Incidence and Predictors of Postoperative Delirium in Patients Undergoing Elective Hip and Knee Arthroplasty: A Prospective Observational Study
<b>Background/Objectives</b>: Postoperative delirium has not been well explored in patients undergoing elective hip and knee arthroplasty. This study assessed the incidence of delirium in these patients in the postanesthetic care unit (PACU) and throughout their hospital admission. Predi...
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2025-05-01
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| author | James Paul Amir Hamid Heung Kan Ma Thomas Kim Lehana Thabane Thuva Vanniyasingam |
| author_facet | James Paul Amir Hamid Heung Kan Ma Thomas Kim Lehana Thabane Thuva Vanniyasingam |
| author_sort | James Paul |
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| description | <b>Background/Objectives</b>: Postoperative delirium has not been well explored in patients undergoing elective hip and knee arthroplasty. This study assessed the incidence of delirium in these patients in the postanesthetic care unit (PACU) and throughout their hospital admission. Predictors of postoperative delirium and impact of delirium on length of stay were also analyzed. <b>Methods</b>: This prospective observational study recruited patients (n = 978) with normal cognitive function presenting for elective primary hip or knee arthroplasty at a single tertiary academic center. Delirium was assessed using the Nursing Delirium Scoring Scale (NuDESC) in the PACU, and twice daily after that on postoperative days 1, 2 and 3, or until discharge, whichever came first. <b>Results</b>: In total, 26 (2.7%) patients developed delirium postoperatively. Unadjusted logistic regression analyses revealed that age; history of cardiovascular, central nervous system, hematologic, endocrinologic, psychiatric disease; postoperative opioid use; and ASA level were associated with an increased risk of delirium, with odds ratios (95% confidence interval) of 1.7 (1.35 to 2.11), 3.6 (1.09 to 12.25), 3.5 (1.53 to 8.03), 2.7 (1.09 to 6.45), 2.3 (1.04 to 4.97), 4.7 (2.10 to 10.70), 0.4 (0.17 to 0.89), and 2.37 (1.05 to 5.33), respectively. A Mann–Whitney U test showed no difference in PACU or hospital length of stay between patients who did and did not have delirium in the PACU (within the first hour). <b>Conclusions</b>: Age, ASA > 3, a history of cardiovascular disease, central nervous system disease, hematologic disease, endocrinologic disease, psychiatric disease and postoperative opioid use are individually associated with postoperative delirium. A future study with an even larger sample size is needed to further evaluate these factors in an adjusted analysis. |
| format | Article |
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| institution | Kabale University |
| issn | 2813-5806 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | MDPI AG |
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| series | Anesthesia Research |
| spelling | doaj-art-de8a709224fd44bbaa93a0200045205a2025-08-20T03:26:20ZengMDPI AGAnesthesia Research2813-58062025-05-01221110.3390/anesthres2020011Incidence and Predictors of Postoperative Delirium in Patients Undergoing Elective Hip and Knee Arthroplasty: A Prospective Observational StudyJames Paul0Amir Hamid1Heung Kan Ma2Thomas Kim3Lehana Thabane4Thuva Vanniyasingam5Department of Anesthesia, McMaster University, Hamilton, ON L8S 4L8, CanadaAlmonte General Hospital, Almonte, ON K0A 1A0, CanadaDepartment of Anesthesia, University of Toronto, Toronto, ON M5G 0A8, CanadaDepartment of Anesthesia, University of British Columbia, Vancouver, BC V6T 1Z3, CanadaDepartment of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON L8S 4L8, CanadaCytel, Toronto, ON M6K 1E6, Canada<b>Background/Objectives</b>: Postoperative delirium has not been well explored in patients undergoing elective hip and knee arthroplasty. This study assessed the incidence of delirium in these patients in the postanesthetic care unit (PACU) and throughout their hospital admission. Predictors of postoperative delirium and impact of delirium on length of stay were also analyzed. <b>Methods</b>: This prospective observational study recruited patients (n = 978) with normal cognitive function presenting for elective primary hip or knee arthroplasty at a single tertiary academic center. Delirium was assessed using the Nursing Delirium Scoring Scale (NuDESC) in the PACU, and twice daily after that on postoperative days 1, 2 and 3, or until discharge, whichever came first. <b>Results</b>: In total, 26 (2.7%) patients developed delirium postoperatively. Unadjusted logistic regression analyses revealed that age; history of cardiovascular, central nervous system, hematologic, endocrinologic, psychiatric disease; postoperative opioid use; and ASA level were associated with an increased risk of delirium, with odds ratios (95% confidence interval) of 1.7 (1.35 to 2.11), 3.6 (1.09 to 12.25), 3.5 (1.53 to 8.03), 2.7 (1.09 to 6.45), 2.3 (1.04 to 4.97), 4.7 (2.10 to 10.70), 0.4 (0.17 to 0.89), and 2.37 (1.05 to 5.33), respectively. A Mann–Whitney U test showed no difference in PACU or hospital length of stay between patients who did and did not have delirium in the PACU (within the first hour). <b>Conclusions</b>: Age, ASA > 3, a history of cardiovascular disease, central nervous system disease, hematologic disease, endocrinologic disease, psychiatric disease and postoperative opioid use are individually associated with postoperative delirium. A future study with an even larger sample size is needed to further evaluate these factors in an adjusted analysis.https://www.mdpi.com/2813-5806/2/2/11emergence deliriumarthroplastyperioperative medicinepostoperative delirium |
| spellingShingle | James Paul Amir Hamid Heung Kan Ma Thomas Kim Lehana Thabane Thuva Vanniyasingam Incidence and Predictors of Postoperative Delirium in Patients Undergoing Elective Hip and Knee Arthroplasty: A Prospective Observational Study Anesthesia Research emergence delirium arthroplasty perioperative medicine postoperative delirium |
| title | Incidence and Predictors of Postoperative Delirium in Patients Undergoing Elective Hip and Knee Arthroplasty: A Prospective Observational Study |
| title_full | Incidence and Predictors of Postoperative Delirium in Patients Undergoing Elective Hip and Knee Arthroplasty: A Prospective Observational Study |
| title_fullStr | Incidence and Predictors of Postoperative Delirium in Patients Undergoing Elective Hip and Knee Arthroplasty: A Prospective Observational Study |
| title_full_unstemmed | Incidence and Predictors of Postoperative Delirium in Patients Undergoing Elective Hip and Knee Arthroplasty: A Prospective Observational Study |
| title_short | Incidence and Predictors of Postoperative Delirium in Patients Undergoing Elective Hip and Knee Arthroplasty: A Prospective Observational Study |
| title_sort | incidence and predictors of postoperative delirium in patients undergoing elective hip and knee arthroplasty a prospective observational study |
| topic | emergence delirium arthroplasty perioperative medicine postoperative delirium |
| url | https://www.mdpi.com/2813-5806/2/2/11 |
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