Protocol for a single-centre prospective observational study of postoperative delirium following total joint arthroplasties among South East Asians

Hairil Rizal Abdullah, Sapphire RouXi Tan, Si Jia Lee, Hamid Rahmatullah Bin Abd Razak, Rachel Huiqi Seet, Hao Ying, Ervin Sethi, Eileen Yilin Sim, Hairil Rizal Abdullah, Sapphire RouXi Tan, Si Jia Lee, Hamid Rahmatullah Bin Abd Razak, Rachel Huiqi Seet, Hao Ying, Ervin Sethi, Eileen Yilin Sim

Abstract

Introduction: Postoperative delirium is a serious and common complication in older adults following total joint arthroplasties (TJA). It is associated with increased risk of postoperative complications, mortality, length of hospital stay and postdischarge institutionalisation. Thus, it has a negative impact on the health-related quality of life of the patient and poses a large economic burden. This study aims to characterise the incidence of postoperative delirium following TJA in the South East Asian population and investigate any risk factors or associated outcomes.

Methods and analysis: This is a single-centre prospective observational study recruiting patients between 65 and 90 years old undergoing elective total knee arthroplasty or total hip arthroplasty. Exclusion criteria included patients with clinically diagnosed dementia. Preoperative and intraoperative data will be obtained prospectively. The primary outcome will be the presence of postoperative delirium assessed using the Confusion Assessment Method on postoperative days 1, 2 and 3 and day of discharge. Other secondary outcomes assessed postoperatively will include hospital outcomes, pain at rest, knee and hip function, health-related quality of life and Postoperative Morbidity Survey-defined morbidity. Data will be analysed to calculate the incidence of postoperative delirium. Potential risk factors and any associated outcomes of postoperative delirium will also be determined.

Ethics and dissemination: This study has been approved by the Singapore General Hospital Institutional Review Board (SGH IRB) (CIRB Ref: 2017/2467) and is registered on the ClinicalTrials.gov registry (Identified: NCT03260218). An informed consent form will be signed by all participants before recruitment and translators will be made available to non-English-speaking participants. The results of this study will be presented at international conferences and submitted to a peer-reviewed journal. The data collected will also be made available in a public data repository.

Trial registration number: NCT03260218.

Keywords: delirium; incidence; postoperative; total joint arthroplasty.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Confusion Assessment Method (CAM) criteria: at least one criterion on each of the three rows must be met for a positive result.
Figure 2
Figure 2
Flow chart depicting a patient’s timeline during the study. CAM, Confusion Assessment Method; CoCI, Comprehensive Complication Index; DAOH, days alive and out of hospital; HHS, Harris Hip Score; HRQoL, health-related quality of life; KSFS, Knee Society Function Score; KSKS, Knee Society Knee Score; MMSE, Mini–Mental State Examination; OKS, Oxford Knee Score; PEC, preoperative evaluation clinic; PMS, Parker Mobility Score; POD, postoperative day; POMS, Postoperative Morbidity Survey; SF-36, 36-Item Short Form Health Survey; THA, total hip arthroplasty; TJA, total joint arthroplasty; TKA, total knee arthroplasty; VAS, visual analogue scale.

References

    1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fifth Edition Arlington: VA, American Psychiatric Association, 2013.
    1. Scott JE, Mathias JL, Kneebone AC. Incidence of delirium following total joint replacement in older adults: a meta-analysis. Gen Hosp Psychiatry 2015;37:223–9. 10.1016/j.genhosppsych.2015.02.004
    1. Rudolph JL, Marcantonio ER. Review articles: postoperative delirium: acute change with long-term implications. Anesth Analg 2011;112:1202–11. 10.1213/ANE.0b013e3182147f6d
    1. Rudolph JL, Jones RN, Rasmussen LS, et al. . Independent vascular and cognitive risk factors for postoperative delirium. Am J Med 2007;120:807–13. 10.1016/j.amjmed.2007.02.026
    1. Marcantonio ER, Goldman L, Mangione CM, et al. . A clinical prediction rule for delirium after elective noncardiac surgery. JAMA 1994;271:134–9. 10.1001/jama.1994.03510260066030
    1. Witlox J, Eurelings LS, de Jonghe JF, et al. . Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA 2010;304:443 10.1001/jama.2010.1013
    1. Lovald ST, Ong KL, Malkani AL, et al. . Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients. J Arthroplasty 2014;29:510–5. 10.1016/j.arth.2013.07.020
    1. Kurtz S, Ong K, Lau E, et al. . Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007;89:780 10.2106/JBJS.F.00222
    1. Raats JW, van Eijsden WA, Crolla RM, et al. . Risk Factors and Outcomes for Postoperative Delirium after Major Surgery in Elderly Patients. PLoS One 2015;10:e0136071 10.1371/journal.pone.0136071
    1. Elie M, Cole MG, Primeau FJ, et al. . Delirium risk factors in elderly hospitalized patients. J Gen Intern Med 1998;13:204–12. 10.1046/j.1525-1497.1998.00047.x
    1. Singapore General Hospital. Quick facts. 2017. (accessed 14 Jul 2017).
    1. Singapore General Hospital. Adult reconstructive service. 2014. (accessed 14 Jul 2017).
    1. Inouye SK, et al. . Clarifying Confusion: The Confusion Assessment Method. Ann Intern Med 1990;113:941 10.7326/0003-4819-113-12-941
    1. Folstein MF, Folstein SE, McHugh PR. ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–98.
    1. Katzman R, Zhang MY, Ouang-Ya-Qu, et al. . A Chinese version of the Mini-Mental State Examination; impact of illiteracy in a Shanghai dementia survey. J Clin Epidemiol 1988;41:971–8. 10.1016/0895-4356(88)90034-0
    1. Sahadevan S, Lim PP, Tan NJ, et al. . Diagnostic performance of two mental status tests in the older chinese: influence of education and age on cut-off values. Int J Geriatr Psychiatry 2000;15:234–41. 10.1002/(SICI)1099-1166(200003)15:3<234::AID-GPS99>;2-G
    1. Ng TP, Niti M, Chiam PC, et al. . Ethnic and educational differences in cognitive test performance on mini-mental state examination in Asians. Am J Geriatr Psychiatry 2007;15:130–9. 10.1097/01.JGP.0000235710.17450.9a
    1. Inouye SK. Confusion Assessment Method. © 1988, 2003, Hospital Elder Life Program. Ann Intern Med 1988;1990:941–8.
    1. Pye A, Charalambous AP, Leroi I, et al. . Screening tools for the identification of dementia for adults with age-related acquired hearing or vision impairment: a scoping review. Int Psychogeriatrics 2017:1–14.
    1. Mathiowetz V, Weber K, Volland G, et al. . Reliability and validity of grip and pinch strength evaluations. J Hand Surg Am 1984;9:222–6. 10.1016/S0363-5023(84)80146-X
    1. Ong HL, Abdin E, Chua BY, et al. . Hand-grip strength among older adults in Singapore: a comparison with international norms and associative factors. BMC Geriatr 2017;17:176 10.1186/s12877-017-0565-6
    1. Daabiss M. American Society of Anaesthesiologists physical status classification. Indian J Anaesth 2011;55:111–5. 10.4103/0019-5049.79879
    1. Charlson ME, Pompei P, Ales KL, et al. . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–83. 10.1016/0021-9681(87)90171-8
    1. Charlson M, Szatrowski TP, Peterson J, et al. . Validation of a combined comorbidity index. J Clin Epidemiol 1994;47:1245–51. 10.1016/0895-4356(94)90129-5
    1. Prasad KT, Sehgal IS, Agarwal R, et al. . Assessing the likelihood of obstructive sleep apnea: a comparison of nine screening questionnaires. Sleep Breath 2017;21:909–17. 10.1007/s11325-017-1495-4
    1. Bennett-Guerrero E, Welsby I, Dunn TJ, et al. . The use of a postoperative morbidity survey to evaluate patients with prolonged hospitalization after routine, moderate-risk, elective surgery. Anesth Analg 1999;89:514–9.
    1. Grocott MP, Browne JP, Van der Meulen J, et al. . The Postoperative Morbidity Survey was validated and used to describe morbidity after major surgery. J Clin Epidemiol 2007;60:919–28. 10.1016/j.jclinepi.2006.12.003
    1. Slankamenac K, Graf R, Barkun J, et al. . The Comprehensive Complication Index. Ann Surg 2013;258:1–7. 10.1097/SLA.0b013e318296c732
    1. Insall JN, Dorr LD, Scott RD, et al. . Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989;248:13–14. 10.1097/00003086-198911000-00004
    1. Scuderi GR, Bourne RB, Noble PC, et al. . The new Knee Society Knee Scoring System. Clin Orthop Relat Res 2012;470:3–19. 10.1007/s11999-011-2135-0
    1. Dawson J, Fitzpatrick R, Murray D, et al. . Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 1998;80:63–9. 10.1302/0301-620X.80B1.7859
    1. Garratt AM, Brealey S, Gillespie WJ; DAMASK Trial Team. Patient-assessed health instruments for the knee: a structured review. Rheumatology 2004;43:1414–23. 10.1093/rheumatology/keh362
    1. van Hove RP, Brohet RM, van Royen BJ, et al. . High correlation of the Oxford Knee Score with postoperative pain, but not with performance-based functioning. Knee Surgery, Sport Traumatol Arthrosc 2016;24:3369–75. 10.1007/s00167-015-3585-9
    1. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51:737–55.
    1. Söderman P, Malchau H. Is the Harris hip score system useful to study the outcome of total hip replacement? Clin Orthop Relat Res 2001;384:189–97. 10.1097/00003086-200103000-00022
    1. Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br 1993;75:797–8.
    1. Kristensen MT, Bandholm T, Foss NB, et al. . High inter-tester reliability of the new mobility score in patients with hip fracture. J Rehabil Med 2008;40:589–91. 10.2340/16501977-0217
    1. Kristensen MT, Foss NB, Ekdahl C, et al. . Prefracture functional level evaluated by the New Mobility Score predicts in-hospital outcome after hip fracture surgery. Acta Orthop 2010;81:296–302. 10.3109/17453674.2010.487240
    1. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30:473–83.
    1. Ariti CA, Cleland JG, Pocock SJ, et al. . Days alive and out of hospital and the patient journey in patients with heart failure: Insights from the candesartan in heart failure: assessment of reduction in mortality and morbidity (CHARM) program. Am Heart J 2011;162:900–6. 10.1016/j.ahj.2011.08.003

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