Postoperative delirium among elderly elective orthopedic patients in Addis Ababa Ethiopia: a multicentere longitudinal study

Sep 28, 2024BMC anesthesiology

Delirium after planned orthopedic surgery in older adults in Addis Ababa, Ethiopia

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Abstract

The incidence of among elderly elective orthopedic surgical patients is 33.7%.

Advanced age is associated with a lower risk of postoperative delirium in patients aged 65-75.
Induction using ketamine is linked to a higher likelihood of developing postoperative delirium.
Perioperative opioid use is associated with an increased risk of postoperative delirium.
Intraoperative use of anticholinergic medications is related to a higher incidence of postoperative delirium.
A recent history of hospitalization is associated with an increased risk of postoperative delirium.
Blood transfusion during surgery is linked to a higher likelihood of developing postoperative delirium.

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BACKGROUND: Delirium is a neurocognitive disorder characterized by an acute and relatively rapid decline in cognition, disturbance of consciousness, reduced ability to focus, and shift of attention. It mainly affects elderly patients with an incidence of about 8-23% after an operation. It frequently occurs between 24-hrs and 5 days after surgery. It results in serious medical management problems. Hence, identifying the incidence and associated factors may help prevent and manage its sequel in the elderly.

OBJECTIVE: Assessment of the incidence and associated factors of (POD) among elderly elective orthopedic surgical patients in Addis Ababa public hospitals, Ethiopia, 2024.

METHODS: A multi-centered longitudinal study was conducted on 220 elderly (age ≥ 65 years) patients in four selected public hospitals of the study area from February 2024 to May 2024, and a systematic sampling technique was used to select the study units. Data was collected through chart review and interviews of patients, and postoperative delirium was assessed using the confusion assessment method (CAM). Both bivariable and multivariable logistic regression models were used for statistical analysis. The strength of association was determined with an (AOR) with a 95% confidence interval(CI) at a p-value of < 0.05.

RESULTS: A total of 220 patients were studied, and the incidence of POD among elderly elective orthopedic surgical patients was 33.7%. Age 65-75(AOR = 0.47, 95%CI (0.226-0.97)), Induction using ketamine (AOR = 1.32, 95%CI(1.109-3.87), p = 0.003)), perioperative opioid use (AOR = 2.20, 95%CI(1.073 4.5313)), intraoperative anticholinergic use(AOR = 2.24,95%CI(1.831-4.235)), recent hospitalization history (AOR = 2.24,95%CI(1.202-4.206)), and transfusion (AOR = 2.83,95%CI(1.295-6.193)) were significantly associated with POD (p < 0.05).

CONCLUSION AND RECOMMENDATIONS: The incidence of POD in the study area was high (33.7%); advanced age, hospitalization history, Anesthesia induction by Ketamine, perioperative anticholinergic uses, opioid use, and blood transfusion use were associated factors for postoperative delirium. We recommend giving due attention to elderly patients with advanced age, history of hospitalization, perioperative Ketamie use, perioperative anticholinergic uses, opioid use, and blood transfusion use undergoing elderly elective orthopedic surgery.

Key numbers

33.7%

Incidence of

Percentage of elderly orthopedic patients experiencing in the study.

0.47

Odds of Developing by Age

for patients aged 65-75 vs. those older than 85.

2.24

Increased Odds from Hospitalization History

for patients with a recent hospitalization history.

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Postoperative delirium among elderly elective orthopedic patients in Addis Ababa Ethiopia: a multicentere longitudinal study

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