The Motoric Types of Delirium and Estimated Blood Loss during Perioperative Period in Orthopedic Elderly Patients

Abstract

Background Delirium is a common and serious syndrome in elderly patients. The hypoactive type of delirium is known to have different characteristics, but further studies are needed to define the specificities of these characteristics. Our study aims at finding specific risk factors, especially estimated blood loss during operations of hyper- and hypoactive delirium in orthopedic elderly patients. Methods One hundred and seventy-five elderly patients were evaluated using the Confusion Assessment Method (CAM) and the 4th edition text revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Trained psychiatrists interviewed the subjects directly at pre- and postoperative time points. We reviewed medical records after the patients were discharged. Results Thirty-nine patients (22.3%) were diagnosed with multiple types of delirium, which included 17 hyperactive types (65.9%), 13 hypoactive types (33.3%), and 9 mixed types (23.1%). Although the mean estimated blood loss in patients with either hyper- or hypoactive symptoms was larger than in patients lacking these symptoms, the odds ratio was only significant in patients with hyperactive symptoms. In addition, age, preoperative daily function, and preoperative hyponatremia were found to be risk factors for hyperactive but not hypoactive symptoms. Conclusion Patients with hypoactive symptoms had different risk factors than patients with hyperactive symptoms of delirium. The estimated blood loss, well-known risk factors for delirium, might be risk factors for only hyperactive delirium. The acute precipitating factors seemed to show stronger correlation with the hyperactive type of delirium than with the hypoactive type.

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

“…It is regarded to be caused by maladaptation of the brain to the surgical stress [3,4]. Postoperative delirium is a common complication in geriatric patients after major surgery [5,6]. The reported incidence of delirium after THA ranges from 5 to 17%, which varies for many reasons, such as patient population, definition and diagnosis of delirium [1,[7][8][9].…”

Biomarkers and Clinical Features of Delirium in Elderly Individuals With Hip Fracture Surgery.

“…These findings are in agreement with previous results. (64,65) Other clinical findings are worth mentioning including that delirium due to hip fracture and surgery was associated with increased psychomotor retardation and agitation (and consequent necessity to be restrained), more sleep disorders as assessed with the SWC and aberrations in the sleep-wake cycle as assessed with the DRS-R-98. These are all important features of the delirium phenome which are described in the diagnostic criteria.…”

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

“…It is regarded to be caused by maladaptation of the brain to the surgical stress [3,4]. Postoperative delirium is a common complication in geriatric patients after major surgery [5,6]. The reported incidence of delirium after THA ranges from 5% to 17%, which varied among studies depending on the patient population [1,7,8,9].…”