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Orthopedic delirium

Jai Gon Seo, Sang Min Kim, Jung Min Shin, Youngjun Kim, Byung Hoon Lee
INTRODUCTION: Simultaneous bilateral total knee arthroplasty (TKA) has been associated with a high risk of morbidity and mortality. The orthopedic surgeon must, therefore, decide whether bilateral simultaneous TKA is a safe operation to perform and endeavor to decrease the risk of serious complications or even death. METHODS: This retrospective review included 2098 consecutive patients who underwent bilateral simultaneous TKAs by the protocol used in our institution, including the use of extramedullary instruments to minimize medullary canal invasion and overlapping procedures for both knees to decrease operation time...
November 2016: Archives of Orthopaedic and Trauma Surgery
Sara J E Beishuizen, Rikie M Scholtens, Barbara C van Munster, Sophia E de Rooij
OBJECTIVES: To assess the association between serum S100B levels (a marker of brain damage), delirium, and subsequent cognitive decline. DESIGN: Substudy of a multicenter randomized controlled trial. SETTING: Surgical, orthopedic, and trauma surgery wards of two teaching hospitals. PARTICIPANTS: Individuals aged 65 and older (range 65-102) admitted for hip fracture surgery (N = 385). MEASUREMENTS: During hospitalization, presence of delirium was assessed daily...
September 19, 2016: Journal of the American Geriatrics Society
Jan Hirsch, Susana Vacas, Niccolo Terrando, Miao Yuan, Laura P Sands, Joel Kramer, Kevin Bozic, Mervyn M Maze, Jacqueline M Leung
BACKGROUND: Postoperative delirium is prevalent in older patients and associated with worse outcomes. Recent data in animal studies demonstrate increases in inflammatory markers in plasma and cerebrospinal fluid (CSF) even after aseptic surgery, suggesting that inflammation of the central nervous system may be part of the pathogenesis of postoperative cognitive changes. We investigated the hypothesis that neuroinflammation was an important cause for postoperative delirium and cognitive dysfunction after major non-cardiac surgery...
2016: Journal of Neuroinflammation
Giuseppe Bellelli, Alessandro Morandi, Simona G Di Santo, Andrea Mazzone, Antonio Cherubini, Enrico Mossello, Mario Bo, Angelo Bianchetti, Renzo Rozzini, Ermellina Zanetti, Massimo Musicco, Alberto Ferrari, Nicola Ferrara, Marco Trabucchi
BACKGROUND: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy...
2016: BMC Medicine
Amanda Tow, Roee Holtzer, Cuiling Wang, Alok Sharan, Sun Jin Kim, Aharon Gladstein, Yossef Blum, Joe Verghese
OBJECTIVES: To examine the role of cognitive reserve in reducing delirium incidence and severity in older adults undergoing surgery. DESIGN: Prospective cohort study. SETTING: Hospital. PARTICIPANTS: Older adults (mean age 71.2, 65% women) undergoing elective orthopedic surgery (N = 142). MEASUREMENTS: Incidence (Confusion Assessment Method) and severity (Memorial Delirium Assessment Scale) of postoperative delirium were the primary outcomes...
June 2016: Journal of the American Geriatrics Society
Asli Koskderelioglu, Ozlem Onder, Melike Gucuyener, Taskin Altay, Cemil Kayali, Muhtesem Gedizlioglu
AIM: The aim of the present study was to estimate the incidence and risk factors of delirium during the early postoperative period after hip fracture surgery. Furthermore, we investigated the accuracy of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) for detection and assessment of delirium in orthopedic patients. METHODS: We consecutively recruited patients aged 65 years or older undergoing hip fracture surgery. The presence of delirium was determined daily by two of the authors according to the CAM-ICU criteria...
June 10, 2016: Geriatrics & Gerontology International
Sif Blandfort, Merete Gregersen, Lars Carl Borris, Else Marie Damsgaard
OBJECTIVES: To investigate whether a liberal blood transfusion strategy [Hb levels ≥11.3 g/dL (7 mmol/L)] reduces the risk of postoperative delirium (POD) on day 10, among nursing home residents with hip fracture, compared to a restrictive transfusion strategy [Hb levels ≥9.7 g/dL (6 mmol/L)]. Furthermore, to investigate whether POD influences mortality within 90 days after hip surgery. METHODS: This is a post hoc analysis based on The TRIFE - a randomized controlled trial...
June 1, 2016: Aging Clinical and Experimental Research
Che-Sheng Chu, Chih-Kuang Liang, Ming-Yueh Chou, Yu-Te Lin, Chien-Jen Hsu, Chin-Liang Chu, Po-Han Chou
OBJECTIVE: Postoperative delirium (POD) is a highly prevalent complex neuropsychiatric syndrome in elderly patients. However, its pathophysiology is currently unknown. Early detection and prevention of POD is important; therefore, the aim of this study was to investigate the link between preoperative insulin growth factor 1 (IGF-1) levels in the serum and POD in the Chinese elderly patients. METHODS: One hundred and three patients who were undergoing an orthopedic operation took part in the study...
May 2016: Psychiatry Investigation
Richard W Shulman, Saurabh Kalra, Joanne Zhuan Jiang
BACKGROUND: Delirium is a common condition in hospitalized seniors that nonetheless often goes undetected by nurses or is delayed in being detected which negatively impacts quality of care and outcomes. We sought to develop a new screening tool for delirium, The Sour Seven Questionnaire, a 7-item questionnaire suitable to be completed from informal or untrained caregiver observation. The study aimed to develop the scoring criteria for a positive delirium screen and assess concurrent validity of the questionnaire against a geriatric psychiatrist's assessment...
2016: BMC Geriatrics
Susan Freter, Michael Dunbar, Katalin Koller, Chris MacKnight, Kenneth Rockwood
BACKGROUND AND PURPOSE: Delirium is common after hip fracture. Previous work has shown that a simple delirium risk factor tool, the Delirium Elderly At Risk instrument (DEAR), has a high inter-rater reliability in this population. Little research has looked at the ability of risk factor screening tools to identify patients at high risk of pre-operative delirium. This study investigates the ability of the DEAR to identify patients at high risk of pre-operative delirium, as well as reporting its performance in a post-operative validation sample...
December 2015: Canadian Geriatrics Journal: CGJ
Eva M Schmitt, Jane S Saczynski, Cyrus M Kosar, Richard N Jones, David C Alsop, Tamara G Fong, Eran Metzger, Zara Cooper, Edward R Marcantonio, Thomas Travison, Sharon K Inouye
OBJECTIVES: To describe baseline characteristics and quality assurance procedures of the Successful Aging after Elective Surgery (SAGES) study, which was designed to examine novel risk factors and long-term outcomes associated with delirium. DESIGN: Long-term prospective cohort study. SETTING: Three academic medical centers. PARTICIPANTS: Individuals aged 70 and older (average age 77, 58% female) without recognized dementia scheduled for elective major surgery (N = 566)...
December 2015: Journal of the American Geriatrics Society
Katrin Singler, Tobias Roth, Sacha Beck, Michael Cunningham, Markus Gosch
INTRODUCTION: Research by AOTrauma's orthogeriatrics education taskforce identified ongoing educational needs for surgeons and trainees worldwide regarding the medical management of older adults with a fracture. To address practicing surgeons' preference for increased use of mobile learning, a point-of-care educational app was planned by a committee of experienced faculty. The goals were to deliver the app to surgeons, trainees, and other healthcare professionals, to measure usage, and to evaluate the impact on patient care...
January 2016: Archives of Orthopaedic and Trauma Surgery
Ki Hwa Lee, Ji Yeon Kim, Jeong Won Kim, Jang Su Park, Kyu Won Lee, Sang Yoon Jeon
BACKGROUND: Postoperative cognitive dysfunction (POCD) is a serious and frequent complication after surgery, especially in elderly patients. Ketamine is an N-methyl D-aspartic acid receptor antagonist with demonstrated neuroprotective effects. An intravenous bolus of a sub-anesthetic dose (0.5 mg/kg) of ketamine can reduce postoperative delirium (POD) and POCD after cardiac surgery. But, the influence of ketamine on early POCD after non-cardiac surgery is unclear. OBJECTIVES: The current study aimed to evaluate the influence of ketamine on early postoperative cognitive function after orthopedic surgery in elderly patients...
October 2015: Anesthesiology and Pain Medicine
Kristine S Todd, Jean Barry, Susan Hoppough, Eleanor McConnell
Delirium is a common and potentially devastating problem for older patients following hip fracture. Although early detection is recommended, description and evaluation of standardized approaches are scarce. The aims of this quality improvement project were to: (1) implement a clinical algorithm for improving delirium detection and management and (2) assess the impact of the clinical algorithm on length of stay, discharge disposition and patient satisfaction. The pilot study was implemented on an orthopedic unit to evaluate the effectiveness of a clinical protocol for delirium detection and management to improve outcomes...
November 2015: International Journal of Orthopaedic and Trauma Nursing
A H Leischker
In the elderly, fractures and other severe injuries frequently lead to substantial restrictions in the activities of daily living (ADLs) resulting in dependency. Typical complications following a fracture include acute delirium, deep vein thrombosis, pneumonia and other infections. It has been demonstrated that early surgery (osteosynthesis) and early mobilization significantly decrease the risk of these complications. An interdisciplinary cooperation between orthopedic surgeons and geriatricians leads to a shorter length of hospitalization, better mobility and, most importantly, to an improvement in the quality of life...
January 2016: Der Unfallchirurg
Lauren J Gleason, Eva M Schmitt, Cyrus M Kosar, Patricia Tabloski, Jane S Saczynski, Thomas Robinson, Zara Cooper, Selwyn O Rogers, Richard N Jones, Edward R Marcantonio, Sharon K Inouye
IMPORTANCE: Major postoperative complications and delirium contribute independently to adverse outcomes and high resource use in patients who undergo major surgery; however, their interrelationship is not well examined. OBJECTIVE: To evaluate the association of major postoperative complications and delirium, alone and combined, with adverse outcomes after surgery. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study in 2 large academic medical centers of 566 patients who were 70 years or older without recognized dementia or a history of delirium and underwent elective major orthopedic, vascular, or abdominal surgical procedures with a minimum 3-day hospitalization between June 18, 2010, and August 8, 2013...
December 2015: JAMA Surgery
Markus F Luger, Stephan Müller, Christian Kammerlander, Markus Gosch, Thomas J Luger
BACKGROUND: To investigate incidence and predictors of the various postoperative cognitive declines in old patients with hip fracture. METHODS: This retrospective chart study evaluated 411 patients (age ≥80 years, follow-up 5 years). After exclusion of 82 patients (preexisting dementia or delirium), 70 patients showing either diagnosed postoperative delirium (POD; group 1; N = 18, 5.5%) or an unspecified cognitive dysfunction and behavior (group 2; N = 52, 15...
December 2014: Geriatric Orthopaedic Surgery & Rehabilitation
Neomi Heyman, Frances Nili, Ron Shahory, Irena Seleznev, Merav Ben Natan
The aim of this study was to assess the prevalence of delirium among geriatric patients with hip fractures and to examine the influence of delirium on rehabilitation outcomes. A prospective study was carried out among 95 hip fracture patients admitted to an orthopedic geriatric rehabilitation ward. At admission, the following data were gathered: sociodemographic data, prefracture Activities of Daily Living (ADL), Functional Independence Measure (FIM), Mini-Mental State Examination, comorbidities, and medication...
September 2015: International Journal of Rehabilitation Research. Revue Internationale de Recherches de Réadaptation
Juan Wang, Zhiwei Li, Yu Yu, Bo Li, Gaohai Shao, Qunbo Wang
INTRODUCTION: Postoperative delirium is a common clinical manifestation in geriatric patients, resulting in prolonged hospitalization and increased economic burden, in addition to higher morbidity and mortality rates. Therefore, identifying non-obvious risk factors that contribute to the development of postoperative delirium in geriatric patients is crucial. METHODS: From January 2011 to June 2013, 200 geriatric patients of over 65 years of age scheduled for orthopedic surgery were randomly selected and statistically analyzed with respect to the effects of the following 12 factors on postoperative delirium: sex, age, anesthesia type, surgical type (i...
December 2015: Asia-Pacific Psychiatry: Official Journal of the Pacific Rim College of Psychiatrists
A K Konkayev, N V Bekmagambetova
UNLABELLED: Delirium seriously complicates the recovery period after surgery, injury and increases mortality in elderly patients with femoral fractures. PATIENTS AND METHODS: We examined 80 geriatric patients admitted to the Institute of Traumatology and Orthopedics in Astana in the period from September 2012 to June 2014. We evaluated the efficacy of dexmedetomidine and haloperidol sedation according to RASS, communication ability and level of tolerance of procedures...
January 2015: Anesteziologiia i Reanimatologiia
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