Incidence and associated factors of postoperative delirium among elderly elective orthopedic surgical patients in selected Addis Ababa Public hospitals
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Date
2024-05
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Addis Ababa University
Abstract
Background: Delirium is a neurocognitive disorder characterized by an acute and relatively
rapid decline in cognition, disturbance of consciousness, reduced ability to focus and shift of
attention. Additionally, it is well recognized that it mostly affects elderly patients, and its
incidence is increased during the postoperative period. Occurring in 8% to 20% of older patients
after an operation, and frequently it occurs between 24 hours and 5 days after surgery. And it can
result in serious medical management problem; therefore, identification of the possible
contributing factors and magnitude of the burden will help in the management of delirium in
elderly patients.
Objective: To assess the incidence and associated factors of postoperative delirium among
elderly elective orthopedic surgical patients in selected Addis Ababa public hospitals, Ethiopia,
from February 2024 to May 2024.
Method and tools: A multi-center longitudinal study was conducted on elderly patients in four
selected Addis Ababa public hospitals from February 2024 to May 2024, and a systematic
sampling technique was used to select the study participants. Patients aged ≥65 years old who
underwent elective orthopedic surgery were included in this study. Data was collected through
chart review and interview of patients, and postoperative delirium was assessed by using
confusion assessment method (CAM). Both bivariable and multivariable logistic regression
model were used for statistical analysis.
Results: 220 patients who underwent elective orthopedic surgery at four selected Addis Ababa
public hospitals were included; most of the patients were male, 68.1% of the patients underwent
lower extremity surgery, and 62.3% of the patients received spinal anesthesia. The incidence of
postoperative delirium among elderly elective orthopedic surgical patients was 33.7%, and age
65-75(AOR =0.468, 95%CI (0.226-0.97),perioperative opioid usage (AOR=2.200, 95%CI
(1.073-4.5313), intraoperative anticholinergic usage(AOR=2.238,95%CI(1.831-4.235),history of
hospitalization(AOR=2.24,95%CI(1.202-4.206),and blood transfusion (AOR=2.83,95%CI(1.295
-6.193) were significantly associated with postoperative delirium.
Conclusion: The incidence of postoperative delirium among elderly elective orthopedic surgical
patients was high in the study area (33.7%); advanced age, blood transfusion, intraoperative
anticholinergic usage, pervious history of hospitalization and perioperative opioid usage were the
associated factors for postoperative delirium.
Recommendation: We recommend that special attention should be paid for elderly patients
with history of hospitalization, blood transfusion, who use opioid and anticholinergic
medications. in addition to this, reducing opioid-based pain treatment is important. We also
recommend that feature researchers to do ongoing research on long-term impact of postoperative
delirium on elderly patients.
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Keywords
Orthopedic surgery, Postoperative delirium, Confusion assessment method.