The Implementation of Perioperative Geriatric Management Could Decrease the Incidence of Postoperative Delirium in the Elderly Undergoing Major Orthopedic Surgeries

Abstract

Objectives: This study aimed to explore the association of perioperative geriatric management (PGM) in major orthopedic surgeries. Methods: One hundred seventy-five participants aged 75 and older were in-hospital patients who underwent major orthopedic surgery from September 2020 to September 2021, and they received PGM and necessary treatment for indicators with abnormal value (the PGM group). Another 175 participants in the control group only received the evaluation part of the PGM, recruited by filtering in the electronic medical record system from March 2016 to March 2017. The treatment included joint intervention of psychiatrists and rehabilitation physicians. For example, for patients at risk for falling, evaluation of inadequate blood volume, delirium, abnormal gait, and visual impairment should be performed. The logistic regression analysis was adopted to determine the association of PGM and postoperative delirium. Results: The prevalence of postoperative delirium among participants was 13.71%. Compared with the empirical treatment group, the postoperative delirium was significantly decreased (7.43% versus 14.29%) (P<0.05). Compared with the control group, participants were in the PGM group were at lower risk of postoperative delirium, mainly attributed to these following factors: Charlson comorbidity index <5 [odds ratio (OR)=0.620; 95% CI: 0.010-0.623], mini cog >2 (OR=0.224; 95% CI: 0.061-0.824), Confusion Assessment Method score indicating low risk (OR=0.079; 95% CI: 0.010-0.623), nutritional risk screening scale <3 (OR=0.306; 95% CI: 0.095-0.989), and major adverse cardiovascular events <3 (OR=0.253; 95% CI: 0.073-0.720). After adjusting for the length of hospital stay and reason for hospitalization, the association between the parameters above and postoperative delirium is still significant (P<0.05). Conclusions: The implementation of the PGM could decrease the incidence of postoperative delirium significantly, which might contribute to improving the overall prognosis in elderly patients who underwent major orthopedic surgeries.