Login Register Cart 0
Generic placeholder image

Current Pharmaceutical Design

Editor-in-Chief

ISSN (Print): 1381-6128
ISSN (Online): 1873-4286

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
General Research Article

Postoperative Serum Albumin Decrease Independently Predicts Delirium in the Elderly Subjects after Total Joint Arthroplasty

Author(s): Jianmin Qi, Cheng Liu, Li'an Chen and Junping Chen*

Volume 26, Issue 3, 2020

Page: [386 - 394] Pages: 9

DOI: 10.2174/1381612826666191227153150

Price: $65

Abstract

Background: Postoperative delirium (POD), a neurobehavioral syndrome induced by dysfunction of neural activity, is a common and serious complication. This current study aimed to investigate independent predictors for POD in elderly subjects after total joint arthroplasty (TJA).

Methods: Eligible elderly patients (≥65 years) who underwent elective unilateral primary hip or knee arthroplasty under epidural anesthesia from October 2016 to January 2019 were consecutively enrolled. POD was diagnosed following the guidance of the 5th edition of Diagnostic and Statistical Manual of Mental Disorders, (DSM V, 2013). The relative change in serum Alb (ΔAlb) was defined as the absolute value of (preoperative Alb value– nadir value within postoperative day 2)/preoperative Alb ×100%. The predictive value of ΔAlb for POD was evaluated by receiver operating characteristic (ROC) curve analysis. Univariate and multivariate logistic regression analyses were used for evaluating risk factors for POD.

Results: A total of 328 patients were enrolled in the analysis, of which 68 (20.7%, 68/328) patients developed POD within postoperative 7 days. ΔAlb was an effective predictor for POD with an area under the curve (AUC) of 0.821, a sensitivity of 76.15% and a specificity of 70.59%, respectively (P<0.001). Univariate and multivariate logistic regression analyses indicated that ΔAlb was the only independent risk factor for POD (OR: 2.43, 95%CI: 1.17–4.86, P=0.015).

Conclusion: ΔAlb was an independent risk factor for POD in elderly subjects after TJA.

Keywords: Postoperative delirium, total joint arthroplasty, elderly, risk factor, albumin, neurobehavioral.

« Previous
[1]
Zenilman ME. Delirium: an important postoperative complication. JAMA 2017; 317(1): 77-8.
[http://dx.doi.org/10.1001/jama.2016.18174] [PMID: 28030685]
[2]
Demeure MJ, Fain MJ. The elderly surgical patient and postoperative delirium. J Am Coll Surg 2006; 203(5): 752-7.
[http://dx.doi.org/10.1016/j.jamcollsurg.2006.07.032] [PMID: 17084339]
[3]
Park SA, Tomimaru Y, Shibata A, Miyagawa S, Noguchi K, Dono K. Incidence and risk factors for postoperative delirium in patients after hepatectomy. World J Surg 2017; 41(11): 2847-53.
[http://dx.doi.org/10.1007/s00268-017-4079-3] [PMID: 28608014]
[4]
Siddiqi N, House AO, Holmes JD. Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing 2006; 35(4): 350-64.
[http://dx.doi.org/10.1093/ageing/afl005] [PMID: 16648149]
[5]
Chung KS, Lee JK, Park JS, Choi CH. Risk factors of delirium in patients undergoing total knee arthroplasty. Arch Gerontol Geriatr 2015; 60(3): 443-7.
[http://dx.doi.org/10.1016/j.archger.2015.01.021] [PMID: 25704295]
[6]
Flink BJ, Rivelli SK, Cox EA, et al. Obstructive sleep apnea and incidence of postoperative delirium after elective knee replacement in the nondemented elderly. Anesthesiology 2012; 116(4): 788-96.
[http://dx.doi.org/10.1097/ALN.0b013e31824b94fc] [PMID: 22337162]
[7]
Jankowski CJ, Trenerry MR, Cook DJ, et al. Cognitive and functional predictors and sequelae of postoperative delirium in elderly patients undergoing elective joint arthroplasty. Anesth Analg 2011; 112(5): 1186-93.
[http://dx.doi.org/10.1213/ANE.0b013e318211501b] [PMID: 21415433]
[8]
Nandi S, Harvey WF, Saillant J, Kazakin A, Talmo C, Bono J. Pharmacologic risk factors for post-operative delirium in total joint arthroplasty patients: a case-control study. J Arthroplasty 2014; 29(2): 268-71.
[http://dx.doi.org/10.1016/j.arth.2013.06.004] [PMID: 23831083]
[9]
Marcantonio ER, McKean S, Goldfinger M, Kleefield S, Yurkofsky M, Brennan TA. Factors associated with unplanned hospital readmission among patients 65 years of age and older in a medicare managed care plan. Am J Med 1999; 107(1): 13-7.
[http://dx.doi.org/10.1016/S0002-9343(99)00159-X] [PMID: 10403347]
[10]
Guo Y, Jia P, Zhang J, Wang X, Jiang H, Jiang W. Prevalence and risk factors of postoperative delirium in elderly hip fracture patients. J Int Med Res 2016; 44(2): 317-27.
[http://dx.doi.org/10.1177/0300060515624936] [PMID: 26920926]
[11]
Wang LH, Xu DJ, Wei XJ, Chang HT, Xu GH. Electrolyte disorders and aging: risk factors for delirium in patients undergoing orthopedic surgeries. BMC Psychiatry 2016; 16(1): 418.
[http://dx.doi.org/10.1186/s12888-016-1130-0] [PMID: 27881118]
[12]
Hirsch J, DePalma G, Tsai TT, Sands LP, Leung JM. Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery. Br J Anaesth 2015; 115(3): 418-26.
[http://dx.doi.org/10.1093/bja/aeu458] [PMID: 25616677]
[13]
Mangusan RF, Hooper V, Denslow SA, Travis L. Outcomes associated with postoperative delirium after cardiac surgery. Am J Crit Care 2015; 24(2): 156-63.
[http://dx.doi.org/10.4037/ajcc2015137] [PMID: 25727276]
[14]
Dillon ST, Vasunilashorn SM, Ngo L, et al. Higher C-reactive protein levels predict postoperative delirium in older patients undergoing major elective surgery: a longitudinal nested case-control study. Biol Psychiatry 2017; 81(2): 145-53.
[http://dx.doi.org/10.1016/j.biopsych.2016.03.2098] [PMID: 27160518]
[15]
Hübner M, Mantziari S, Demartines N, Pralong F, Coti-Bertrand P, Schäfer M. Postoperative albumin drop is a marker for surgical stress and a predictor for clinical outcome: a pilot study. Gastroenterol Res Pract 2016; 2016 8743187
[http://dx.doi.org/10.1155/2016/8743187] [PMID: 26880899]
[16]
Fleck A, Raines G, Hawker F, et al. Increased vascular permeability: a major cause of hypoalbuminaemia in disease and injury. Lancet 1985; 1(8432): 781-4.
[http://dx.doi.org/10.1016/S0140-6736(85)91447-3] [PMID: 2858667]
[17]
Lee JI, Kwon M, Roh JL, et al. Postoperative hypoalbuminemia as a risk factor for surgical site infection after oral cancer surgery. Oral Dis 2015; 21(2): 178-84.
[http://dx.doi.org/10.1111/odi.12232] [PMID: 24605906]
[18]
Ryan AM, Hearty A, Prichard RS, Cunningham A, Rowley SP, Reynolds JV. Association of hypoalbuminemia on the first postoperative day and complications following esophagectomy. J Gastrointest Surg 2007; 11(10): 1355-60.
[http://dx.doi.org/10.1007/s11605-007-0223-y] [PMID: 17682826]
[19]
Fujiwara Y, Shiba H, Shirai Y, et al. Perioperative serum albumin correlates with postoperative pancreatic fistula after pancreaticoduodenectomy. Anticancer Res 2015; 35(1): 499-503.
[PMID: 25550594]
[20]
Lee EH, Chin JH, Choi DK, et al. Postoperative hypoalbuminemia is associated with outcome in patients undergoing off-pump coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 2011; 25(3): 462-8.
[http://dx.doi.org/10.1053/j.jvca.2010.09.008] [PMID: 21093290]
[21]
Uppal S, Al-Niaimi A, Rice LW, et al. Preoperative hypoalbuminemia is an independent predictor of poor perioperative outcomes in women undergoing open surgery for gynecologic malignancies. Gynecol Oncol 2013; 131(2): 416-22.
[http://dx.doi.org/10.1016/j.ygyno.2013.08.011] [PMID: 23962700]
[22]
Bohl DD, Shen MR, Hannon CP, Fillingham YA, Darrith B, Della Valle CJ. Serum albumin predicts survival and postoperative course following surgery for geriatric hip fracture. J Bone Joint Surg Am 2017; 99(24): 2110-8.
[http://dx.doi.org/10.2106/JBJS.16.01620] [PMID: 29257017]
[23]
Hardt J, Pilz L, Magdeburg J, Kienle P, Post S, Magdeburg R. Preoperative hypoalbuminemia is an independent risk factor for increased high-grade morbidity after elective rectal cancer resection. Int J Colorectal Dis 2017; 32(10): 1439-46.
[http://dx.doi.org/10.1007/s00384-017-2884-7] [PMID: 28823064]
[24]
Spolverato G, Kim Y, Ejaz A, Frank SM, Pawlik TM. Effect of relative decrease in blood hemoglobin concentrations on postoperative morbidity in patients who undergo major gastrointestinal surgery. JAMA Surg 2015; 150(10): 949-56.
[http://dx.doi.org/10.1001/jamasurg.2015.1704] [PMID: 26222497]
[25]
Wang Y, Shen X. Postoperative delirium in the elderly: the potential neuropathogenesis. Aging Clin Exp Res 2018; 30(11): 1287-95.
[http://dx.doi.org/10.1007/s40520-018-1008-8] [PMID: 30051417]
[26]
Scott JE, Mathias JL, Kneebone AC. Incidence of delirium following total joint replacement in older adults: a meta-analysis. Gen Hosp Psychiatry 2015; 37(3): 223-9.
[http://dx.doi.org/10.1016/j.genhosppsych.2015.02.004] [PMID: 25774049]
[27]
Chen W, Ke X, Wang X, et al. Prevalence and risk factors for postoperative delirium in total joint arthroplasty patients: a prospective study. Gen Hosp Psychiatry 2017; 46: 55-61.
[http://dx.doi.org/10.1016/j.genhosppsych.2017.03.008] [PMID: 28622817]
[28]
Rade MC, Yadeau JT, Ford C, Reid MC. Postoperative delirium in elderly patients after elective hip or knee arthroplasty performed under regional anesthesia. HSS J 2011; 7(2): 151-6.
[http://dx.doi.org/10.1007/s11420-011-9195-2] [PMID: 22754416]
[29]
Sousa G, Pinho C, Santos A, Abelha FJ. Postoperative delirium in patients with history of alcohol abuse. Rev Esp Anestesiol Reanim 2017; 64(4): 214-22.
[http://dx.doi.org/10.1016/j.redar.2016.07.009] [PMID: 27641821]
[30]
Ten Broeke M, Koster S, Konings T, Hensens AG, van der Palen J. Can we predict a delirium after cardiac surgery? A validation study of a delirium risk checklist. Eur J Cardiovasc Nurs 2018; 17(3): 255-61.
[http://dx.doi.org/10.1177/1474515117733365] [PMID: 28980478]
[31]
Leung JM, Sands LP, Mullen EA, Wang Y, Vaurio L. Are preoperative depressive symptoms associated with postoperative delirium in geriatric surgical patients? J Gerontol A Biol Sci Med Sci 2005; 60(12): 1563-8.
[http://dx.doi.org/10.1093/gerona/60.12.1563] [PMID: 16424289]
[32]
Makiguchi T, Yokoo S, Kurihara J. Risk factors for postoperative delirium in patients undergoing free flap reconstruction for oral cancer. Int J Oral Maxillofac Surg 2018; 47(8): 998-1002.
[http://dx.doi.org/10.1016/j.ijom.2018.03.011] [PMID: 29650354]
[33]
Cereghetti C, Siegemund M, Schaedelin S, et al. Independent predictors of the duration and overall burden of postoperative delirium after cardiac surgery in adults: an observational cohort study. J Cardiothorac Vasc Anesth 2017; 31(6): 1966-73.
[http://dx.doi.org/10.1053/j.jvca.2017.03.042] [PMID: 28711314]
[34]
Densky J, Eskander A, Kang S, et al. Risk factors associated with postoperative delirium in patients undergoing head and neck free flap reconstruction. JAMA Otolaryngol Head Neck Surg 2019; 145(3): 216-21.
[http://dx.doi.org/10.1001/jamaoto.2018.3820] [PMID: 30605208]
[35]
Afonso A, Scurlock C, Reich D, et al. Predictive model for postoperative delirium in cardiac surgical patients. Semin Cardiothorac Vasc Anesth 2010; 14(3): 212-7.
[http://dx.doi.org/10.1177/1089253210374650] [PMID: 20647262]
[36]
Yang Y, Zhao X, Dong T, Yang Z, Zhang Q, Zhang Y. Risk factors for postoperative delirium following hip fracture repair in elderly patients: a systematic review and meta-analysis. Aging Clin Exp Res 2017; 29(2): 115-26.
[http://dx.doi.org/10.1007/s40520-016-0541-6] [PMID: 26873816]
[37]
Gernhardt C, Kluge S, Meon M, et al. Risk factors for postoperative delirium after cardiac surgery. Fortschr Neurol Psychiatr 2017; 85(5): 274-9.
[PMID: 28561177]
[38]
Xiang D, Xing H, Tai H, Xie G. Preoperative C-reactive protein as a risk factor for postoperative delirium in elderly patients undergoing laparoscopic surgery for colon carcinoma. BioMed Res Int 2017; 2017 5635640
[http://dx.doi.org/10.1155/2017/5635640] [PMID: 29181397]
[39]
Vasunilashorn SM, Dillon ST, Inouye SK, et al. High C-reactive protein predicts delirium incidence, duration, and feature severity after major noncardiac surgery. J Am Geriatr Soc 2017; 65(8): e109-16.
[http://dx.doi.org/10.1111/jgs.14913] [PMID: 28555781]
[40]
Plas M, Hemmer PHJ, Been LB, van Ginkel RJ, de Bock GH, van Leeuwen BL. Incidence and predictors of postoperative delirium after cytoreduction surgery-hyperthermic intraperitoneal chemotherapy. J Surg Oncol 2018; 117(2): 260-8.
[http://dx.doi.org/10.1002/jso.24811] [PMID: 28940461]
[41]
Zhang DF, Su X, Meng ZT, et al. Preoperative severe hypoalbuminemia is associated with an increased risk of postoperative delirium in elderly patients: Results of a secondary analysis. J Crit Care 2018; 44: 45-50.
[http://dx.doi.org/10.1016/j.jcrc.2017.09.182] [PMID: 29055835]
[42]
Ge X, Dai X, Ding C, et al. Early postoperative decrease of serum albumin predicts surgical outcome in patients undergoing colorectal resection. Dis Colon Rectum 2017; 60(3): 326-34.
[http://dx.doi.org/10.1097/DCR.0000000000000750] [PMID: 28177996]
[43]
Margarson MP, Soni N. Serum albumin: touchstone or totem? Anaesthesia 1998; 53(8): 789-803.
[http://dx.doi.org/10.1046/j.1365-2044.1998.00438.x] [PMID: 9797524 ]

Rights & Permissions Print Cite
Article Metrics
57
11
1
World Health Day
© 2024 Bentham Science Publishers | Privacy Policy