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Interrelationship of postoperative delirium and cognitive impairment and their impact on the functional status in older patients undergoing orthopaedic surgery: a prospective cohort study.
PLoS One. 2014; 9(11):e110339.Plos

Abstract

BACKGROUND

The impact of postoperative delirium on post-discharge functional status of older patients remains unclear, and little is known regarding the interrelationship between cognitive impairment and post-operative delirium. Therefore, the main purpose was to evaluate the post-discharge functional status of patients who experience delirium after undergoing orthopaedic surgery and the interrelationship of postoperative delirium with underlying cognitive impairment.

METHOD

This prospective cohort study, conducted at a tertiary care medical center from April 2011 to March 2012, enrolled all subjects aged over 60 years who were admitted for orthopaedic surgery. The baseline characteristics (age, gender, BMI, and living arrangement), surgery-related factors (ASA class, admission type, type of surgery, and length of hospital stay), results of geriatric assessment (postoperative delirium, cognition, depressive mood, comorbidity, pain, malnutrition, polypharmacy, ADL, and instrumental [I]ADL) and 1-12-month postoperative ADL and IADL functional status were collected for analysis.

RESULTS

Overall, 9.1% of 232 patients (mean age: 74.7 ± 7.8 years) experienced postoperative delirium, which was significantly associated with IADL decline at only 6 and 12 months postoperatively (RR: 6.22, 95% CI: 1.08-35.70 and RR: 12.54, 95% CI: 1.88-83.71, respectively). Delirium superimposed on cognitive impairment was a significant predictor for poor functional status at 6 and 12 months postoperatively (RR: 12.80, 95% CI: 1.65-99.40 for ADL at the 6th month, and RR: 7.96, 95% CI: 1.35-46.99 at the 12th month; RR: 13.68, 95% CI: 1.94-96.55 for IADL at the 6th month, and RR: 30.61, 95% CI: 2.94-318.54 at the 12th month, respectively).

CONCLUSION

Postoperative delirium is predictive of IADL decline in older patients undergoing orthopaedic surgery, and delirium superimposed on cognitive impairment is an independent risk factor for deterioration of ADL and IADL functional status. Early identification of cognitive function and to prevent delirium are needed to improve functional status following orthopaedic surgery.

Authors+Show Affiliations

Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital Kaohsiung, Taiwan; Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital Kaohsiung, Taiwan; Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

25402484

Citation

Liang, Chih-Kuang, et al. "Interrelationship of Postoperative Delirium and Cognitive Impairment and Their Impact On the Functional Status in Older Patients Undergoing Orthopaedic Surgery: a Prospective Cohort Study." PloS One, vol. 9, no. 11, 2014, pp. e110339.
Liang CK, Chu CL, Chou MY, et al. Interrelationship of postoperative delirium and cognitive impairment and their impact on the functional status in older patients undergoing orthopaedic surgery: a prospective cohort study. PLoS ONE. 2014;9(11):e110339.
Liang, C. K., Chu, C. L., Chou, M. Y., Lin, Y. T., Lu, T., Hsu, C. J., & Chen, L. K. (2014). Interrelationship of postoperative delirium and cognitive impairment and their impact on the functional status in older patients undergoing orthopaedic surgery: a prospective cohort study. PloS One, 9(11), e110339. https://doi.org/10.1371/journal.pone.0110339
Liang CK, et al. Interrelationship of Postoperative Delirium and Cognitive Impairment and Their Impact On the Functional Status in Older Patients Undergoing Orthopaedic Surgery: a Prospective Cohort Study. PLoS ONE. 2014;9(11):e110339. PubMed PMID: 25402484.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Interrelationship of postoperative delirium and cognitive impairment and their impact on the functional status in older patients undergoing orthopaedic surgery: a prospective cohort study. AU - Liang,Chih-Kuang, AU - Chu,Chin-Liang, AU - Chou,Ming-Yueh, AU - Lin,Yu-Te, AU - Lu,Ti, AU - Hsu,Chien-Jen, AU - Chen,Liang-Kung, Y1 - 2014/11/17/ PY - 2014/04/25/received PY - 2014/09/15/accepted PY - 2014/11/18/entrez PY - 2014/11/18/pubmed PY - 2015/7/15/medline SP - e110339 EP - e110339 JF - PloS one JO - PLoS ONE VL - 9 IS - 11 N2 - BACKGROUND: The impact of postoperative delirium on post-discharge functional status of older patients remains unclear, and little is known regarding the interrelationship between cognitive impairment and post-operative delirium. Therefore, the main purpose was to evaluate the post-discharge functional status of patients who experience delirium after undergoing orthopaedic surgery and the interrelationship of postoperative delirium with underlying cognitive impairment. METHOD: This prospective cohort study, conducted at a tertiary care medical center from April 2011 to March 2012, enrolled all subjects aged over 60 years who were admitted for orthopaedic surgery. The baseline characteristics (age, gender, BMI, and living arrangement), surgery-related factors (ASA class, admission type, type of surgery, and length of hospital stay), results of geriatric assessment (postoperative delirium, cognition, depressive mood, comorbidity, pain, malnutrition, polypharmacy, ADL, and instrumental [I]ADL) and 1-12-month postoperative ADL and IADL functional status were collected for analysis. RESULTS: Overall, 9.1% of 232 patients (mean age: 74.7 ± 7.8 years) experienced postoperative delirium, which was significantly associated with IADL decline at only 6 and 12 months postoperatively (RR: 6.22, 95% CI: 1.08-35.70 and RR: 12.54, 95% CI: 1.88-83.71, respectively). Delirium superimposed on cognitive impairment was a significant predictor for poor functional status at 6 and 12 months postoperatively (RR: 12.80, 95% CI: 1.65-99.40 for ADL at the 6th month, and RR: 7.96, 95% CI: 1.35-46.99 at the 12th month; RR: 13.68, 95% CI: 1.94-96.55 for IADL at the 6th month, and RR: 30.61, 95% CI: 2.94-318.54 at the 12th month, respectively). CONCLUSION: Postoperative delirium is predictive of IADL decline in older patients undergoing orthopaedic surgery, and delirium superimposed on cognitive impairment is an independent risk factor for deterioration of ADL and IADL functional status. Early identification of cognitive function and to prevent delirium are needed to improve functional status following orthopaedic surgery. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/25402484/Interrelationship_of_postoperative_delirium_and_cognitive_impairment_and_their_impact_on_the_functional_status_in_older_patients_undergoing_orthopaedic_surgery:_a_prospective_cohort_study_ L2 - http://dx.plos.org/10.1371/journal.pone.0110339 DB - PRIME DP - Unbound Medicine ER -