Recovery Room Delirium Predicts Postoperative Delirium After Hip-Fracture Repair

Abstract

In patients undergoing hip-fracture repair, recovery room delirium is a strong predictor of postoperative delirium when using a standardized protocol for general anesthesia and postoperative pain management.

Sedation Depth During Spinal Anesthesia and the Development of Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Repair

“…4 The mechanism whereby intraoperative sedation level affects the occurrence of postoperative delirium in elderly patients has not been elucidated. Hypotheses range from a cerebrovascular origin due to decreased perfusion associated with greater anesthetic depth in more deeply sedated patients, to toxicity of the larger doses of propofol administered to the deep sedation group, to a fundamental alteration in brain activity induced by deeper sedation.…”

“…The study was powered by assuming a prevalence of postoperative delirium of 0.36 in the deep sedation group, similar to that observed after hip fracture repair in elderly patients under general anesthesia, 4 and a prevalence of 0.12 in the light sedation group, similar to that seen after knee replacement in elderly patients under epidural anesthesia with sedation. 40 On the basis of these assumptions, each group would require 49 patients to achieve a power of 0.80 at a significance level of .05.…”

“…1,2 The prevalence ranges from 0% to 73%, depending on the study and type of surgery, 2 with a prevalence of 16% to 62% after hip fracture repair. [3][4][5] Although postoperative delirium usually resolves within 48 hours of onset, 6 delirium can persist and is associated with poor functional recovery, increased length of stay, higher costs, and greater likelihood of placement in an assisted living facility after surgery. 3,5,[7][8][9][10][11][12][13] Therefore, interventions capable of reducing the occurrence of post-OBJECTIVE: To determine whether limiting intraoperative sedation depth during spinal anesthesia for hip fracture repair in elderly patients can decrease the prevalence of postoperative delirium.…”

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“…Delirium is an acute and fluctuating alteration of mental state of reduced awareness and disturbance of attention. POD (Post Operative Delirium) often starts in the recovery room and occurs up to 5 days after surgery [3][4][5]. One investigation [4] found that many patients with POD on the peripheral ward already had POD in the recovery room.…”

“…POD (Post Operative Delirium) often starts in the recovery room and occurs up to 5 days after surgery [3][4][5]. One investigation [4] found that many patients with POD on the peripheral ward already had POD in the recovery room.More than 230 million surgical procedures are performed each year worldwide, of which more than 80 million are in Europe [6][7][8]. In Europe, the in-hospital mortality rate up to a maximum of 60 days is 3% after elective surgery and nearly 10% after emergency surgery [7].…”