Risk Factors for Delirium After Orthopaedic Surgery

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Picture created by Bruce Blaus under a Creative Commons 4.0 License

Li-Hong Wang, Dong-Juan Xu, Xian-Jiao Wei, Hao-Teng Chang and Guo-Hong Xu have published a paper titled ‘Electrolyte disorders and aging: risk factors for delirium in patients undergoing orthopedic surgeries’ under a Creative Commons 4.0 license.

The researchers note that

In different hospital units, the incidence of delirium varied from 10% in emergency departments … to 70% in intensive care units

  • The researchers undertook a retrospective study of casenotes including people who had received a DSM-IV diagnosis from an attending Psychiatrist and comparing them with a control group without Delirium. The study took place in Dongyang, China.
  • The exclusion criteria were Dementia, mental illness, use of psychiatric medication, severe hearing or visual impairment, emergency or bilateral surgery and stroke.
  • The researchers utilised a range of outcome measures including electrolytes, haemoglobin and albumin. They compared the Delirium and non-Delirium groups with the student t-test, univariate and multivariate logistic regression.
  • Age and electrolyte disturbances were the factors which were correlated with an increased risk of Delirium post-operatively.
  • The odds ratio for Delirium post-operatively compared to those under the age of 70,  was 6.328 for those aged 70-79 (95% CI 1.350-29.667) and for those aged 80 or over it was 26.371 (95% CI 5.415-128.416). The upper limit of 128 for the odds ratio in the latter group should be noted.
  • The odds ratio for Delirium in those with electrolytes compared with those without was 2.376 (95% CI 1.157-4.879). Electrolyte disturbances were hypocalcaemia and hyponatraemia with the exception of 2 cases of hypernatraemia.

The researchers have identified three main risk factors for post-operative delirium with 4 orthopaedic operations – age, hypocalcaemia and hyponatraemia. Hyponatraemia and age as risk factors are particularly well described in the literature and this study reinforces these findings. Hypocalcaemia has also been described as a risk factor (e.g. this study).The researchers have identified the limitations in the study but provided useful data in terms of the odds ratios for comparison with other studies.

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Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

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