Relationship between delirium incidence and different operation timings of hip arthroplasty in elderly patients

doi:10.3877/cma.j.issn.1674-134X.2018.04.007

Abstract

Abstract:

Objective

To study the effect of different timing of surgery on the incidence of postoperative delirium in elderly patients undergoing hip replacement.

Method

According to the criteria of admission, a total of 83 patients undergoing hip replacement over 65 years old were selected in Shunde Second People’s Hospital from February 2013 to February 2017. The total hip replacement group (THR, 39 cases) and the femoral head replacement group (FHR, 44 cases) were divided into the total hip replacement group. The patients of different operation method were divided into the control group (C) and the experimental group (T) according to the operation time (later than 48 h or earlier than 48 h after injury). Finally, four groups of THR-C(25 cases)、THR-T(14 cases)、FHR-C(21 cases)、FHR-T(23 cases) were obtained. Anesthesia and operation were performed by intraspinal anesthesia. Heart rate (HR), mean arterial pressure (MAP), and surplus pulse O₂(SpO₂) were maintained before the operation (T_p), during the operation (T₀) and three days after theoperation(T₁~T₃), and pain score (VAS) at each time point was recorded. The confusion assessment method- Chinese reversion (CAM-CR) for delirium was used to assess the delirium at each time point and record the number of delirium at each time point. Chi-square test or rank sum test were used to analyse the data.

Results

Before operation, all the patients were in moderate and severe pain (VAS: 6-8), high blood pressure (MAP: 110-99mmHg), and intraoperative and postoperative indexes improved significantly (VAS: H=201.22; MAP: F=576.348, P<0.05). The incidence of delirium on the 3^rd day after operation: the delirium incidence of surgical treatment within 48 h was less than that late than 48 h (THR-C vs THR-T: χ²=4.92; FHR-C vs FHR-T: χ²=7.58, both P<0.05); and the delirium incidence of FHR was lower than that of THR (THR-C vs THR-T: χ²=4.27, P<0.05); among them, THR-C group had the highest incidence of 56.0%, while FHR-T group had the lowest incidence of 13.0% (χ²=7.877, P<0.05). The duration of hospitalization the patients operated within 48 h was significantly shorter than the patients operated late than 48 h(THR-C vs THR-T: F=6.892; FHR-C vs FHR-T: F=127.489, P<0.05); the FHR-T group had the shortest length of hospital stay(14.8±7.6)d(F=214.086, P<0.05). The length of hospital stay in the patients operated within 48 h was significantly shorter than the patients operated late than 48 h (THR: F=6.892; FHR: F=127.489, both P<0.05).

Conclusion

The incidence of postoperative delirium in the elderly patients with hip replacement is affected by the surgical timing, and surgical treatment within 48 h can significantly reduce the incidence of postoperative delirium and shorten the time of hospitalization.

Key words: Aged, Hip, Arthroplasty, Delirium, Incidence

Xiaolei Chen, Chunhui Wu, Shaosheng Mai, Xiaofen Li. Relationship between delirium incidence and different operation timings of hip arthroplasty in elderly patients[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2018, 12(04): 478-483.

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Figures/Tables 4

References 20

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组别	例数	年龄[岁，M(P25，P75)]	性别(男/女，例)	术前Hb[g/L，(±s)]	BMI[kg/m²，(±s)]	ASA分级(Ⅱ/Ⅲ，例)	高血压史(无/有，例)	冠心病史(无/有，例)	糖尿病史(无/有，例)
THR-C组	25	78.0(73.0，81.0)	14/11	113±18	21.3±4.3	10/15	10/15	16/9	17/8
THR-T组	14	77.0(71.0，80.0)	8/6	109±21	22.4±4.9	4/10	6/8	7/7	10/4
FHR-C组	21	80.0(74.0，83.0)	11/10	98±26	21.6±5.1	9/12	8/13	12/9	15/6
FHR-T组	23	79.0(72.0，80.0)	13/10	103±23	20.8±5.2	9/14	8/15	14/9	18/5
统计值	?	H＝5.183	χ²＝0.110	F＝1.655	F＝1.193	χ²＝0.778	χ²＝0.271	χ²＝0.791	χ²＝0.652
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	年龄[岁，M(P25，P75)]	性别(男/女，例)	术前Hb[g/L，(±s)]	BMI[kg/m²，(±s)]	ASA分级(Ⅱ/Ⅲ，例)	高血压史(无/有，例)	冠心病史(无/有，例)	糖尿病史(无/有，例)
THR-C组	25	78.0(73.0，81.0)	14/11	113±18	21.3±4.3	10/15	10/15	16/9	17/8
THR-T组	14	77.0(71.0，80.0)	8/6	109±21	22.4±4.9	4/10	6/8	7/7	10/4
FHR-C组	21	80.0(74.0，83.0)	11/10	98±26	21.6±5.1	9/12	8/13	12/9	15/6
FHR-T组	23	79.0(72.0，80.0)	13/10	103±23	20.8±5.2	9/14	8/15	14/9	18/5
统计值	?	H＝5.183	χ²＝0.110	F＝1.655	F＝1.193	χ²＝0.778	χ²＝0.271	χ²＝0.791	χ²＝0.652
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	麻醉时长(min)	手术时长(min)	术中失血量(ml)	输血量(U)	住院天数(d)
THR-T组	14	201.3(157.5，205.1)	135.0 (126.3，173.0)	300.0(200.0，400.0)	2.0(1.5，3.5)	20.0(15.0，26.0)^ab
THR-C组	25	191.6(156.2，227.0)	131.3(125.5，181.5)	250.0(150.0，350.0)	2.0(1.0，3.0)	25.0(15.0，31.0)
FHR-T组	23	110.1(80.2，120.0)^b	80.7(50.6，92.6)^b	150.0(100.0，200)^b	1.0(0.0，1.5)	14.0(10.0，16.0)^db
FHR-C组	21	101.3(78.5，125.1)^c	78.3(55.0，90.0)^c	150.0(100.0，250.0)^c	1.0(0.0，2.0)	17.0(16.0，22.0)^c
统计值	?	H＝61.559	H＝63.192	H＝51.712	H＝49.147	H＝55.879
P值	?	<0.01	<0.01	<0.01	<0.01	<0.01

组别	例数	麻醉时长(min)	手术时长(min)	术中失血量(ml)	输血量(U)	住院天数(d)
THR-T组	14	201.3(157.5，205.1)	135.0 (126.3，173.0)	300.0(200.0，400.0)	2.0(1.5，3.5)	20.0(15.0，26.0)^ab
THR-C组	25	191.6(156.2，227.0)	131.3(125.5，181.5)	250.0(150.0，350.0)	2.0(1.0，3.0)	25.0(15.0，31.0)
FHR-T组	23	110.1(80.2，120.0)^b	80.7(50.6，92.6)^b	150.0(100.0，200)^b	1.0(0.0，1.5)	14.0(10.0，16.0)^db
FHR-C组	21	101.3(78.5，125.1)^c	78.3(55.0，90.0)^c	150.0(100.0，250.0)^c	1.0(0.0，2.0)	17.0(16.0，22.0)^c
统计值	?	H＝61.559	H＝63.192	H＝51.712	H＝49.147	H＝55.879
P值	?	<0.01	<0.01	<0.01	<0.01	<0.01

组别	例数	T₀	T₁	T₂	T₃	总发生率
THR-C组	25	1(4)	8(32)	4(16)	1(4.0)	14(56)^ad
THR-T组	14	0(0)	2(14)	0(0)	0(0)	2(14)^ac
FHR-C组	21	0(0)	3(14)	2(9)	0(0)	5(24)^b
FHR-T组	23	0(0)	2(9)	1(4)	0(0)	3(13)^bcd
χ²值	?	?	?	?	?	9.443
P值	?	?	?	?	?	<0.01

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