The Rothman Institute of Orthopaedics at Thomas Jefferson University, Egg Harbor Township, New Jersey.
Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.
J Arthroplasty. 2018 Apr;33(4):1171-1176. doi: 10.1016/j.arth.2017.11.015. Epub 2017 Nov 13.
Delirium is a common complication among elderly patients undergoing total joint arthroplasty (TJA). Its incidence has been reported from 4% to 53%. The Centers for Medicare and Medicaid Services consider delirium following TJA a "never-event." The purpose of this study is to evaluate a simple perioperative protocol used to identify delirium risk patients and prevent its incidence following TJA.
Our group developed a protocol to identify and prevent delirium in patients undergoing TJA. All patients were screened and scored in the preoperative assessment, on criteria such as age, history of forgetfulness, history of agitation or visual hallucinations, history of falls, history of postoperative confusion, and inability to perform higher brain functions. Patients were scored on performance in a simple mental examination. The patients were classified as low, medium, or high risk. Patients who were identified as high risk were enrolled in a delirium avoidance protocol that minimized narcotics and emphasized nursing involvement and fluids administration.
Five of 7659 (0.065%) consecutive TJA patients from 2010 to 2015 developed delirium. A total of 422 patients were identified as high risk. All 5 patients who suffered delirium were within the high risk group. No low or medium risk patients suffered a delirium complication. Three (0.039%) patients suffered drug-induced delirium, 1 (0.013%) had delirium related to alcohol withdrawal, and 1 (0.013%) had delirium after a systemic infection.
This protocol is effective in identifying patients at high delirium risk and diminishing the incidence of this complication by utilizing a simple screening tool and perioperative protocol.
谵妄是老年患者接受全关节置换术（TJA）的常见并发症。其发病率报告从 4%到 53%不等。医疗保险和医疗补助服务中心认为 TJA 后谵妄是“从不发生的事件”。本研究的目的是评估一种简单的围手术期方案，用于识别谵妄风险患者并预防 TJA 后谵妄的发生。
我们小组制定了一项方案，以识别和预防接受 TJA 的患者发生谵妄。所有患者均在术前评估中进行筛查和评分，评分标准包括年龄、健忘史、激越或视幻觉史、跌倒史、术后意识混乱史以及无法进行高级脑功能。患者在简单的心理检查中进行评分。患者被分为低危、中危或高危。被确定为高危的患者将被纳入谵妄预防方案，该方案最大限度地减少了麻醉药物的使用，强调了护理的参与和液体的给予。
2010 年至 2015 年期间，7659 例连续 TJA 患者中有 5 例（0.065%）发生谵妄。共有 422 例患者被确定为高危。所有 5 例发生谵妄的患者均在高危组。无低危或中危患者发生谵妄并发症。3 例（0.039%）患者发生药物性谵妄，1 例（0.013%）患者因酒精戒断引起谵妄，1 例（0.013%）患者因全身感染引起谵妄。
该方案通过使用简单的筛查工具和围手术期方案，有效识别高谵妄风险患者，并降低了该并发症的发生率。
