Risk Factors and a Nomogram Model Establishment for Postoperative Delirium in Elderly Patients Undergoing Arthroplasty Surgery: A Single-Center Retrospective Study.

Daiyu Chen,Jun Cao,Ying Li,Qingshu Li,Jiaoni Li,Siqi Wang,Wuxi Gao,Cheng Ni

doi:10.1155/2021/6607386

Abstract

Objective To explore the related risk factors of postoperative delirium (POD) after hip or knee arthroplasty in elderly orthopedic patients and the predictive value of related risk factors. Material and Methods. In total, 309 patients (≥60 years) who received knee and hip arthroplasty between January 2017 and May 2020 were consecutively selected into the POD and nonpostoperative delirium (NPOD) groups. Group bias was eliminated through propensity score matching. Univariate and multivariable logistic analysis was used to determine the risk factors for POD. The nomogram was made by R. Results 58 patients were included in each group after propensity score matching; multivariable analysis demonstrated that LDH (OR = 4.364, P = 0.017), CHE (OR = 4.640, P = 0.004), Cystatin C (OR = 5.283, P = 0.006), arrhythmia (OR = 5.253, P = 0.002), and operation duration (OR = 1.017, P = 0.050) were independent risk factors of POD. LDH, CHE, Cystatin C, and arrhythmia were used to construct a nomogram to predict the POD. The nomogram was well calibrated and had moderate discriminative ability (AUC = 0.821, 95% CI: 0.760~0.883). Decision curve analysis demonstrated that the nomogram was clinically useful. Conclusions Our study revealed that arrhythmia, operation duration, the increase of lactate dehydrogenase and Cystatin C, and the decrease of cholinesterase were reliable factors for predicting postoperative delirium after elderly hip and knee arthroplasty. Meanwhile, the nomogram we developed can assist the clinician to filtrate potential patients with postoperative delirium.

Highlights

Knee and hip arthroplasty are taking up an increasing proportion of orthopedic surgery, and the demand especially from those patients mainly over 60 years old will continue to grow [1, 2]
Patients who underwent hip and knee arthroplasty in our hospital from 2017.01 to 2020.05 were included. 68 patients with postoperative delirium and 241 patients without postoperative delirium were selected into the POD group and 309 elder arthroplasty patients were approached for study
65 and 195 patients were eligible for the study and separately divided into the POD group and the nonpostoperative delirium (NPOD) group, respectively. 58 patients were included in each group after Propensity score matching (PSM)

Summary

Introduction

Knee and hip arthroplasty are taking up an increasing proportion of orthopedic surgery, and the demand especially from those patients mainly over 60 years old will continue to grow [1, 2]. Evidence has indicated that postoperative delirium (POD) is a relatively common and serious complication in patients undergoing hip and knee arthroplasty, and the probability of occurrence is up to 17.6% [3]. POD is an acute clinical reversible syndrome characterized by a typical dysfunction of the patient’s cognition and attention after anesthesia and surgery [4]. It is extremely important to identify patients with potential risk of POD before surgery, which can help clinical decision-makers to achieve preventive effect through a variety of interventions during the perioperative period. Many risk factors have been identified, but the risk factors obtained from most studies are limited to demographic characteristics, such as patient’s age, sex, and past history [7,8,9,10], while few studies on risk factors related to laboratory data, and rarely focus on knee and hip arthroplasty surgeries.

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Results

Conclusion