Analysis of incidence and risk factors of postoperative delirium in elderly patients undergoing major orthopedic surgery_West China Medical Journal

Authors：

ZHANG Weili ¹ , SONG Mi ¹ , SONG Jie ² , SONG Yuxiang ³ , CAO Jiangbei ³ ,  GAO Yuan ²

1. Chinese PLA Medical School, Beijing 100853, P. R. China;
2. Department of Nursing, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, P. R. China;
3. Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, P. R. China;

Corresponding author：

GAO Yuan, Email: gaoyuanzd@163.com

Keywords：

Major orthopedic surgery; the elderly; postoperative delirium; postoperative cognitive dysfunction; risk factors

DOI：

10.7507/1002-0179.202308212

Video：

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Objective To investigate the prevalence of postoperative delirium (POD) in elderly patients undergoing major orthopedic surgery and analyze its influencing factors, so as to provide evidence for early screening and intervention of POD. Methods The medical records of elderly patients undergoing major orthopedic surgery in the Department of Orthopaedics of the First Medical Center, Chinese PLA General Hospital between January 2021 and December 2022 were retrospectively collected. The included patients were divided into POD group and non-POD group. The patients’ demographic characteristics, medical history, laboratory indicators, perioperative medication, intraoperative and postoperative indicators were collected to analyze the risk factors affecting POD. Results A total of 455 elderly patients were included. Among them, there were 75 cases in the POD group and 380 cases in the non-POD group. The incidence of POD was 16.5% (75/455). There were statistically significant differences in age, body mass index, number of combined underlying diseases≥3, albumin<35 g/L, American Society of Anesthesiologists (ASA) classification, intraoperative blood loss≥200 mL, intraoperative blood transfusion, postoperative Visual Analogue Scale (VAS) score, indwelling catheters, admission to intensive care unit (ICU), and length of ICU stay between the two groups (P<0.05). The results of logistic regression analysis showed that age≥79 years, number of combined underlying diseases≥3, albumin<35 g/L, intraoperative blood loss≥200 mL, ASA grade≥Ⅲ, postoperative VAS score, and postoperative admission to ICU (P<0.05) were independent influencing factors for POD occurrence in elderly patients undergoing major orthopedic surgery. Conclusions POD is one of the common postoperative complications in elderly patients undergoing major orthopedic surgery. Age≥79 years, number of combined underlying diseases≥3, albumin<35 g/L, intraoperative blood loss≥200 mL, ASA grade≥Ⅲ, postoperative VAS score, and postoperative admission to ICU are independent risk factors for POD in elderly patients undergoing major orthopedic surgery. Clinical staff should evaluate and screen these factors early and take preventive measures to reduce the incidence of POD.

Citation： ZHANG Weili, SONG Mi, SONG Jie, SONG Yuxiang, CAO Jiangbei, GAO Yuan. Analysis of incidence and risk factors of postoperative delirium in elderly patients undergoing major orthopedic surgery. West China Medical Journal, 2023, 38(10): 1474-1479. doi: 10.7507/1002-0179.202308212 Copy

1.	中华医学会骨科学分会. 中国骨科大手术静脉血栓栓塞症预防指南. 中华骨科学杂志, 2016, 36(2): 65-71.
2.	彭晨健. 老年髋膝骨关节炎患者关节置换术后并发症发生的影响因素分析. 南京: 南京中医药大学, 2019.
3.	Venkatakrishnaiah NK, Anandkumar UM, Wooly S, et al. Identification of factors contributing to the development of postoperative delirium in geriatric patients with hip fractures- a prospective study. J Family Med Prim Care, 2022, 11(8): 4785-4790.
4.	吕晓春, 周雁. 膝关节置换患者术后谵妄的危险因素分析. 临床麻醉学杂志, 2017, 33(3): 264-268.
5.	Kong D, Luo W, Zhu Z, et al. Factors associated with post-operative delirium in hip fracture patients: what should we care. Eur J Med Res, 2022, 27(1): 40.
6.	叶磊, 张爱琴, 荣芸, 等. 老年髋部骨折患者术后谵妄风险预测模型的系统评价. 护理学报, 2023, 30(7): 48-52.
7.	Oh ES, Fong TG, Hshieh TT, et al. Delirium in older persons: advances in diagnosis and treatment. JAMA, 2017, 318(12): 1161-1174.
8.	Qi YM, Li YJ, Zou JH, et al. Risk factors for postoperative delirium in geriatric patients with hip fracture: a systematic review and meta-analysis. Front Aging Neurosci, 2022, 14: 960364.
9.	Lee KF, Wood MD, Maslove DM, et al. Dysfunctional cerebral autoregulation is associated with delirium in critically ill adults. J Cereb Blood Flow Metab, 2019, 39(12): 2512-2520.
10.	Chen M, Zhang L, Shao M, et al. E4BP4 coordinates circadian control of cognition in delirium. Adv Sci (Weinh), 2022, 9(23): e2200559.
11.	中国老年医学学会麻醉学分会. 中国老年患者术后谵妄防治专家共识. 国际麻醉学与复苏杂志, 2023, 44(1): 1-27.
12.	Grover S, Avasthi A. Clinical practice guidelines for management of delirium in elderly. Indian J Psychiatry, 2018, 60(Suppl 3): S329-S340.
13.	中华医学会神经病学分会神经心理与行为神经病学学组. 综合医院谵妄诊治中国专家共识(2021). 中华老年医学杂志, 2021, 40(10): 1226-1233.
14.	Kuhn E, Du X, McGrath K, et al. Validation of a consensus method for identifying delirium from hospital records. PLoS One, 2014, 9(11): e111823.
15.	Ahmed N, Kuo YH. Delirium risk in geriatric hip hemi-arthroplasty (DRIGHA): development and validation of a novel score using a national data. Injury, 2022, 53(4): 1469-1476.
16.	Chu Z, Wu Y, Dai X, et al. The risk factors of postoperative delirium in general anesthesia patients with hip fracture: attention needed. Medicine (Baltimore), 2021, 100(22): e26156.
17.	Meehan AJ, Maher AB, Brent L, et al. The international collaboration of orthopaedic nursing (ICON): Best practice nursing care standards for older adults with fragility hip fracture. Int J Orthop Trauma Nurs, 2019, 32: 3-26.
18.	Juliebø V, Bjøro K, Krogseth M, et al. Risk factors for preoperative and postoperative delirium in elderly patients with hip fracture. J Am Geriatr Soc, 2009, 57(8): 1354-1361.
19.	Kristoffersen MH, Dybvik E, Steihaug OM, et al. Validation of orthopaedic surgeons’ assessment of cognitive function in patients with acute hip fracture. BMC Musculoskelet Disord, 2019, 20(1): 268.
20.	Yang Y, Wang T, Guo H, et al. Development and validation of a nomogram for predicting postoperative delirium in patients with elderly hip fracture based on data collected on admission. Front Aging Neurosci, 2022, 14: 914002.
21.	张伟丽, 宋咪, 邱晨, 等. 老年髋部骨折手术后谵妄危险因素的 Meta 分析. 海南医学院学报(2023-06-19): 1-15.
22.	张莹, 胡玉萍, 郭宪, 等. 术前营养不良的老年病人全麻下髋关节置换术后谵妄的危险因素. 实用老年医学, 2022, 36(12): 1203-1206.
23.	张伟丽, 娄景盛, 宋玉祥, 等. 生物标志物在老年患者术后谵妄诊疗中的应用综述. 解放军医学院学报, 2023, 44(2): 197-200.
24.	文新平, 贾黎, 韩英华, 等. 术前营养不良与老年人髋部骨折术后谵妄的相关性研究. 实用老年医学, 2020, 34(5): 451-453, 461.
25.	Sankar A, Johnson SR, Beattie WS, et al. Reliability of the American Society of Anesthesiologists physical status scale in clinical practice. Br J Anaesth, 2014, 113(3): 424-432.
26.	Janssen TL, Steyerberg EW, Faes MC, et al. Risk factors for postoperative delirium after elective major abdominal surgery in elderly patients: a cohort study. Int J Surg, 2019, 71: 29-35.
27.	苏保童, 王翰宇, 许忆浪, 等. 基于医院病历资料构建老年髋部骨折术后谵妄 Nomogram 预测模型. 中国组织工程研究, 2021, 25(24): 3844-3849.
28.	王喜波, 夏永法, 钱涛. 高龄髋部骨折患者失血量与谵妄相关性研究. 浙江中西医结合杂志, 2018, 28(4): 299-302.
29.	Jin Z, Hu J, Ma D. Postoperative delirium: perioperative assessment, risk reduction, and management. Br J Anaesth, 2020, 125(4): 492-504.
30.	Hughes CG, Boncyk CS, Culley DJ, et al. American society for enhanced recovery and perioperative quality initiative joint consensus statement on postoperative delirium prevention. Anesth Analg, 2020, 130(6): 1572-1590.
31.	徐荣鹏, 杨春, 朱滨. ICU 谵妄的研究进展. 中华危重病急救医学, 2020, 32(5): 636-640.
32.	Bounds M, Kram S, Speroni KG, et al. Effect of ABCDE bundle implementation on prevalence of delirium in intensive care unit patients. Am J Crit Care, 2016, 25(6): 535-544.

1. 中华医学会骨科学分会. 中国骨科大手术静脉血栓栓塞症预防指南. 中华骨科学杂志, 2016, 36(2): 65-71.
2. 彭晨健. 老年髋膝骨关节炎患者关节置换术后并发症发生的影响因素分析. 南京: 南京中医药大学, 2019.
3. Venkatakrishnaiah NK, Anandkumar UM, Wooly S, et al. Identification of factors contributing to the development of postoperative delirium in geriatric patients with hip fractures- a prospective study. J Family Med Prim Care, 2022, 11(8): 4785-4790.
4. 吕晓春, 周雁. 膝关节置换患者术后谵妄的危险因素分析. 临床麻醉学杂志, 2017, 33(3): 264-268.
5. Kong D, Luo W, Zhu Z, et al. Factors associated with post-operative delirium in hip fracture patients: what should we care. Eur J Med Res, 2022, 27(1): 40.
6. 叶磊, 张爱琴, 荣芸, 等. 老年髋部骨折患者术后谵妄风险预测模型的系统评价. 护理学报, 2023, 30(7): 48-52.
7. Oh ES, Fong TG, Hshieh TT, et al. Delirium in older persons: advances in diagnosis and treatment. JAMA, 2017, 318(12): 1161-1174.
8. Qi YM, Li YJ, Zou JH, et al. Risk factors for postoperative delirium in geriatric patients with hip fracture: a systematic review and meta-analysis. Front Aging Neurosci, 2022, 14: 960364.
9. Lee KF, Wood MD, Maslove DM, et al. Dysfunctional cerebral autoregulation is associated with delirium in critically ill adults. J Cereb Blood Flow Metab, 2019, 39(12): 2512-2520.
10. Chen M, Zhang L, Shao M, et al. E4BP4 coordinates circadian control of cognition in delirium. Adv Sci (Weinh), 2022, 9(23): e2200559.
11. 中国老年医学学会麻醉学分会. 中国老年患者术后谵妄防治专家共识. 国际麻醉学与复苏杂志, 2023, 44(1): 1-27.
12. Grover S, Avasthi A. Clinical practice guidelines for management of delirium in elderly. Indian J Psychiatry, 2018, 60(Suppl 3): S329-S340.
13. 中华医学会神经病学分会神经心理与行为神经病学学组. 综合医院谵妄诊治中国专家共识(2021). 中华老年医学杂志, 2021, 40(10): 1226-1233.
14. Kuhn E, Du X, McGrath K, et al. Validation of a consensus method for identifying delirium from hospital records. PLoS One, 2014, 9(11): e111823.
15. Ahmed N, Kuo YH. Delirium risk in geriatric hip hemi-arthroplasty (DRIGHA): development and validation of a novel score using a national data. Injury, 2022, 53(4): 1469-1476.
16. Chu Z, Wu Y, Dai X, et al. The risk factors of postoperative delirium in general anesthesia patients with hip fracture: attention needed. Medicine (Baltimore), 2021, 100(22): e26156.
17. Meehan AJ, Maher AB, Brent L, et al. The international collaboration of orthopaedic nursing (ICON): Best practice nursing care standards for older adults with fragility hip fracture. Int J Orthop Trauma Nurs, 2019, 32: 3-26.
18. Juliebø V, Bjøro K, Krogseth M, et al. Risk factors for preoperative and postoperative delirium in elderly patients with hip fracture. J Am Geriatr Soc, 2009, 57(8): 1354-1361.
19. Kristoffersen MH, Dybvik E, Steihaug OM, et al. Validation of orthopaedic surgeons’ assessment of cognitive function in patients with acute hip fracture. BMC Musculoskelet Disord, 2019, 20(1): 268.
20. Yang Y, Wang T, Guo H, et al. Development and validation of a nomogram for predicting postoperative delirium in patients with elderly hip fracture based on data collected on admission. Front Aging Neurosci, 2022, 14: 914002.
21. 张伟丽, 宋咪, 邱晨, 等. 老年髋部骨折手术后谵妄危险因素的 Meta 分析. 海南医学院学报(2023-06-19): 1-15.
22. 张莹, 胡玉萍, 郭宪, 等. 术前营养不良的老年病人全麻下髋关节置换术后谵妄的危险因素. 实用老年医学, 2022, 36(12): 1203-1206.
23. 张伟丽, 娄景盛, 宋玉祥, 等. 生物标志物在老年患者术后谵妄诊疗中的应用综述. 解放军医学院学报, 2023, 44(2): 197-200.
24. 文新平, 贾黎, 韩英华, 等. 术前营养不良与老年人髋部骨折术后谵妄的相关性研究. 实用老年医学, 2020, 34(5): 451-453, 461.
25. Sankar A, Johnson SR, Beattie WS, et al. Reliability of the American Society of Anesthesiologists physical status scale in clinical practice. Br J Anaesth, 2014, 113(3): 424-432.
26. Janssen TL, Steyerberg EW, Faes MC, et al. Risk factors for postoperative delirium after elective major abdominal surgery in elderly patients: a cohort study. Int J Surg, 2019, 71: 29-35.
27. 苏保童, 王翰宇, 许忆浪, 等. 基于医院病历资料构建老年髋部骨折术后谵妄 Nomogram 预测模型. 中国组织工程研究, 2021, 25(24): 3844-3849.
28. 王喜波, 夏永法, 钱涛. 高龄髋部骨折患者失血量与谵妄相关性研究. 浙江中西医结合杂志, 2018, 28(4): 299-302.
29. Jin Z, Hu J, Ma D. Postoperative delirium: perioperative assessment, risk reduction, and management. Br J Anaesth, 2020, 125(4): 492-504.
30. Hughes CG, Boncyk CS, Culley DJ, et al. American society for enhanced recovery and perioperative quality initiative joint consensus statement on postoperative delirium prevention. Anesth Analg, 2020, 130(6): 1572-1590.
31. 徐荣鹏, 杨春, 朱滨. ICU 谵妄的研究进展. 中华危重病急救医学, 2020, 32(5): 636-640.
32. Bounds M, Kram S, Speroni KG, et al. Effect of ABCDE bundle implementation on prevalence of delirium in intensive care unit patients. Am J Crit Care, 2016, 25(6): 535-544.

West China Medical Journal

Analysis of incidence and risk factors of postoperative delirium in elderly patients undergoing major orthopedic surgery

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