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Low Postoperative Delirium Risk after Elective Orthopedic Fast-Track Procedures

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  • Andreas Porsborg Andreasen, Aarhus University, Denmark
  • Marie Louise Clemmesen
  • Helle Madsen, Center for Planlagt Kirurgi, Regionshospitalet Silkeborg, Denmark
  • Christine L. Larsen, Center for Planlagt Kirurgi, Regionshospitalet Silkeborg, Denmark
  • Lotte Cecilie Nørgaard, Center for Planlagt Kirurgi, Regionshospitalet Silkeborg
  • ,
  • Iben N. Johansen, Center for Planlagt Kirurgi, Regionshospitalet Silkeborg, Denmark
  • Mai H. Skovbjerg, Center for Planlagt Kirurgi, Regionshospitalet Silkeborg, Denmark
  • Pia K. Ryhammer
  • Charlotte Runge
  • Trine Astrup Bech Vestergaard
  • Finn M. Radtke, Region Zealand, Denmark
  • Jens Rolighed Larsen
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
Original languageEnglish
Article number114
JournalJournal of Regional Anesthesia & Pain Medicine
Pages (from-to)1-4
Number of pages4
Publication statusPublished - Jul 2022

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