Abstract
Introduction: The current status of postoperative delirium (POD) risk in selected orthopedic elective surgery cohorts is
unclear. The influence of fast-track surgery, in combination with regional anesthetic nerve blocks, BIS-monitoring and
modernized patient trajectories, may well reduce POD risk, even in an elderly population.
Methods: An observational cohort, screening for postoperative delirium using the Nu-DESC (Nursing-Delirium Screening
Scale) in 879 consecutive elective orthopedic surgery patients. Nu-DESC rating at 4 preset time points; preoperatively, at
emergence, at post-anesthesia care unit (PACU) admittance, at PACU discharge.
Results: Overall, 6 of the (n=) 879 participants (0.68%) scored ≥2 Nu-DESC points when interviewed at PACU discharge.
These were distributed amongst surgical categories as follows; Knee (0.0%), Hip (2 out of 227 = 0.88%), Shoulder (0 out of
70 = 0%), Minor Lumbar Spine (1 out of 226 = 0.44%), and Major Lumbar spine (3 out of 129 = 2.3%). 3.98% of all patients
scored ≥2 NuDESC at PACU arrival. Though there was a significant overrepresentation of general anesthesia patients among
≥2 NuDESC, these select patients were not related to BIS-monitoring or Ketamine infusion, and inversely correlated to spinal
anesthesia and regional anesthetic nerve blocks.
Discussion: We report a lower-than anticipated incidence of POD-related ≥2 NuDESC scores at PACU discharge in a selected,
elective orthopedic surgery cohort, but still a significant incidence at PACU arrival. Modern anesthesia management and
techniques may help lower clinical POD in the elderly patient.
Keywords: Postoperative delirium; Delirium score; orthopedic surgery; fast-track; patient pathways; regional anesthesia
unclear. The influence of fast-track surgery, in combination with regional anesthetic nerve blocks, BIS-monitoring and
modernized patient trajectories, may well reduce POD risk, even in an elderly population.
Methods: An observational cohort, screening for postoperative delirium using the Nu-DESC (Nursing-Delirium Screening
Scale) in 879 consecutive elective orthopedic surgery patients. Nu-DESC rating at 4 preset time points; preoperatively, at
emergence, at post-anesthesia care unit (PACU) admittance, at PACU discharge.
Results: Overall, 6 of the (n=) 879 participants (0.68%) scored ≥2 Nu-DESC points when interviewed at PACU discharge.
These were distributed amongst surgical categories as follows; Knee (0.0%), Hip (2 out of 227 = 0.88%), Shoulder (0 out of
70 = 0%), Minor Lumbar Spine (1 out of 226 = 0.44%), and Major Lumbar spine (3 out of 129 = 2.3%). 3.98% of all patients
scored ≥2 NuDESC at PACU arrival. Though there was a significant overrepresentation of general anesthesia patients among
≥2 NuDESC, these select patients were not related to BIS-monitoring or Ketamine infusion, and inversely correlated to spinal
anesthesia and regional anesthetic nerve blocks.
Discussion: We report a lower-than anticipated incidence of POD-related ≥2 NuDESC scores at PACU discharge in a selected,
elective orthopedic surgery cohort, but still a significant incidence at PACU arrival. Modern anesthesia management and
techniques may help lower clinical POD in the elderly patient.
Keywords: Postoperative delirium; Delirium score; orthopedic surgery; fast-track; patient pathways; regional anesthesia
| Originalsprog | Engelsk |
|---|---|
| Artikelnummer | 114 |
| Tidsskrift | Journal of Regional Anesthesia & Pain Medicine |
| Vol/bind | 2 |
| Nummer | 2 |
| Sider (fra-til) | 1-4 |
| Antal sider | 4 |
| ISSN | 2661-7390 |
| DOI | |
| Status | Udgivet - jul. 2022 |