Incidence and risk factors associated with postoperative delirium following primary elective total hip arthroplasty: a retrospective nationwide inpatient sample database study

• Published in: BMC psychiatry 2020-07, Vol.20 (1), p.1-343, Article 343
• Main Authors: Yang, Qinfeng, Wang, Jian, Huang, Xusheng, Xu, Yichuan, Zhang, Yang
• Format: Article
• Language: English
• Subjects: Age; Body weight loss; Cardiovascular disease; Codes; Comorbidity; Confidence intervals; Congestive heart failure; Coronary artery disease; Delirium; Demographics; Demography; Diabetes; Diabetes mellitus; Drug abuse; Electrolytes; Fractures; Health aspects; Health risk assessment; Heart failure; Hip; Hip replacement arthroplasty; Hospital patients; Hospitals; Joint replacement surgery; Joint surgery; Kidneys; Liver diseases; Lung diseases; Medical research; Mortality; Nationwide inpatient sample; Nervous system diseases; Neurological diseases; Neurological disorders; Patients; Pneumonia; Postoperative delirium; Psychiatry; Psychosis; Regression analysis; Renal failure; Risk factors; Serbia; Surgery; Total hip arthroplasty
• ISSN: 1471-244X; 1471-244X
• DOI: 10.1186/s12888-020-02742-6

Background Postoperative delirium is a common complication following major surgeries, leading to a variety of adverse effects. However, there is a paucity of literatures studying the incidence and risk factors associated with delirium after primary elective total hip arthroplasty (THA) using a large-scale national database. Methods A retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2009 to 2014. Patients who underwent primary elective THA were included. Patient demographics, preoperative comorbidities, length of hospital stay (LOS), total charges, in-hospital mortality, and major and minor perioperative complications were evaluated. Results A total of 388,424 primary elective THAs were obtained from the NIS database, and the general incidence of delirium after THA was 0.90%. Patients with delirium after THA presented more preoperative comorbidities, longer LOS, extra hospital charges, and higher in-hospital mortality rate (P < 0.001). Delirium following THA was associated with major complications during hospitalization including acute renal failure and pneumonia. Preoperative risk factors associated with postoperative delirium included advanced age, alcohol or drug abuse, depression, neurological disorders, psychoses, fluid and electrolyte disorders, diabetes, weight loss, deficiency anemia, coagulopathy, hypertension, congestive heart failure, valvular disease, pulmonary circulation disorders, peripheral vascular disorders, and renal failure. Both female and obesity were detected to be protective factors. Conclusions The results of our study identified a relatively low incidence of delirium after primary elective THA, which is as reported in the NIS and not necessarily the surgical population as a whole. Postoperative delirium of THA was associated with increased preoperative comorbidities, LOS, total charges, in-hospital mortality, and major perioperative complications including acute renal failure and pneumonia. It is of benefit to study risk factors associated with postoperative delirium to moderate its consequences. Keywords: Postoperative delirium, Total hip arthroplasty, Nationwide inpatient sample