Yaşlı Hastalarda Femur Kırıklarında Uygulanan Anestezi Tekniğinin Postoperatif Dönemde Görülen Deliryuma Etkisi: Retrospektif Çalışma

Abstract

Karsavuran E. G. The Effect of Anesthesia Technique on Postoperative Delirium in Elderly Patients with Femoral Fractures: A Retrospective Study. Hacettepe University Faculty of Medicine, Department of Anesthesiology and Reanimation, Ankara, 2023. Introduction & Objectives: Nowadays, with the increase in life expectancy, the incidence of hip fracture has increased in the elderly population. One of the most common complication after hip fracture surgery is delirium. Emergency, cardiac or major orthopedic surgeries are the cases with the highest incidence. Postoperative delirium is associated with increased mortality, hospital-acquired complications, persistent cognitive impairment, poor functional recovery, and increased healthcare costs. In this study, we aimed to examine the effect of anesthesic procedure which is applied and other perioperative factors affecting the delirium after hip fracture surgery in elderly patients who were operated for hip fracture in our clinic. Material & Methods: Patients aged 65 and over who were operated for hip fracture at Hacettepe University Medical Faculty Hospital between January 2015 and December 2019 were included in the study. Demographic and clinical characteristics of the patients were obtained retrospectively from the hospital electronic database. The diagnosis of delirium was determined on the basis of the “Confusion Assessment Method (CAM-ICU)”, which is routinely evaluated in intensive care unit admission in our clinic. The effects of anesthesia techniques and other perioperative factors on postoperative delirium were investigated by statistical methods. Results: A total of 167 patients [121 (72.5%) females and 46 (27.5%) males] included in the study had an median age of 83 (65-95). One hundred six (63.5%) patients were operated under general anesthesia and 61 (36.5%) patients under regional anesthesia. Among the anesthetic agents administered (both for general anesthesia and sedation); propofol, rocuronium, sevoflurane, fentanyl, nitrous protoxide, midazolam, remifentanil, ketamine, dexmedetomidine and thiopental were not statistically significantly associated with postoperative delirium. Statistically significant correlations were found between modified fragility index, use of anticoagulant drugs, length of hospital stay, patient age, dementia, and intraoperative desflurane use and postoperative delirium. Conclusion: Our study showed that increasing age, presence of dementia, increased modified fragility index and prolonged hospitalization were risk factors for postoperative delirium; however, anesthesia methods were not associated with the development of postoperative delirium. Factors associated with postoperative delirium were revealed. Increasing age, presence of dementia, increased fragility and prolonged use of hospitalization were shown to be risk factors for postoperative delirium by statistical analysis. Delirium seen in the postoperative period in geriatric patients is an important cause of morbidity and mortality. Therefore, studies with larger patient groups are needed to improve the prevention, diagnosis and treatment of delirium.