Incidence and Associated Factors of Delirium after Orthopedic Surgery

Si-Wook Lee; Chul-Hyun Cho; Ki-Cheor Bae; Kyung-Jae Lee; Eun-Seok Son; Sang-Hyun Um

doi:10.4055/jkoa.2019.54.2.157

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Lee, Cho, Bae, Lee, Son, and Um: Incidence and Associated Factors of Delirium after Orthopedic Surgery

Original Article

Journal of the Korean Orthopaedic Association 2019; 54(2): 157-163.

Published online: 30 April 2019

DOI: https://doi.org/10.4055/jkoa.2019.54.2.157

Incidence and Associated Factors of Delirium after Orthopedic Surgery

Si-Wook Lee, M.D., Chul-Hyun Cho, M.D.

, Ki-Cheor Bae, M.D., Kyung-Jae Lee, M.D., Eun-Seok Son, M.D., Sang-Hyun Um, M.D.

Department of Orthopedic Surgery, Keimyung University School of Medicine, Daegu, Korea.

Correspondence to: Chul-Hyun Cho, M.D. Department of Orthopedic Surgery, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 41931, Korea. TEL: +82-53-250-7729, FAX: +82-53-250-7205, oscho5362@dsmc.or.kr

Received 12 June 2018 Revised 25 June 2018 Accepted 1 July 2018

The Korean Orthopaedic Association

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the incidence and associated factors of delirium after orthopedic surgery.

Materials and Methods

A total of 2,122 cases, who were older than 20 years and underwent orthopedic surgery at a single medical center during a one year period were included. Among them, 132 patients who were diagnosed with delirium after surgery under the Diagnostic and Statistical Manual of Mental Disorders-V criteria and medicated under the consultation of a psychiatrist were included in the study The differences in the incidence of delirium and several affecting factors were analyzed.

Results

The overall incidence of delirium after surgery was 6.2% (132 in 2,122 cases). The mean age of the delirium group was 77.4 years (range, 54–92 years), which was higher than that of the non-delirium group (58.1 years). The percentage of women in the delirium group was 63.6% (84 in 132 cases), which was higher than that of the women in the non-delirium group (49.0%). The incidence of delirium after surgery was 9.3% (85 in 916 cases) due to trauma and 3.9% (47 in 1206 cases) due to disease. The incidence of postoperative delirium according to the surgical region was 29.2% (7 in 24 cases) in two or more regions, 13.7% (72 in 526 cases) in the hip, and 9.6% (14 in 146 cases) in the spine, 3.5% (20 in 577 cases) in the knee-lower leg, 2.5% (5 in 199 cases) in the foot-ankle, 2.4% (11 in 457 cases) in the shoulder-elbow, and 1.6% (3 in 189 cases) in the forearm-wrist-hand. Delirium occurred more rapidly in women and surgery due to disease, and the duration of delirium was longer in patients with dementia and major depressive disorders.

Conclusion

The incidence of postoperative delirium was high in cases of surgery due to trauma and in cases of surgery in two or more sites. The incidence of postoperative delirium according to a single surgical region was higher in the order of the hip, spine, and knee. Active intervention is needed regarding the correctable risk factor.

Keywords: delirium, orthopedics

Figures and Tables

Figure 1

Incidence of postoperative delirium according to the cause of operation.

Figure 2

Incidence of postoperative delirium according to the anatomical regions.

Table 1

Demographic Data of Patient with Postoperative Delirium

Values are presented as number (%) or median (range). DM, diabetes mellitus; HTN, hypertension; MDD, major depressive disorder.

Table 2

Statistical Analysis between Delirium and Patient Factor

^*Correlation analysis; ^†Multi-regression analysis; ^‡p<0.05. MDD, major depressive disorder.

Table 3

Statistical Analysis between Delirium and Hospital Factors

^*Correlation analysis; ^†Multi-regression analysis; ^‡p<0.05. VAS: visual analogue scale.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

Appendix

Diagnostic criteria of Diagnostic and Statistical Manual V for the diagnosis of delirium.

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ORCID iDs: Chul-Hyun Cho
https://orcid.org/0000-0003-0252-8741
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