Interrelationship of postoperative delirium and cognitive impairment and their impact on the functional status in older patients undergoing orthopaedic surgery: a prospective cohort study.
BACKGROUND
The impact of postoperative delirium on post-discharge functional status of older patients remains unclear, and little is known regarding the interrelationship between cognitive impairment and post-operative delirium. Therefore, the main purpose was to evaluate the post-discharge functional status of patients who experience delirium after undergoing orthopaedic surgery and the interrelationship of postoperative delirium with underlying cognitive impairment.


METHODS
This prospective cohort study, conducted at a tertiary care medical center from April 2011 to March 2012, enrolled all subjects aged over 60 years who were admitted for orthopaedic surgery. The baseline characteristics (age, gender, BMI, and living arrangement), surgery-related factors (ASA class, admission type, type of surgery, and length of hospital stay), results of geriatric assessment (postoperative delirium, cognition, depressive mood, comorbidity, pain, malnutrition, polypharmacy, ADL, and instrumental [I]ADL) and 1-12-month postoperative ADL and IADL functional status were collected for analysis.


RESULTS
Overall, 9.1% of 232 patients (mean age: 74.7 ± 7.8 years) experienced postoperative delirium, which was significantly associated with IADL decline at only 6 and 12 months postoperatively (RR: 6.22, 95% CI: 1.08-35.70 and RR: 12.54, 95% CI: 1.88-83.71, respectively). Delirium superimposed on cognitive impairment was a significant predictor for poor functional status at 6 and 12 months postoperatively (RR: 12.80, 95% CI: 1.65-99.40 for ADL at the 6th month, and RR: 7.96, 95% CI: 1.35-46.99 at the 12th month; RR: 13.68, 95% CI: 1.94-96.55 for IADL at the 6th month, and RR: 30.61, 95% CI: 2.94-318.54 at the 12th month, respectively).


CONCLUSIONS
Postoperative delirium is predictive of IADL decline in older patients undergoing orthopaedic surgery, and delirium superimposed on cognitive impairment is an independent risk factor for deterioration of ADL and IADL functional status. Early identification of cognitive function and to prevent delirium are needed to improve functional status following orthopaedic surgery.
Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital Kaohsiung, Taiwan; Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.
Chih-Kuang
CK
Liang
Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Chin-Liang
CL
Chu
Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Ming-Yueh
MY
Chou
Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital Kaohsiung, Taiwan; Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.
Yu-Te
YT
Lin
Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Ti
T
Lu
Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Chien-Jen
CJ
Hsu
Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.
Liang-Kung
LK
Chen
D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology*; D003693:Delirium / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011159:Population Surveillance; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors