Incidence and risk factors associated with postoperative delirium following primary elective total hip arthroplasty: a retrospective nationwide inpatient sample database study

Abstract

Background: Postoperative delirium is a common complication following major surgeries, leading to a variety of adverse effects. However, there is a paucity of literatures studying the incidence and risk factors associated with delirium after primary elective total hip arthroplasty (THA) using a large-scale national database. Methods: A retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2009 to 2014. Patients who underwent primary elective THA were included. Patient demographics, preoperative comorbidities, length of hospital stay (LOS), total charges, in-hospital mortality, and major and minor perioperative complications were evaluated. Results: A total of 388,424 primary elective THAs were obtained from the NIS database, and the general incidence of delirium after THA was 0.90%. Patients with delirium after THA presented more preoperative comorbidities, longer LOS, extra hospital charges, and higher in-hospital mortality rate (P < 0.001). Delirium following THA was associated with major complications during hospitalization including acute renal failure and pneumonia. Preoperative risk factors associated with postoperative delirium included advanced age, alcohol or drug abuse, depression, neurological disorders, psychoses, fluid and electrolyte disorders, diabetes, weight loss, deficiency anemia, coagulopathy, hypertension, congestive heart failure, valvular disease, pulmonary circulation disorders, peripheral vascular disorders, and renal failure. Both female and obesity were detected to be protective factors. Conclusions: The results of our study identified a relatively low incidence of delirium after primary elective THA, which is as reported in the NIS and not necessarily the surgical population as a whole. Postoperative delirium of THA was associated with increased preoperative comorbidities, LOS, total charges, in-hospital mortality, and major perioperative complications including acute renal failure and pneumonia. It is of benefit to study risk factors associated with postoperative delirium to moderate its consequences.

Preoperative prognostic nutritional index is useful factor for predicting postoperative delirium after primary total joint arthroplasty

“…Consistent with the previous studies [ 27 , 28 ], the present study demonstrated that hypertension was strongly associated with both incidence and severity of PD following TJA, and this condition was especially in patients with moderate to severe hypertension. According to the previous studies [ 29 , 30 ], hypertension is significantly associated with increased endothelial dysfunction and atherosclerosis, thus leading to an increased risk of cerebral embolization.…”

Preoperative Prognostic Nutritional Index Is Useful Factor for Predicting Postoperative Delirium After Primary Total Joint Arthroplasty

“…Consistent with the previous studies [27,28], the present study demonstrated that hypertension was especially associated with PD following TJA. According to the previous studies [29,30], hypertension is signi cantly associated with increased endothelial dysfunction and atherosclerosis, thus leading to an increased risk of cerebral embolization.…”

Preoperative anxiety predicted the incidence of postoperative delirium in patients undergoing total hip arthroplasty: a prospective cohort study

“…In this prospective study, every delirium case was confirmed by the skillful geriatric psychiatrist. Moreover, it was also proved in the multivariable logistic regression model, in which anxiety, age, alcohol abuse, education level and stroke history were detected as predictors that were also reported in some researches [26,41,42]. As anxiety was a quite common symptom before surgery.…”