the risks of post-operative delirium in such patients.

Association of Anemia with Dementia and Cognitive Decline among Community-Dwelling Elderly

“…Fatigue is another consequence of anemia which may lead to physical inactivity with an increased risk for dementia [24]. Anemia may render the brain more vulnerable and more susceptible to postoperative delirium [25]. Anemia may challenge the aging brain vasculature and the brain neurons as changes that occur in cerebral blood vessels, as well as in the neural cells themselves, appear to result in reduced energy availability to neurons.…”

Predictors of Postoperative Delirium in Elderly Patients Following Total Hip and Knee Arthroplasty: A Systematic Review and Meta‑Analysis

“…In addition, 66 studies that did not have su cient quantitative data and 9 studies that did not report meaningful results were all excluded. Finally, 15 cohort studies that were identi ed as meeting the criteria were included in the metaanalysis [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] . (Fig.…”

“…Therefore, low preoperative hemoglobin levels can indirectly predict the high incidence of POD. Notably, there is still no conclusive evidence that correcting preoperative hemoglobin levels can reduce the risk of postoperative delirium 26 . Therefore, for elderly patients with low preoperative hemoglobin levels, it is necessary to reduce other potential risk factors of POD and take preventive measures in advance.…”

Research status and prospect of peri‐extubation delirium

“…Other prevention and treatment measures that have been proved to be efective in reducing perioperative delirium include psychological intervention (Packiasabapathy, et al, 2019), oral probiotics (Wang, et al, 2021), infusion of magnesium sulfate (Xie, et al, 2016), maintenance of Hb > 11.1 g/dL (Kijima, et al, 2020), early preventive application of haloperidol (Fukata, et al, 2017), use of ulinastatin (Lin, et al, 2019).…”