SIMPLE-MODEL FOR PREDICTING POSTOPERATIVE DELIRIUM IN OLDER PATIENTS UNDERGOING ELECTIVE ORTHOPEDIC-SURGERY

OBJECTIVE: To determine the incidence, and severity of postoperative d elirium (POD) in older patients undergoing elective orthopedic procedu res and to identify potential preoperative risk factors. DESIGN: A pro spectively studied cohort of elective orthopedic surgery patients. SET TING: A University teaching hospital. PATIENTS: Eighty patients who at tended a preadmission clinic and, subsequently, underwent elective ort hopedic surgery. All patients were aged 60 years or older, and all spo ke English. MEASUREMENTS: Patients underwent preoperative medical, cog nitive, and activities of daily living assessment with standardized in struments and were followed postoperatively with daily visits, telepho ne interviews with attending nurses using a modified confusion assessm ent model (CAM), and repeated cognitive testing. Suspected delirium wa s verified by direct physician assessment. RESULTS: The elective group had 14 (17.5%) cases of POD, of which six (7.5%) were severe. These i ncidences are low compared with those of nonelective surgery groups re ported elsewhere in the literature. Stepwise multiple logistic regress ion identified two POD risk factors: clock-drawing scores less than or equal to 6 (OR = 9.0, CI, 2.8 to 45.6) and male gender (OR = 5.6, CI 1.9 to 33.8).CONCLUSION: A simple model using clock-drawing scores and male gender for preoperative identification of elective patients at g reatest risk for POD appears sensitive, predictive, and practical for the preadmission clinic setting, but it should be validated in a prosp ective trial.