Abstract
BackgroundDelirium is an important postoperative complication. Recent research suggested that 5-hydroxytryptamine 3 (5-HT3) receptor antagonists may have clinical effect in the treatment and prevention of delirium. We investigated the association between 5-HT3 receptor antagonists and the occurrence of postoperative delirium (POD).MethodsRetrospectively, the electronic medical records were reviewed in patients aged ≥ 65 years who underwent orthopedic lower limb surgery under regional anesthesia (spinal or combined spinal-epidural anesthesia) and administered intravenous 0.075 mg palonosetron or 0.3 mg ramosetron prior to the end of surgery between July 2012 and September 2015. POD incidence and anesthesia-, surgery-, and patient-related factors were evaluated. To investigate the association between 5-HT3 receptor antagonists and the occurrence of POD, multivariable logistic regression analysis was performed.ResultsOf the 855 patients included, 710 (83%) were administered 5-HT3 receptor antagonists. POD was confirmed in 46 (5.4%) patients. 5-HT3 receptor antagonists reduced the POD incidence by 63% (odds ratio [OR] 0.37; 95% confidence interval [CI], 0.15–0.94; P = 0.04). Moreover, the POD incidence decreased by 72% (OR 0.28, 95% CI 0.10–0.77, P = 0.01) when palonosetron was administered. Other identified risk factors for POD were emergency surgery, older age, hip surgery, lower body mass index, and intraoperative propofol sedation.Conclusion5-HT3 receptor antagonists may be related with a significantly reduced risk for POD in older patients undergoing orthopedic lower limb surgery. Notably, palonosetron was more effective for POD prevention.
Highlights
In older patients, postoperative delirium (POD) is an important complication, with a reported incidence of 5– 61% following orthopedic surgery (Morrison et al 1998; Rade et al 2011; Robertson and Robertson 2006)
Most previous clinical researches of 5-Hydroxytryptamine 3 (5-HT3) receptor antagonists have focused on POD after cardiac surgery (Bayndr et al 2000; Tagarakis et al 2012), with few studies investigating their effects after orthopedic surgery (Papadopoulos et al 2014)
In the present study, we found that older patients who received 5-HT3 receptor antagonists had a lower incidence of POD than those who did not receive these drugs
Summary
Postoperative delirium (POD) is an important complication, with a reported incidence of 5– 61% following orthopedic surgery (Morrison et al 1998; Rade et al 2011; Robertson and Robertson 2006). It has been related with higher mortality and morbidity rates, prolonged hospital stays, and delayed functional recovery (Liang et al 2014; Rade et al 2011; Robertson and Robertson 2006). Most previous clinical researches of 5-HT3 receptor antagonists have focused on POD after cardiac surgery (Bayndr et al 2000; Tagarakis et al 2012), with few studies investigating their effects after orthopedic surgery (Papadopoulos et al 2014). We investigated the association between 5-HT3 receptor antagonists and the occurrence of postoperative delirium (POD)
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