Effects of Preoperative Anxiety on Postoperative Delirium in Elderly Patients Undergoing Elective Orthopedic Surgery: A Prospective Observational Cohort Study
Apr 5, 2021Clinical interventions in aging
Pre-surgery anxiety linked to confusion after planned bone surgery in older adults
was present in 15.2% of elderly patients undergoing elective orthopedic surgery.
Among 263 patients, 27.8% were diagnosed with (POD).
The median duration of delirium was 2 days.
Preoperative anxiety was identified as a significant independent predictor of POD, with an odds ratio of 3.119.
Age and cognitive function, as measured by the Mini Mental State Examination, were also independently associated with POD.
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BACKGROUND: (POD) is common and has negative effects on elderly patients. There is a critical need to identify patients at high risk of POD so that providers can better offer targeted interventions in the preoperative and intraoperative periods. We aimed to characterize the prevalence of and investigate whether preoperative anxiety predicted the onset of POD in elderly patients undergoing elective orthopedic surgery.
METHODS: We conducted a prospective observational cohort study of elderly patients (aged 65 years or older) undergoing elective orthopedic surgery. Preoperative anxiety was assessed using the Hospital Anxiety and Depression Scale-Anxiety (HADS-A), with clinically significant values defined as HADS-A>7. POD was diagnosed according to the Confusion Assessment Method (CAM) criteria on the 5 postoperative days. To determine the independent risk factors for POD, multivariable logistic regression was conducted, including those variables with a p-value <0.05 at univariate analysis.
RESULTS: There were 263 patients included in the study. Seventy-three (27.8%) patients were diagnosed to be POD. Median duration of delirium was 2 days. Forty (15.2%) patients were assessed to experience preoperative anxiety. The occurrence of preoperative anxiety in total hip arthroplasty (THA), proximal femoral nail antirotation (PFNA), and total knee arthroplasty (TKA) was 12.5%, 16.1%, and 19.5%, respectively. Based on multivariable analysis, only age (odds ratio [OR]= 1.099, 95% Confidence Interval [CI]: 1.013-1.192;=0.023), Mini Mental State Examination (MMSE) (OR= 0.603, 95% CI: 0.432-0.842;=0.003) and preoperative anxiety (OR= 3.119, 95% CI: 1.144-8.500;=0.026) were independently associated with POD. P P P
CONCLUSION: In conclusion, the current study reveals that preoperative anxiety helps to predict the risk of POD in elderly patients undergoing elective orthopedic surgery. Relieving preoperative anxiety could be a new target for preventive interventions to reduce POD.
Key numbers
40 of 263 patients
Occurrence
Total patients assessed for anxiety
3.119
Increased Risk of
Odds ratio from multivariable analysis
73 of 263 patients
Incidence of
Total patients diagnosed with
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