Yang Qinfeng, Wang Jian, Chen Yuhang, Lian Qiang, Shi Zhanjun, Zhang Yang
Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China.
Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China.
Knee. 2022 Mar;35:61-70. doi: 10.1016/j.knee.2022.02.006. Epub 2022 Feb 24.
Postoperative delirium is a common complication following major surgeries, causing a variety of adverse effects. However, the incidence and risk factors of delirium after primary total knee arthroplasty (TKA) has not been well studied using a large-scale national database.
A retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005-2014. Patients who underwent primary TKA were included. Patient demographics, comorbidities, length of stay (LOS), total charges, type of payer, in-hospital mortality, and perioperative complications were evaluated.
A total of 1,228,879 TKAs were obtained from the NIS database. The general incidence of delirium after TKA was 1.00%, which peaked in the year 2008.Patients with delirium after TKA presented increased comorbidities, LOS, hospital charges, usage of medicare, and in-hospital mortality (P < 0.0001). Delirium following TKA was associated with medical complications during hospitalization including acute renal failure, acute myocardial infarction, pneumonia, pulmonary embolism, stroke, and urinary tract infection. Risk factors of postoperative delirium included advanced age, neurological disorders, alcohol and drug abuse, depression, psychoses, fluid and electrolyte disorders, diabetes, weight loss, deficiency and chronic blood loss anemia, coagulopathy, congestive heart failure, chronic pulmonary disease, pulmonary circulation disorders, peripheral vascular disorders, chronic renal failure, and teaching hospital. Notably, neurological disorders were found to have the strongest association with the occurrence of postoperative delirium.
A relatively low incidence of delirium after TKA was identified. It is of benefit to study risk factors of postoperative delirium to ensure the appropriate management and moderate its consequences.
术后谵妄是大手术后常见的并发症，会引发多种不良影响。然而，使用大规模全国性数据库对初次全膝关节置换术（TKA）后谵妄的发生率及危险因素尚未进行充分研究。
基于2005年至2014年的全国住院患者样本（NIS）进行回顾性数据库分析。纳入接受初次TKA的患者。评估患者的人口统计学特征、合并症、住院时间（LOS）、总费用、支付方类型、院内死亡率及围手术期并发症。
从NIS数据库中获取了总计1,228,879例TKA病例。TKA后谵妄的总体发生率为1.00%，在2008年达到峰值。TKA后发生谵妄的患者合并症更多、住院时间更长、住院费用更高、医疗保险使用率更高且院内死亡率更高（P < 0.0001）。TKA后谵妄与住院期间的医疗并发症相关，包括急性肾衰竭、急性心肌梗死、肺炎、肺栓塞、中风及尿路感染。术后谵妄的危险因素包括高龄、神经疾病、酒精和药物滥用、抑郁、精神病、液体和电解质紊乱、糖尿病、体重减轻、营养缺乏及慢性失血性贫血、凝血障碍、充血性心力衰竭、慢性肺病、肺循环障碍、外周血管疾病、慢性肾衰竭及教学医院。值得注意的是，发现神经疾病与术后谵妄的发生关联最为密切。
确定了TKA后谵妄的发生率相对较低。研究术后谵妄的危险因素有助于进行适当管理并减轻其后果。
