title: Short-Form Mini Nutritional Assessment as a useful method of predicting the development of postoperative delirium in elderly patients undergoing orthopedic surgery.
abstract: OBJECTIVE
  Postoperative delirium (POD) is a major cause for concern among elderly patients undergoing surgery, often resulting in poor outcome. It is therefore important to predict and prevent POD. The aim of this study was to evaluate the Mini Nutritional Assessment Short-Form (MNA-SF) as a predictor of POD after orthopedic surgery.
  
  
  METHODS
  Elderly patients undergoing orthopedic surgery between April 2011 and March 2013 were included in the study (n=544; mean age, 74.24 ± 7.92 years). The MNA-SF was used to evaluate preoperative nutritional status. Delirium was assessed daily after surgery using the confusion assessment method. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria were used to confirm delirium diagnosis. Univariate and multivariate logistic regression analyses were performed to identify key factors associated with POD.
  
  
  RESULTS
  POD occurred in 52 patients (9.6%). According to the MNA-SF, 17.5% of subjects were at risk of undernutrition. Adjusting for all potential factors in the final model, age, male gender and lower Mini-Mental State Examination and higher Charlson Comorbidity Index scores were associated with significantly increased likelihood of POD. Subjects who were identified preoperatively as at risk of undernutrition were 2.85 times more likely to develop POD compared to normally nourished subjects (odds ratio: 2.85, 95% confidence interval: 1.19-6.87).
  
  
  CONCLUSIONS
  These results suggest that the MNA-SF is a simple and effective tool that can be used to predict incident delirium in elderly patients after orthopedic surgery.
authors.affiliation: Department of Psychiatry, Puli Branch, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Che-Sheng
authors.initials: CS
authors.lastname: Chu
authors.affiliation: Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chih-Kuang
authors.initials: CK
authors.lastname: Liang
authors.affiliation: Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ming-Yueh
authors.initials: MY
authors.lastname: Chou
authors.affiliation: Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Yu-Te
authors.initials: YT
authors.lastname: Lin
authors.affiliation: Department of Medical Education, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Chien-Jen
authors.initials: CJ
authors.lastname: Hsu
authors.affiliation: Department of Psychiatry, Taichung Veterans General Hospital, Taichung City, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: phchou1980@gmail.com.
authors.forename: Po-Han
authors.initials: PH
authors.lastname: Chou
authors.affiliation: Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. Electronic address: mdjim0814@gmail.com.
authors.forename: Chin-Liang
authors.initials: CL
authors.lastname: Chu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003661:Decision Support Techniques; D003693:Delirium / Q000453:epidemiology*; D004435:Eating; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D051346:Mobility Limitation; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D019637:Orthopedic Procedures; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D018570:Risk Assessment; D013315:Stress, Psychological / Q000453:epidemiology*; D015431:Weight Loss
keywords: Aged; Delirium; Orthopedic surgery; Short-form Mini Nutritional Assessment