Delirium after fast-track hip and knee arthroplasty - a cohort study of 6331 elderly patients

作者：Petersen P B; Jorgensen C C; Kehlet H

来源：Acta Anaesthesiologica Scandinavica, 2017, 61(7): 767-772.

DOI：10.1111/aas.12932

BackgroundPostoperative delirium (PD) is a well-known complication among elderly surgical patients and associated with increased morbidity, mortality and length of stay (LOS). In elective orthopedic surgery, including hip and knee arthroplasty (THA/TKA), most studies report incidences between 5% and 10%. The multimodal optimization of perioperative care (fast-track) aims to enhance recovery and reduce morbidity and LOS, but limited data are available on the effect on PD. Consequently, the study investigated signs of PD associated with LOS >4days.
MethodsProspective risk assessment study with retrospective analysis of discharge notes or medical records of signs of PD in 6331 elective primary unilateral THA and TKA patients 70years, and LOS >4days. Preoperative patient characteristics collected from eight high volume centers with similar standardized fast-track protocols from January 2010 to November 2013.
ResultsWe identified 43 (0.7%) cases of PD symptoms mentioned as a reason for LOS >4days among the 789 patients with LOS >4days (12.5% of all THA and TKA). PD patients had a mean age of 80.7 [[95% CI] 79.3-82.1] years, being 4.0 [[95% CI] 2.5-5.5] years older compared to patients without PD (P<0.001). LOS was median 10 [[Q2-Q3] 7-14] days in the PD group vs. 3 [2-3] days in the non-PD group (P<0.001), without differences in gender or site of arthroplasty (P=0.139 and 0.499, respectively).
ConclusionPostoperative delirium symptoms contributing to LOS >4days in fast-track THA and TKA are rare in elderly patients.

• 出版日期2017-8