Effects of Preoperative Anxiety on Postoperative Delirium in Elderly Patients Undergoing Elective Orthopedic Surgery: A Prospective Observational Cohort Study

Figures & data

Table 1 Demographic and Clinical Data of the Study Population

	ALL (N=263)	POD (N=73)	No POD (N=190)	P value
Age (years)	74.2 (7.3)	80.9 (7.7)	71.7 (5.3)	<0.001^a
Male, sex	74 (28.1%)	20 (27.4%)	54 (28.4%)	0.869^b
BMI (kg·m−^Citation2)	24.2 (3.9)	23.3 (4.0)	24.6 (3.8)	0.011^c
Education level				0.001^b
Illiteracy	87 (33.1%)	37 (50.7%)	50 (26.3%)
Primary or junior high graduates	84 (31.9%)	20 (27.4%)	64 (33.7%)
High school and college or higher	92 (35.0%)	16 (21.9%)	76 (40.0%)
History of smoking	37 (14.1%)	10 (13.7%)	27 (14.2%)	0.915^b
Alcohol use	42 (16.0%)	13 (17.8%)	29 (15.3%)	0.614^b
Comorbidities
Hypertension	90 (34.2%)	28 (38.4%)	62 (32.6%)	0.381^b
Diabetes	42 (16.0%)	15 (20.5%)	27 (14.2%)	0.209^b
Coronary heart disease	27 (10.3%)	11 (15.1%)	16 (8.4%)	0.112^b
COPD	4 (1.5%)	2 (2.7%)	2 (1.1%)	0.661^b
CKD	2 (0.8%)	1 (1.4%)	1 (0.5%)	0.930^b
DVT	10 (3.8%)	4 (5.5%)	6 (3.2%)	0.602^b
History of cancer	4 (1.5%)	1 (1.4%)	3 (1.6%)	0.661^b
CCI	3.2 (1.0)	3.9 (0.9)	3.0 (0.9)	<0.001^a
ASA classification				<0.001^b
I	20 (7.6%)	0 (0%)	20 (10.5%)
II	85 (32.3%)	5 (6.8%)	80 (42.1%)
III	158 (60.1%)	68 (93.2%)	90 (47.4%)
VAS pain score (at rest)	3.0 (0.8)	3.0 (0.8)	2.9 (0.8)	0.373^a
MMSE	24 (2.3)	22.0 (2.2)	24.5 (2.0)	<0.001^a
Preoperative anxiety	40 (15.2%)	13 (17.8%)	27 (14.2%)	0.467^a
Laboratory tests
Albumin (g/L)	39.5 (4.4)	37.3 (4.7)	40.4 (4.0)	<0.001^a
Serum sodium (mmol/L)	140.2 (3.4)	138.9 (4.3)	140.6 (2.9)	0.007^a
Hemoglobin (g/dl)	12.4 (6.4)	11.5 (2.3)	12.7 (7.4)	0.007^a

Notes: Data are mean (SD) or number (%). ^aMann–Whitney U-test, ^bChi-square test, ^cStudent’s t test.

Abbreviations: POD, postoperative delirium; BMI, body mass index; COPD, chronic obstructive pulmonary disease; CKD, chronic kidney disease; DVT, deep vein thrombosis; CCI, Charlson Comorbidity Index; ASA, American Society of Anesthesiologists; VAS, visual analogue scale; MMSE, Mini Mental State Examination.

Table 2 Surgical Variables and Postoperative Outcomes

	ALL (N=263)	POD (N=73)	No POD (N=190)	P value
Type of surgery				0.195^b
THA	120 (45.6%)	38 (52.1%)	82 (43.2%)
PFNA	56 (21.3%)	17 (23.3%)	39 (20.5%)
TKA	87 (33.1%)	18 (24.6%)	69 (36.3%)
Duration of anesthesia (min)	136.6 (40.3)	134.3 (45.6)	137.5 (38.2)	0.265^a
Duration of surgery (min)	108.2 (37.4)	106.6 (44.4)	108.9 (34.5)	0.237^a
Blood transfusion	45 (17.1%)	18 (24.7%)	27 (14.2%)	0.044^b
Total fluid administration (mL)	1543 (493)	1438 (429)	1583 (511)	0.039^a
Nerve block	151 (57.4%)	40 (54.8%)	111 (58.4%)	0.594^b
Intraoperative medications
Corticosteroid	59 (22.4%)	13 (17.8%)	46 (24.2%)	0.265^b
Dexmedetomidine (ug)	27 (18)	28 (16)	27 (19)	0.796^a
Benzodiazepines	219 (83.3%)	47 (64.4%)	172 (90.5%)	<0.001^b
PCIA	209 (79.5%)	63 (86.3%)	146 (76.8%)	0.265^b
ICU admission	53 (20.2%)	33 (45.2%)	20 (10.5%)	<0.001^b
LOS (days)	14.2 (4.7)	15.5 (4.9)	13.7 (4.6)	0.262^a
Postoperative LOS (days)	9.3 (4.0)	10.2 (4.2)	9.0 (3.8)	0.041^a

Notes: Data are mean (SD) or number (%). ^aMann–Whitney U-test, ^bChi-square test.

Abbreviations: THA, total hip arthroplasty; PFNA, proximal femoral nail antirotation; TKA, total knee arthroplasty; PCIA, patient-controlled intravenous analgesia; LOS, length of hospital stay.

Figure 1 Flowchart for participant enrollment.

Figure 2 The incidence of preoperative anxiety and postoperative delirium in different types of surgery.

Abbreviations: THA, total hip arthroplasty, PFNA, proximal femoral nail antirotation, TKA, total knee arthroplasty.

Figure 3 Forest plot of multivariate logistic regression analysis demonstrating factors associated with POD.

Bruce AJ, Ritchie CW, Blizard R, Lai R, Raven P. The incidence of delirium associated with orthopedic surgery: a meta-analytic review. Int Psychogeriatr. 2007;19(2):197–214. doi:10.1017/S104161020600425X16973101

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