title: Pharmacologic risk factors for post-operative delirium in total joint arthroplasty patients: a case-control study.
abstract: Total joint arthroplasty (TJA) patients are at increased risk of post-operative delirium (POD) given their demographics and functional impairment. Certain pharmacologic agents are known to cause delirium, but those that cause delirium following TJA are unknown. Our aim was to explore if specific anesthetic agents, opiate pain medications, or benzodiazepines are associated with POD following TJA. A matched case (n=98)-control (n=365) design and conditional logistic regression model were used to examine risk factors for POD among TJA patients at our institution from 2006 to 2010. The model was adjusted for gender, pre-operative alcohol use, and pre-operative depression. Our data suggest that isoflurane and benzodiazepines are associated with an increased risk of delirium in TJA patients and should be used with caution. Hydromorphone and morphine did not increase the risk of delirium in TJA patients and may be considered for post-operative pain control.
authors.affiliation: Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Sumon
authors.initials: S
authors.lastname: Nandi
authors.affiliation: Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts; Department of Orthopedic Surgery, Tufts University Medical Center, Boston, Massachusetts.
authors.forename: William F
authors.initials: WF
authors.lastname: Harvey
authors.affiliation: Department of Orthopedic Surgery, Tufts University Medical Center, Boston, Massachusetts.
authors.forename: Jason
authors.initials: J
authors.lastname: Saillant
authors.affiliation: Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Anatoly
authors.initials: A
authors.lastname: Kazakin
authors.affiliation: Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Carl
authors.initials: C
authors.lastname: Talmo
authors.affiliation: Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: James
authors.initials: J
authors.lastname: Bono
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects; D000777:Anesthetics / Q000009:adverse effects; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001569:Benzodiazepines / Q000009:adverse effects; D016022:Case-Control Studies; D003072:Cognition Disorders; D003693:Delirium / Q000139:chemically induced* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000701:Analgesics, Opioid; D000777:Anesthetics; D001569:Benzodiazepines
keywords: anesthesia; benzodiazepines; delirium; opiates; total joint arthroplasty