Ashley Knebel, Manjot Singh, Rhea Rasquinha, Mohammad Daher, Joseph E Nassar, John Hanna, Eric M Cohen, Bassel G Diebo, Alan H Daniels
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After matching by age, sex, and comorbidities, electrolyte disturbances and 90-day postoperative complications were analysed.</p><p><strong>Results: </strong>Among 2,518,918 (99.7%) no POD and 7240 (0.3%) POD patients who underwent total knee or hip arthroplasty, mean age was 65.58 years, 60.2% were female, and mean CCI was 1.50 for the whole cohort. POD patients frequently had baseline cognitive impairment (<i>P</i> <i><</i> 0.001). Incidence of POD decreased from 0.54% in 2010 to 0.10% in 2022 (<i>P</i> <i><</i> 0.001) and increased with age (<i>P</i> <i><</i> 0.001). POD patients had higher 90-day costs (TKA = $19,572 vs. $10,397, <i>P</i> <i><</i> 0.001; THA = $18,496 vs. $9,877 <i>P</i> <i><</i> 0.001). After matching, POD TKA patients had higher rates of hypernatraemia (6.1% vs 4.5%, <i>P</i> <i>=</i> 0.001) and POD THA patients had higher rates of hyponatraemia (26.5% vs 23.1%, <i>P</i> <i>=</i> 0.008). POD patients had higher rates of 90-day postoperative medical and surgical complications (<i>P</i> <i><</i> 0.05) than no POD patients.</p><p><strong>Conclusions: </strong>Nearly 0.3% of patients who underwent either TKA or THA between 2010 and 2022 developed transient delirium. POD was most common in elderly patients with baseline cognitive impairment undergoing revision surgery. POD patients had higher rates of 90-day postoperative surgical and joint-related complications. While POD rates have decreased, continued initiative to prevent POD in total joint arthroplasty patients is imperative.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"11207000241305771"},"PeriodicalIF":1.3000,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Postoperative delirium following total joint arthroplasty: epidemiology, risk factors, and associated complications.\",\"authors\":\"Ashley Knebel, Manjot Singh, Rhea Rasquinha, Mohammad Daher, Joseph E Nassar, John Hanna, Eric M Cohen, Bassel G Diebo, Alan H Daniels\",\"doi\":\"10.1177/11207000241305771\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Postoperative delirium (POD) is a feared complication following major surgery in elderly patients. Further investigation of the risk factors and consequences of POD following total joint arthroplasty is warranted.</p><p><strong>Methods: </strong>Patients who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA) were identified using PearlDiver. Patients were filtered into 2 cohorts based on the presence or absence of POD within 7 days of surgery. Epidemiological analyses were performed to examine trends in POD following TKA and THA by age group and year. Comparative analyses were performed on patient demographics and baseline cognitive status. After matching by age, sex, and comorbidities, electrolyte disturbances and 90-day postoperative complications were analysed.</p><p><strong>Results: </strong>Among 2,518,918 (99.7%) no POD and 7240 (0.3%) POD patients who underwent total knee or hip arthroplasty, mean age was 65.58 years, 60.2% were female, and mean CCI was 1.50 for the whole cohort. POD patients frequently had baseline cognitive impairment (<i>P</i> <i><</i> 0.001). Incidence of POD decreased from 0.54% in 2010 to 0.10% in 2022 (<i>P</i> <i><</i> 0.001) and increased with age (<i>P</i> <i><</i> 0.001). POD patients had higher 90-day costs (TKA = $19,572 vs. $10,397, <i>P</i> <i><</i> 0.001; THA = $18,496 vs. $9,877 <i>P</i> <i><</i> 0.001). After matching, POD TKA patients had higher rates of hypernatraemia (6.1% vs 4.5%, <i>P</i> <i>=</i> 0.001) and POD THA patients had higher rates of hyponatraemia (26.5% vs 23.1%, <i>P</i> <i>=</i> 0.008). POD patients had higher rates of 90-day postoperative medical and surgical complications (<i>P</i> <i><</i> 0.05) than no POD patients.</p><p><strong>Conclusions: </strong>Nearly 0.3% of patients who underwent either TKA or THA between 2010 and 2022 developed transient delirium. POD was most common in elderly patients with baseline cognitive impairment undergoing revision surgery. POD patients had higher rates of 90-day postoperative surgical and joint-related complications. 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引用次数: 0
摘要
摘要术后谵妄（POD）是老年患者大手术后令人担忧的并发症。进一步调查全关节置换术后POD的危险因素和后果是有必要的。方法：采用PearlDiver对接受全膝关节置换术（TKA）或全髋关节置换术（THA）的患者进行识别。根据手术后7天内是否存在POD，将患者分为2组。进行流行病学分析，按年龄组和年份检查TKA和THA后POD的趋势。对患者人口统计学和基线认知状况进行比较分析。根据年龄、性别和合并症进行匹配后，分析电解质紊乱和术后90天并发症。结果：在2518918例（99.7%）无POD患者和7240例（0.3%）行全膝关节或髋关节置换术的POD患者中，平均年龄为65.58岁，60.2%为女性，整个队列的平均CCI为1.50。POD患者经常有基线认知障碍（p0.001）。POD的发病率从2010年的0.54%下降到2022年的0.10% (P 0.001)，并随着年龄的增长而增加（P 0.001）。POD患者的90天费用更高(TKA = 19,572美元vs. 10,397美元，P 0.001；THA = 18,496美元vs. 9,877美元（P 0.001）。配对后，POD TKA患者高钠血症发生率较高（6.1% vs 4.5%, P = 0.001）， POD THA患者低钠血症发生率较高（26.5% vs 23.1%, P = 0.008）。POD患者术后90天的内科和外科并发症发生率高于无POD患者（P < 0.05）。结论：2010年至2022年间，近0.3%的TKA或THA患者出现了短暂性谵妄。POD在接受翻修手术的基线认知障碍的老年患者中最常见。POD患者术后90天的手术及关节相关并发症发生率较高。虽然POD率有所下降，但在全关节置换术患者中继续主动预防POD是必要的。
Postoperative delirium following total joint arthroplasty: epidemiology, risk factors, and associated complications.
Introduction: Postoperative delirium (POD) is a feared complication following major surgery in elderly patients. Further investigation of the risk factors and consequences of POD following total joint arthroplasty is warranted.
Methods: Patients who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA) were identified using PearlDiver. Patients were filtered into 2 cohorts based on the presence or absence of POD within 7 days of surgery. Epidemiological analyses were performed to examine trends in POD following TKA and THA by age group and year. Comparative analyses were performed on patient demographics and baseline cognitive status. After matching by age, sex, and comorbidities, electrolyte disturbances and 90-day postoperative complications were analysed.
Results: Among 2,518,918 (99.7%) no POD and 7240 (0.3%) POD patients who underwent total knee or hip arthroplasty, mean age was 65.58 years, 60.2% were female, and mean CCI was 1.50 for the whole cohort. POD patients frequently had baseline cognitive impairment (P< 0.001). Incidence of POD decreased from 0.54% in 2010 to 0.10% in 2022 (P< 0.001) and increased with age (P< 0.001). POD patients had higher 90-day costs (TKA = $19,572 vs. $10,397, P< 0.001; THA = $18,496 vs. $9,877 P< 0.001). After matching, POD TKA patients had higher rates of hypernatraemia (6.1% vs 4.5%, P= 0.001) and POD THA patients had higher rates of hyponatraemia (26.5% vs 23.1%, P= 0.008). POD patients had higher rates of 90-day postoperative medical and surgical complications (P< 0.05) than no POD patients.
Conclusions: Nearly 0.3% of patients who underwent either TKA or THA between 2010 and 2022 developed transient delirium. POD was most common in elderly patients with baseline cognitive impairment undergoing revision surgery. POD patients had higher rates of 90-day postoperative surgical and joint-related complications. While POD rates have decreased, continued initiative to prevent POD in total joint arthroplasty patients is imperative.
期刊介绍：
HIP International is the official journal of the European Hip Society. It is the only international, peer-reviewed, bi-monthly journal dedicated to diseases of the hip. HIP International considers contributions relating to hip surgery, traumatology of the hip, prosthetic surgery, biomechanics, and basic sciences relating to the hip. HIP International invites reviews from leading specialists with the aim of informing its readers of current evidence-based best practice.
The journal also publishes supplements containing proceedings of symposia, special meetings or articles of special educational merit.
HIP International is divided into six independent sections led by editors of the highest scientific merit. These sections are:
• Biomaterials
• Biomechanics
• Conservative Hip Surgery
• Paediatrics
• Primary and Revision Hip Arthroplasty
• Traumatology
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