Postoperative serum albumin decrease independently predicts delirium in elderly subjects after total joint arthroplasty.

BACKGROUND Postoperative delirium (POD), as a neurobehavioral syndrome which is 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 of serum Alb (∆Alb) was defined as the absolute value of (preoperative Alb value-nadir value within postoperative day 2)/preoperative Alb ×100%. The predictive and cut-off value of ∆Alb for POD was evaluated by receiver operating characteristic (ROC) curve analysis. Univariate and multivariate logistic regression analyses were used for evaluating assessing risk factors for POD. RESULTS A total of 328 patients were enrolled into the analysis, of which 68 (20.7%, 68/328) patients developed POD within postoperative 7 days. ∆Alb 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 ∆Alb was the only independent risk factor predictor for POD (OR: 2.43, 95%CI: 1.17-4.86, P=0.015). CONCLUSIONS ∆Alb was an independent risk factor for POD in elderly subjects after undergoing TJA.

[1]  R. Carrau,et al.  Risk Factors Associated With Postoperative Delirium in Patients Undergoing Head and Neck Free Flap Reconstruction , 2019, JAMA otolaryngology-- head & neck surgery.

[2]  S. Yokoo,et al.  Risk factors for postoperative delirium in patients undergoing free flap reconstruction for oral cancer. , 2018, International journal of oral and maxillofacial surgery.

[3]  Xia Shen,et al.  Postoperative delirium in the elderly: the potential neuropathogenesis , 2018, Aging Clinical and Experimental Research.

[4]  J. van der Palen,et al.  Can we predict a delirium after cardiac surgery? A validation study of a delirium risk checklist , 2018, European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology.

[5]  R. V. van Ginkel,et al.  Incidence and predictors of postoperative delirium after cytoreduction surgery‐hyperthermic intraperitoneal chemotherapy , 2018, Journal of surgical oncology.

[6]  Xueying Li,et al.  Preoperative severe hypoalbuminemia is associated with an increased risk of postoperative delirium in elderly patients: Results of a secondary analysis , 2017, Journal of critical care.

[7]  M. Seeberger,et al.  Independent Predictors of the Duration and Overall Burden of Postoperative Delirium After Cardiac Surgery in Adults: An Observational Cohort Study. , 2017, Journal of cardiothoracic and vascular anesthesia.

[8]  K. Dono,et al.  Incidence and Risk Factors for Postoperative Delirium in Patients After Hepatectomy , 2017, World Journal of Surgery.

[9]  Hailin Xing,et al.  Preoperative C-Reactive Protein as a Risk Factor for Postoperative Delirium in Elderly Patients Undergoing Laparoscopic Surgery for Colon Carcinoma , 2017, BioMed research international.

[10]  P. Kienle,et al.  Preoperative hypoalbuminemia is an independent risk factor for increased high-grade morbidity after elective rectal cancer resection , 2017, International Journal of Colorectal Disease.

[11]  D. Bohl,et al.  Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture , 2017, The Journal of bone and joint surgery. American volume.

[12]  T. Travison,et al.  High C‐Reactive Protein Predicts Delirium Incidence, Duration, and Feature Severity After Major Noncardiac Surgery , 2017, Journal of the American Geriatrics Society.

[13]  T. Wetterling,et al.  [Risk Factors for Postoperative Delirium after Cardiac Surgery]. , 2017, Fortschritte der Neurologie-Psychiatrie.

[14]  Guojing Yang,et al.  Prevalence and risk factors for postoperative delirium in total joint arthroplasty patients: A prospective study. , 2017, General hospital psychiatry.

[15]  G. Sousa,et al.  Delirio postoperatorio en pacientes con historial de abuso de alcohol , 2017 .

[16]  G. Sousa,et al.  Postoperative delirium in patients with history of alcohol abuse. , 2017, Revista espanola de anestesiologia y reanimacion.

[17]  Ning Li,et al.  Early Postoperative Decrease of Serum Albumin Predicts Surgical Outcome in Patients Undergoing Colorectal Resection , 2017, Diseases of the colon and rectum.

[18]  H. Otu,et al.  Higher C-Reactive Protein Levels Predict Postoperative Delirium in Older Patients Undergoing Major Elective Surgery: A Longitudinal Nested Case-Control Study , 2017, Biological Psychiatry.

[19]  M. Zenilman Delirium: An Important Postoperative Complication. , 2017, JAMA.

[20]  K. Junghanns,et al.  [Risk Factors for Postoperative Delirium after Cardiac Surgery]. , 2017, Fortschritte der Neurologie Psychiatrie.

[21]  Yingze Zhang,et al.  Risk factors for postoperative delirium following hip fracture repair in elderly patients: a systematic review and meta-analysis , 2017, Aging Clinical and Experimental Research.

[22]  Hao-Teng Chang,et al.  Electrolyte disorders and aging: risk factors for delirium in patients undergoing orthopedic surgeries , 2016, BMC Psychiatry.

[23]  Hong Jiang,et al.  Prevalence and risk factors of postoperative delirium in elderly hip fracture patients , 2016, The Journal of international medical research.

[24]  M. Schäfer,et al.  Postoperative Albumin Drop Is a Marker for Surgical Stress and a Predictor for Clinical Outcome: A Pilot Study , 2016, Gastroenterology research and practice.

[25]  A. Ejaz,et al.  Effect of Relative Decrease in Blood Hemoglobin Concentrations on Postoperative Morbidity in Patients Who Undergo Major Gastrointestinal Surgery. , 2015, JAMA surgery.

[26]  L. Sands,et al.  Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery. , 2015, British journal of anaesthesia.

[27]  C. Choi,et al.  Risk factors of delirium in patients undergoing total knee arthroplasty. , 2015, Archives of gerontology and geriatrics.

[28]  J. Mathias,et al.  Incidence of delirium following total joint replacement in older adults: a meta-analysis. , 2015, General hospital psychiatry.

[29]  J. Roh,et al.  Postoperative hypoalbuminemia as a risk factor for surgical site infection after oral cancer surgery. , 2015, Oral diseases.

[30]  L. Travis,et al.  Outcomes associated with postoperative delirium after cardiac surgery. , 2015, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[31]  T. Misawa,et al.  Perioperative serum albumin correlates with postoperative pancreatic fistula after pancreaticoduodenectomy. , 2015, Anticancer research.

[32]  J. Bono,et al.  Pharmacologic risk factors for post-operative delirium in total joint arthroplasty patients: a case-control study. , 2014, The Journal of arthroplasty.

[33]  D. Kushner,et al.  Preoperative hypoalbuminemia is an independent predictor of poor perioperative outcomes in women undergoing open surgery for gynecologic malignancies. , 2013, Gynecologic oncology.

[34]  C. Young,et al.  Obstructive Sleep Apnea and Incidence of Postoperative Delirium after Elective Knee Replacement in the Nondemented Elderly , 2012, Anesthesiology.

[35]  S. Choo,et al.  Postoperative hypoalbuminemia is associated with outcome in patients undergoing off-pump coronary artery bypass graft surgery. , 2011, Journal of cardiothoracic and vascular anesthesia.

[36]  D. Schroeder,et al.  Cognitive and Functional Predictors and Sequelae of Postoperative Delirium in Elderly Patients Undergoing Elective Joint Arthroplasty , 2011, Anesthesia and analgesia.

[37]  J. Yadeau,et al.  Postoperative Delirium in Elderly Patients After Elective Hip or Knee Arthroplasty Performed Under Regional Anesthesia , 2011, HSS journal : the musculoskeletal journal of Hospital for Special Surgery.

[38]  BA MatthewC.Rade,et al.  Postoperative Delirium in Elderly Patients After Elective Hip or Knee Arthroplasty Performed Under Regional Anesthesia , 2011, HSS Journal ®.

[39]  D. Reich,et al.  Predictive Model for Postoperative Delirium in Cardiac Surgical Patients , 2010, Seminars in cardiothoracic and vascular anesthesia.

[40]  J. Reynolds,et al.  Association of Hypoalbuminemia on the First Postoperative Day and Complications Following Esophagectomy , 2007, Journal of Gastrointestinal Surgery.

[41]  M. Fain,et al.  The elderly surgical patient and postoperative delirium. , 2006, Journal of the American College of Surgeons.

[42]  Najma Siddiqi,et al.  Occurrence and outcome of delirium in medical in-patients: a systematic literature review. , 2006, Age and ageing.

[43]  L. Sands,et al.  Are preoperative depressive symptoms associated with postoperative delirium in geriatric surgical patients? , 2005, The journals of gerontology. Series A, Biological sciences and medical sciences.

[44]  T A Brennan,et al.  Factors associated with unplanned hospital readmission among patients 65 years of age and older in a Medicare managed care plan. , 1999, The American journal of medicine.

[45]  N. Soni,et al.  Serum albumin: touchstone or totem? , 1998, Anaesthesia.

[46]  K. Calman,et al.  INCREASED VASCULAR PERMEABILITY: A MAJOR CAUSE OF HYPOALBUMINAEMIA IN DISEASE AND INJURY , 1985, The Lancet.