Preoperative anxiety predicted the incidence of postoperative delirium in patients undergoing total hip arthroplasty: a prospective cohort study

Abstract

Background Delirium was characterized with a series of symptoms of a sudden onset of disturbances in attention, a loss in memory loss and defects in other cognitive abilities that were also appeared in the syndrome of anxiety. Even though there are overlapped clinical symptoms existed in anxiety and delirium, the relationship between anxiety and delirium was still unclear. The propose of this study was to investigated the effect of preoperative anxiety on postoperative delirium. Methods Three hundred and seventy-two adults undergoing total hip arthroplasty were enrolled from October 2019 to May 2020 in the study. The preoperative anxiety was measured with the Hospital Anxiety and Depression Scale-Anxiety (HADS-A). The participants were allocated into anxiety group (HADS-A≧7) and non-anxiety group (HADS-A < 7). The primary outcome was the incidence of the postoperative delirium assessed with the Confusion Assessment Method (CAM). The secondary outcomes were the duration and the severity of delirium evaluated with the Memorial Delirium assessment Scale (MDAS). The risks of delirium were also evaluated with logistic regression analysis. Results There were 325 patients enrolled in the end, 95 of whom met the criteria for anxiety. The incidence of delirium was 17.8% in all participants. The patients with anxiety had a higher incidence of delirium than the non-anxiety patients (25.3% vs. 14.8%, odds ratio (OR) = 0.51, 95% confidence interval (CI) = 0.92–0.29, p = 0.025). However, no significant differences were found in the duration and the severity of the delirium between the above two groups. The age, alcohol abuse, history of stroke, scores of the HADS-A, and education level were considered to be predictors of delirium. Conclusions The preoperative anxiety predicted the incidence of the postoperative delirium in total hip arthroplasty patients. The related intervention may be a good point for delirium prophylaxis. Trial registration It was registered at Chinese Clinical Trial Registry (www.chictr.org.cn) with the name of “the effect of preoperative anxiety on the postoperative cognitive function” (ChiCTR1900026054) at September 19, 2019.

Delirium in elderly postoperative patients: A prospective cohort study

“…Most episodes of POD were registered on the first or second postoperative day, which is in line with previous studies (Chaiwat et al, 2019 ; Saravana‐Bawan et al, 2019 ) describing a higher risk of developing POD during the first 72 hr after surgery. The median POD duration identified in this study was 1 day, which is in line with results from geriatric ortho‐geriatric populations (Ma et al, 2021 ). Yet, in very specific cohorts, such as cardiac‐surgery patients, the mean POD duration was 2.5 days (Koster et al, 2009 ).…”

Influence of Anxiety/Depression, Age, Gender and ASA on 1-Year Follow-Up Outcomes Following Total Hip and Knee Arthroplasty in 5447 Patients

“…Besides poor clinical outcome, preoperative anxiety in THA increases the risk of postoperative delirium [ 29 ]. Anxiety and depression not only influence individual patient recovery but also hospital and personal costs and those incurred by premature retirement and loss of employment [ 22 ].…”

Post-Operative Cognitive Impairment: A Cognitive Epidemiology Perspective

“…Self-reported education was not associated with POD risk ( Cavallari et al 2016 , 2017 ; Cizginer et al 2017 ; Hshiesh et al 2017 ; Inouye et al 2016 ; Tripp et al 2021 ; Vasunilashorn et al 2017 ). Another large study, the PAWEL study based in Germany ( Deeken et al 2022 ), as well as smaller cohort studies from Europe, Asia, and South America support these null results ( Jiang et al 2017 ; Kazmierski et al 2013 ; Mahanna-Gabrielli et al 2020 ; Puustinen et al 2016 ; Ristescu et al 2021 ; Sauer et al 2017 ; Seo et al 2014 ; Xue et al 2016 ), whereas other investigations do suggest a low education as a risk factor for POD ( Dworkin et al 2016 ; Gu et al 2021 ; Guan et al 2021 ; Huang et al 2021 ; Ma et al 2021 ; McAlpine et al 2008 ; Ordóñez-Velasco and Hernández-Leiva 2021 ; Schoen et al 2011 ; Sprung et al 2017 ; Su et al 2019 ; Tenpaku et al 2021 ; Tobar et al 2018 ). Interestingly, one recent Chinese study of 323 laryngectomy patients reported evidence in the opposite direction.…”