Incidence of postoperative delirium in patients undergoing total knee arthroplasty—an Asian perspective

Abstract

Background: Very little is known in the literature with regards to the incidence of postoperative delirium following total knee arthroplasty (TKA) in Asians and the associated surgical factors. We conducted a retrospective study on incidence of postoperative delirium following TKA in Asians. Methods:One thousand sixteen knees of 954 consecutive patients who underwent TKA by the senior author of this study in the year 2006 were included in this review. All written and electronic medical records for patients were screened. Delirium was recorded to be present based on clinical entry onto the patients' inpatient hospital notes and a diagnosis made by psychiatrist based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). All statistical analysis was performed using SPSS v.18.0 (IBM Corp., Armonk, NY, USA). Results:The incidence of postoperative delirium in our patients undergoing TKA was 0.59%. Six patients had a confirmed diagnosis of delirium postoperatively. We noted an association between a higher mean age (P<0.0001), a lower body mass index (P<0.0001), Chinese ethnicity (P=0.002), male gender (P=0.002) and chronic opioid use (P<0.0001) with incidence of post-operative delirium. We also noted a higher proportion of post-operative DVT (P<0.0001) and wound infection (P<0.0001) in the delirium group. Conclusions:The incidence of postoperative delirium in Asians undergoing TKA in our institution is very low at 0.59%. Advanced age, lower body mass index, Chinese ethnicity, male gender and preoperative chronic opioid use may be associated with developing postoperative delirium.

Preoperative medication use and postoperative delirium: a systematic review

“…Twenty-five studies were prospective cohort studies, three studies were retrospective cohorts [ 14 – 16 ] and one was a post hoc analysis of RCT data [ 17 ]. Studies were conducted in USA (six studies), Canada (three studies), Netherlands (three studies), Sweden (two studies), Taiwan (two studies), Italy (two studies), Japan, Brazil, Switzerland, Norway, Australia, Thailand, France, Germany, Korea, Singapore and China (one study in each country).…”

Incidence and Risk Factors of Postoperative Delirium Following Total Knee Arthroplasty: A Retrospective Nationwide Inpatient Sample Database Study

“…reporting the incidence of 0.59% [7]. There are two possible reasons accounting for the former obvious difference.…”

“…Postoperative delirium is a common complication in geriatric patients after major operations [5,6]. The reported incidence of delirium after TKA ranges from 0.59-25%, which varied among studies depending on the patient population [1,[7][8][9][10][11][12][13]. It has become a heavy burden on healthcare resources because it prolongs hospitalization and increases medical costs [1,4,9,[11][12][13][14].…”

“…Additionally, postoperative delirium has an adverse impact on patients, family members, and health care practitioners, as it had been shown to be associated with higher mortality, progressive functional impairment, long-term cognitive disorder and other complications such as pneumonia, acute renal failure, pulmonary edema, and myocardial infarction [4,7,[11][12][13][14][16][17][18][19][20].…”

Effects of Total Intravenous Anesthesia with Propofol Versus Inhalational Anesthesia with Sevoflurane on Postoperative Quality of Life and Postoperative Delirium in Patients Undergoing Total Knee Arthroplasty: A Randomized, Controlled, Double-Blinded Clinical Trial

“…Accordingly, the purpose of clinical treatment of diseases no longer limited to the improvement of the survival rate and extension of the survival time of patients, but more importantly, the improvement of the quality of life of patients [4,5]. Additionally, the postoperative delirium (POD) is also a common complication after TKA [6,7]. Delirium is a brain disorder with an acute onset and a speci c volatility.…”