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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