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Postoperative Delirium in Elderly Patients After Elective Hip or Knee Arthroplasty Performed Under Regional Anesthesia

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HSS Journal ®

Abstract

Delirium is a major adverse postoperative event in elderly patients. Incidence rates of postoperative delirium are difficult to determine. Because of the accuracy, brevity, and ease of use by clinical interviewers, the Confusion Assessment Method (CAM) has become widely used. This study used the CAM to determine the rate of postoperative delirium in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures under regional anesthesia. Following Institutional Review Board approval, a prospective study of 20 patients per group ages 70 and above undergoing unilateral THA or TKA was initiated. Both groups received a combined spinal–epidural, postoperative patient-controlled epidural anesthesia, and postoperative oral opioids. Patient interviews occurred five times: once preoperatively and two times each on postoperative days 1 and 2. Only two patients were assessed as delirious according to the CAM method (one in each group; 5%). Patient assessment by other clinicians indicated that five additional patients experienced acute change in mental status; however, these patients were not delirious at the times of the study interviews. The rate of delirium in the elderly after arthroplasty performed under regional anesthesia is very low. Reasons for this include patient selection criteria and anesthesia type. The study excluded patients with several proposed risk factors for postoperative delirium: prior history of dementia, history of mental illness, and use of benzodiazepines. The use of regional anesthesia may have also reduced the occurrence of postoperative delirium.

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Acknowledgements

Adapted from Inouye et al. [5] and Inouye [4].

We would also like to acknowledge Ruchi Pancholy’s contributions as a patient assessor.

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Authors and Affiliations

  1. Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA

    Matthew C. Rade BA, Jacques T. YaDeau MD, PhD & Carey Ford BA

  2. Weill College of Medicine of Cornell University, New York, NY, 10065, USA

    Jacques T. YaDeau MD, PhD

  3. Department of Medicine, Weill College of Medicine of Cornell University, New York, NY, 10065, USA

    M. C. Reid MD, PhD

Authors
  1. Matthew C. Rade BA
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  2. Jacques T. YaDeau MD, PhD
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  3. Carey Ford BA
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  4. M. C. Reid MD, PhD
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Corresponding author

Correspondence to Jacques T. YaDeau MD, PhD.

Additional information

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participating in the study was obtained.

This study was conducted with approval from the Institutional Review Board of the Hospital for Special Surgery. Work was performed at the Hospital for Special Surgery. All funding was provided by the Department of Anesthesiology, Hospital for Special Surgery.

Level of Evidence: Diagnostic study, level III

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Rade, M.C., YaDeau, J.T., Ford, C. et al. Postoperative Delirium in Elderly Patients After Elective Hip or Knee Arthroplasty Performed Under Regional Anesthesia. HSS Jrnl 7, 151–156 (2011). https://doi.org/10.1007/s11420-011-9195-2

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  • DOI: https://doi.org/10.1007/s11420-011-9195-2

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