Section of Surgical Pathophysiology, 4074, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
Br J Anaesth. 2012 Apr;108(4):607-11. doi: 10.1093/bja/aer493. Epub 2012 Jan 24.
Postoperative delirium (PD) is a serious complication after major surgery in elderly patients. PD is well defined and characterized by reduced attention and disorientation. Multimodal optimization of perioperative care (the fast-track methodology) enhances recovery, and reduces hospital stay and medical morbidity. No data on PD are available in fast-track surgery. The aim of this study was to evaluate the incidence of PD after fast-track hip (THA) and knee arthroplasty (TKA) with anticipated length of stay (LOS) of <3 days.
In a prospective multicentre study to evaluate postoperative cognitive dysfunction, we included 225 non-demented patients with a mean age of 70 yr undergoing either THA or TKA in a fast-track set-up. Anaesthesia and postoperative pain management were standardized with limited opioid use. Nursing staff were trained to look for symptoms of PD which was assessed during interaction with healthcare professionals. Patients were invited for a clinical follow-up 1-2 weeks after surgery.
Clinical follow-up was performed in 220 patients at a mean of 12.0 days after surgery while five patients were followed up by telephone. The mean LOS was 2.6 days (range 1-8 days). Twenty-two patients received general anaesthesia, and the rest had spinal anaesthesia. No patients developed PD (95% confidence interval 0.0-1.6%).
A fast-track set-up with multimodal opioid-sparing analgesia was associated with lack of PD after elective THA and TKA in elderly patients.
术后谵妄（PD）是老年患者大手术后的一种严重并发症。PD 定义明确，其特征为注意力和定向力降低。围手术期多模式优化（快速通道方法）可促进康复，减少住院时间和医疗发病率。快速通道手术中尚无 PD 的相关数据。本研究旨在评估预期住院时间（LOS）<3 天的快速通道髋关节（THA）和膝关节置换术（TKA）后 PD 的发生率。
在一项评估术后认知功能障碍的前瞻性多中心研究中，我们纳入了 225 名年龄均为 70 岁的非痴呆患者，他们在快速通道设置下接受 THA 或 TKA。麻醉和术后疼痛管理标准化，限制使用阿片类药物。护理人员接受培训，以发现 PD 症状，并在与医护人员互动时进行评估。术后 1-2 周邀请患者进行临床随访。
220 名患者在术后平均 12.0 天进行了临床随访，5 名患者通过电话进行了随访。平均 LOS 为 2.6 天（范围 1-8 天）。22 名患者接受全身麻醉，其余患者接受脊髓麻醉。没有患者发生 PD（95%置信区间 0.0-1.6%）。
多模式阿片类药物节约性镇痛的快速通道方案与老年患者择期 THA 和 TKA 后 PD 的发生无关。
