Postoperative delirium after major orthopedic surgery  

作　　者：Michael K Urban Mayu Sasaki Abigail M Schmucker Steven K Magid 

机构地区：[1]Department of Anesthesiology,Hospital for Special Surgery,New York,NY 10021,United States [2]Weill Cornell Medical College,New York,NY 10065,United States [3]Quality Research Center,Hospital for Special Surgery,New York,NY 10021,United States [4]Sidney Kimmel Medical College at Thomas Jefferson University,Philadelphia,PA 19107,United States [5]Department of Rheumatology,Hospital for Special Surgery,New York,NY 10021,United States

出　　处：《World Journal of Orthopedics》2020年第2期90-106,共17页世界骨科杂志（英文版）

摘　　要：BACKGROUND Postoperative delirium(POD)is one of the most common complications in older adult patients undergoing elective surgery.Few studies have compared,within the same institution,the type of surgery,risk factors and type of anesthesia and analgesia associated with the development of POD.AIM To investigate the following three questions:(1)What is the incidence of POD after non-ambulatory orthopedic surgery at a high-volume orthopedic specialty hospital?(2)Does surgical procedure influence incidence of POD after nonambulatory orthopedic surgery?And(3)For POD after non-ambulatory orthopedic surgery,what are modifiable risk factors?METHODS A retrospective cohort study was conducted of all non-ambulatory orthopedic surgeries at a single orthopedic specialty hospital between 2009 and 2014.Patients under 18 years were excluded from the cohort.Patient characteristics and medical history were obtained from electronic medical records.Patients with POD were identified using International Classification of Diseases,9^th Revision(ICD-9)codes that were not present on admission.For incidence analyses,the cohort was grouped into total hip arthroplasty(THA),bilateral THA,total knee arthroplasty(TKA),bilateral TKA,spine fusion,other spine procedures,femur/pelvic fracture,and other procedures using ICD-9 codes.For descriptive and regression analyses,the cohort was grouped,using ICD-9 codes,into THA,TKA,spinal fusions,and all procedures.RESULTS Of 78492 surgical inpatient surgeries,the incidence from 2009 to 2014 was 1.2%with 959 diagnosed with POD.The incidence of POD was higher in patients undergoing spinal fusions(3.3%)than for patients undergoing THA(0.8%);THA patients had the lowest incidence.Also,urgent and/or emergent procedures,defined by femoral and pelvic fractures,had the highest incidence of POD(7.2%)than all other procedures.General anesthesia was not seen as a significant risk factor for POD for any procedure type;however,IV patient-controlled analgesia was a significant risk factor for patients undergoing THA[OddBACKGROUND Postoperative delirium(POD) is one of the most common complications in older adult patients undergoing elective surgery. Few studies have compared, within the same institution, the type of surgery, risk factors and type of anesthesia and analgesia associated with the development of POD.AIM To investigate the following three questions:(1) What is the incidence of POD after non-ambulatory orthopedic surgery at a high-volume orthopedic specialty hospital?(2) Does surgical procedure influence incidence of POD after nonambulatory orthopedic surgery? And(3) For POD after non-ambulatory orthopedic surgery, what are modifiable risk factors?METHODS A retrospective cohort study was conducted of all non-ambulatory orthopedic surgeries at a single orthopedic specialty hospital between 2009 and 2014.Patients under 18 years were excluded from the cohort. Patient characteristics and medical history were obtained from electronic medical records. Patients with POD were identified using International Classification of Diseases, 9 th Revision(ICD-9) codes that were not present on admission. For incidence analyses, the cohort was grouped into total hip arthroplasty(THA), bilateral THA, total knee arthroplasty(TKA), bilateral TKA, spine fusion, other spine procedures,femur/pelvic fracture, and other procedures using ICD-9 codes. For descriptive and regression analyses, the cohort was grouped, using ICD-9 codes, into THA,TKA, spinal fusions, and all procedures.RESULTS Of 78492 surgical inpatient surgeries, the incidence from 2009 to 2014 was 1.2%with 959 diagnosed with POD. The incidence of POD was higher in patients undergoing spinal fusions(3.3%) than for patients undergoing THA(0.8%); THA patients had the lowest incidence. Also, urgent and/or emergent procedures,defined by femoral and pelvic fractures, had the highest incidence of POD(7.2%)than all other procedures. General anesthesia was not seen as a significant risk factor for POD for any procedure type; however, IV patient-controlled analgesia was a significant risk

关 键 词：DELIRIUM ARTHROPLASTY Replacement KNEE Hip Risk factors Pain management Spinal fusion ORTHOPEDICS Incidence ANESTHESIA General Opioid-related disorders NARCOTICS 

分 类 号：R614[医药卫生—麻醉学]