A personality trait contributes to the occurrence of postoperative delirium: a prospective study.
Although various physical risk factors for delirium have been identified, the effect of psychological aspects is currently unknown. This study aimed to examine psychological risk factors for postoperative delirium and to identify hidden subgroups of delirium in clinical and psychological feature space.



Among 200 patients with hip fracture, 78 elderly patients were prospectively evaluated for clinical and psychological assessments before surgery. As delirium was assessed from the next day to the 7th day after surgery, postoperative delirium was found in 40 patients, but not in 38 patients. Univariate and multivariate logistic regression analyses were used to explore risk factors for postoperative delirium. Phenotypic subgroups of delirium were assessed using Topological Data Analysis, in which the significant risk factors were used for evaluating filter and distance metrics.



Mini-Mental State Examination, neuroticism, conscientiousness, and regional anesthesia were identified as a predictive risk factor for postoperative delirium. The filter metric showed significant negative correlations with nutrition-related factors such as total protein and albumin. When filter metric and Euclidean distances were entered, delirious patients were bifurcated as a function of personality traits and anesthesia method in the patient-patient network.



A personality trait of neuroticism and conscientiousness may predispose elderly patients to postoperative delirium and this influence may be amplified by regional anesthesia. This study verifies the contribution of psychological risk factors to delirium and provides new insight for complex etiologies of delirium by mapping various clinical variables in the topological space.
Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Jung Eun
JE
Shin
Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Sunghyon
S
Kyeong
Department of Anesthesia and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Jong-Seok
JS
Lee
Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea.
Jin Young
JY
Park
Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
Woo Suk
WS
Lee
Department of Psychiatry, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, 06273, Seoul, Republic of Korea. jaejkim@yonsei.ac.kr.
Jae-Jin
JJ
Kim
Department of Orthopedic Surgery, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, 06273, Seoul, Republic of Korea. kyang@yuhs.ac.
Kyu Hyun
KH
Yang
D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000009:adverse effects / Q000379:methods / Q000523:psychology*; D001008:Anxiety Disorders / Q000523:psychology*; D003693:Delirium / Q000523:psychology*; D005260:Female; D006620:Hip Fractures / Q000523:psychology / Q000601:surgery; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D000075384:Neuroticism; D010551:Personality; D011183:Postoperative Complications / Q000523:psychology*; D011446:Prospective Studies; D012307:Risk Factors
Delirium; Logistic regression; Personality; Risk factor; Topological data analysis