Ersel GÜLEÇ, İlke KÜPELİ, Ebru BİRİCİK, Yasemin GÜNEŞ, Ömer Sunkar BİÇER

Comparison of incidence and risk factors of delirium between general and regional anesthesia in elderly patients after lower extremity surgery

Amaç: Bu çalışmada; ortopedik cerrahi geçiren yaşlı hastalarda genel anestezi veya rejyonel anestezi sonrası görülen deliryum insidanslarının ve risk faktörlerinin karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Total kalça protezi, total diz protezi, femur kırığı cerrahisi geçiren, 65 yaş üzeri toplam 120 hastada gerçekleştirildi. Genel anestezi (n: 70) veya rejyonel anestezi (n:50) uygulanmasına göre iki gruba ayrıldı. Tüm hastaların, hemodinamik ve kan parametreleri, yaş, cinsiyet, ameliyat süresi, anestezi tipi, eşlik eden hastalıklar, sigara ve kullanılan ilaç miktarı gibi deliryumun potansiyel risk faktörleri, deliryum testleri (Confusion Assessment Method, Delirium Rating Scale-Revised-98), hastanede kalış süreleri ve maliyetleri kaydedildi. Bulgular: demografik veriler, operasyon zamanı, preoperatif ve postoperatif hemodinamik ve laboratuar değerleri her iki grupta aynıydı. Tüm hastalar için deliryum insidansı %12.5 idi. Grup G'de 6 hastada (%8.6), grup R'de 9 hastada (%18) deliryum görüldü. En önemli risk faktörlerinin ileri yaş ve polifarmasi olduğu saptandı. Ağır deliryum görülen hastalarda hastanede yatış süresi ve maliyet yüksekti. Sonuç: bu çalışma total kalça- diz artroplastisi, femur kırığı cerrahisi geçiren yaşlı hastaların %12.5'unda deliryum geliştiğini göstermiştir. Deliryum insidansı rejyonel veya genel anestezi ile değişiklik göstermedi. İleri yaş ve polifarmasi deliryum için risk faktörleridir. Deliryum hastane maliyeti ve hastanede yatış süresini artırır.

Alt ekstremite cerrahisi geçiren yaşlı hastalarda genel ve rejyonel anestezi sonrası görülen deliryum sıklığı ve risk faktörlerinin karşılaştırılması

Purpose: The aim of this study is to compare the risk factors and the incidence of delirium following orthopedic surgery under the general or regional anesthesia in elderly patients. Material and Methods: One hundred twenty elderly patients aged >=65 years scheduled for total hip or knee arthroplasty and femur fracture surgery were enrolled into the study. Patients were allocated into two groups to receive regional anesthesia (group R, n=50) or general anesthesia (group G, n=70). Hemodynamic and blood parameters, potential risk factors of delirium including age, sex, duration of surgery, the type of anesthesia, coexisting disease, smoking and amount of drug used delirium tests (Confusion Assessment Method, Delirium Rating ScaleRevised-98), hospital stay and costs were recorded for all patients. Results: Demographic data, duration of surgery, preoperative and postoperative hemodynamic and laboratory parameters were similar in two groups. Delirium incidence was 12.5% for all patients. We found delirium in six patients (8.6%) of group G and nine patients (18%) of group R. The most important risk factors were advanced age and polypharmacy for all patients. Hospital stay and cost were associated with severity of delirium. Conclusion: We found that the incidence of delirium is 12.5% in elderly patients undergoing total hip or knee arthroplasty and femur fracture surgery. Advanced age and polypharmacy are risk factors of delirium. Delirium increases the hospital stay and cost.

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Ellard L, Katznelson R, Wasowicz M, Ashworth A, Carroll J, Lindsay T et al. Type of anesthesia and postoperative delirium after vascular surgery. J Cardiothorac Vasc Anesth. 2014;28:458-61.
Sharon K. Inouye, M.D., M.P.H. Delirium in older persons. N Engl J Med. 2006;354:1157-65.
Litaker D, Locala J, Franco K, Bronson DL, Tannous Z. Preoperative risk factors for postoperative delirium. Gen Hosp Psychiatry. 2001;23:84-9.
Deiner S, Silverstein JH. Postoperative delirium and cognitive dysfunction. Br J Anaesth. 2009;103:141-6.
Schrader SL, Wellik KE, Demaerschalk BM, Caselli RJ, Woodruff BK, Wingerchuk DM. Adjunctive haloperidol prophylaxis reduces postoperative delirium severity and duration in at-risk elderly patients. Neurologist. 2008;14:134-7.
Steiner LA. Postoperative delirium. part 1: pathophysiology and risk factors. Eur J Anaesth. 2011;28:628-36.
Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383:911-22.
Chaput AJ, Bryson GL. Postoperative delirium: risk factors and management: continuing professional development. Can J Anaesth. 2012;59:304-20.
Inouye SK. Delirium in older persons. New Engl J Med. 2006;354:1157-65.
Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010;304:443-51.
Bryson GL, Wyand A. Evidence-based clinical update: general anesthesia and the risk of delirium and postoperative cognitive dysfunction. Can J Anaesth. 2006;53:669-77.
Slor CJ, de Jonghe JF, Vreeswijk R, Groot E, Ploeg TV, van Gool WA et al. Anesthesia and postoperative delirium in older adults undergoing hip surgery. J Am Geriatr Soc. 2011;59:1313-9.
Mouzopoulos G, Vasiliadis G, Lasanianos N, Nikolaras G, Morakis E, Kaminaris M. Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo-controlled study. J Orthop Traumatol. 2009;10:127-33.
Papaioannou A, Fraidakis O, Michaloudis D, Balalis C, Askitopoulou H. The impact of the type of anaesthesia on cognitive status and delirium during the first postoperative days in elderly patients. Eur J Anaesth. 2005;22:492-9.
Sieber FE, Zakriya KJ, Gottschalk A, Blute MR, Lee HB, Rosenberg PB et al. Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Mayo Clin Proc. 2010;85:18-26.
Marcantonio E, Ta T, Duthie E, Resnick NM. Delirium severity and psychomotor types: Their relationship with outcomes after hip fracture repair. J Am Geriatr Soc. 2002;50:850-7.
Ansaloni L, Catena F, Chattat R, Fortuna D, Franceschi C, Mascitti P et al. Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery. Br J Surg. 2010;97:273-80.
Robinson TN, Raeburn CD, Tran ZV, Angles EM, Brenner LA, Moss M. Postoperative delirium in the elderly: risk factors and outcomes. Ann Surg. 2009;249:173-8.
Slor CJ, Adamis D, Jansen RW, Meagher DJ, Witlox J, Houdijk AP et al. Delirium motor subtypes in elderly hip fracture patients: risk factors, outcomes and longitudinal stability. J Psychosom Res. 2013;74:444-9.
McAlpine JN, Hodgson EJ, Abramowitz S, Richman SM, Su Y, Kelly MG et al. The incidence and risk factors associated with postoperative delirium in geriatric patients undergoing surgery for suspected gynecologic malignancies. Gynecol Oncol. 2008;109:296-302.
Schuurmans MJ, Duursma SA, Shortridge-Baggett LM, Clevers GJ, Pel-Littel R. Elderly patients with a hip fracture: the risk for delirium. Appl Nurs Res. 2003;16:75-84.
Martin NJ, Stones MJ, Young JE, Bedard M. Development of delirium: a prospective cohort study in a community hospital. Int Psychogeriatr. 2000;12:117-27.
Nie H, Zhao B, Zhang YQ, Jiang YH, Yang YX. Pain and cognitive dysfunction are the risk factors of delirium in elderly hip fracture Chinese patients. Arch Gerontol Geriatr. 2012;54:e172-4.
Radtke FM, Franck M, MacGuill M, Seeling M, Lutz A, Westhoff S et al. Duration of fluid fasting and choice of analgesic are modifiable factors for early postoperative delirium. Eur J Anaesthesiol. 2010;27:411-6.
Morrison RS, Magaziner J, Gilbert M, Koval KJ, McLaughlin MA, Orosz G et al. Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol A Biol Sci Med Sci. 2003;58:76-81.
Lynch EP, Lazor MA, Gellis JE, Orav J, Goldman L, Marcantonio ER. The impact of postoperative pain on the development of postoperative delirium. Anesth Analg. 1998;86:781-5.
Rudolph JL, Jones RN, Levkoff SE, Rockett C, Inouye SK, Sellke FW et al. Derivation and validation of a preoperative prediction rule for delirium after cardiac surgery. Circulation. 2009;119:229-36.
Elie M, Cole MG, Primeau FJ, Bellavance F. Delirium risk factors in elderly hospitalized patients. J Gen Int Med. 1998;13:204-12.