Preoperative Risk Factors for Subsyndromal Delirium in Older Adults Who Undergo Joint Replacement Surgery

Abstract

Background Older adults with subsyndromal delirium have similar risks for adverse outcomes following joint replacement surgery as those who suffer from delirium. Purpose This study examined relationships among subsyndromal delirium and select preoperative risk factors in older adults following major orthopaedic surgery. Methods Delirium assessments of a sample of 62 adults age 65 or older were completed on postoperative day 1, 2, and 3 following joint replacement surgery. Data were analyzed for relationships among delirium symptoms and the following preoperative risk factors: increased comorbidity burden, cognitive impairment, fall history, and preoperative fasting time. Results Postoperative subsyndromal delirium occurred in 68% of study participants. A recent fall history and a longer preoperative fasting time were associated with delirium symptoms (p ≤ .05). Conclusions Older adults with a recent history of falls within the past 6 months or a longer duration of preoperative fasting time may be at higher risk for delirium symptoms following joint replacement surgery.

Risk factors for postoperative delirium and subsyndromal delirium in older surgical patients in the general ward: a prospective observational study

“…In this study, the incidence of POD and SSD was 18.8%, compared to the 58.1-67.9% that was reported previously [6,16,17]. Moreover, the incidence was low in comparison to ranges from 11-51% as the common incidence of POD in older patients [2].…”

“…The rst reason would be the characteristics of the department for patient treatment. Participants of prior studies underwent joint replacement surgery [16,17]. Patients with joint disorders tend to have joint pain and limited mobility, that may limit the preoperative ADL, which is a risk factor for SSD [13,31].…”

“…The umbrella term "functioning" that refers to all body functions, activities, and participation is an aspect of the aforementioned risk factors [12]). In contrast, only three risk factors for SSD have been identi ed in the general ward in previous studies: higher pain level, a recent history of falls within the past 6 months, and a longer preoperative fasting time [16,17]. We predicted that there are more risk factors of SSD particular to the general ward, e.g.…”

Development and validation of a postoperative delirium prediction model for patients admitted to an intensive care unit in China: a prospective study

“…A number of predisposing and accelerating risk factors, including surgery, contribute to postoperative surgery delirium 1–3. Moreover, POD in the intensive care unit (ICU-POD) increases the risk of nosocomial infection as well as the mortality rate, prolongs the length of hospital stay and incurs higher inpatient cost 5. In addition, patients above 65 years of age with POD have poorer outcomes and are more likely to have prolonged hospitalisation and ICU stay6 and longer intubation times, particularly after cardiac surgery 7…”

Risk factors for postoperative delirium and subsyndromal delirium in older surgical patients in the surgical ward: a prospective observational study

“…These factors are important aspects for assessing of the living function in older adults. In contrast, only three risk factors for SSD have been identi ed in the surgical ward in previous studies: higher pain level, a recent history of falls within the past 6 months, and a longer preoperative fasting time [12,13]. We predicted that there are more risk factors of SSD, similar to POD, such as cognitive state, ADL, and anxiety.…”