The comparison of delirium incidence and risk factors undergoing in elderly patients lower extremity surgery with general or regional anesthesia

Aim: The aim of this study the comparison of the risk factors and the incidence of delirium following orthopedic surgery under the general or regional anesthesia in elderly. Material and Method: After obtaining the approval of the Ethics Committee and the written consent,. we evaluated 120 elderly patients (older than 65 years) who underwent total hip or knee artroplasty, femur fracture surgery for the development of delirium and categorized them into two groups; regional anesthesia (n=50) or general anesthesia (n=70) . All patients enrolled underwent preoperative physical examination and the following parameters were recorded: blood pressure, heart rate and SpO2, American Society of Anesthesiologists score (I-III) ,. delirium tests (CAM and DRS-R-98). The following haematological parameters were measured: haematocrit, red and white blood cell counts, Na+, K+, creatinine, glycaemia. Group 1 (general anesthesia n=70) ; all patients, anesthesia was inducedwith propofol (1.5 to 2 mg/kg) and intravenous and rocuronium bromide IV (0.6 mg/kg) Anesthesia was maintained using sevoflurane and %65 N2O / %35 O2. For postoperative analgesia, morphine was applied (0,1 mg/kg) 30 minutes before the end of operation. Group 2 ( CSEA n =50) was given 0.5% isobaric bupivacaine (10-15 mg) and fentanyl (25 μg) by spinal route. In the postoperative period, bupivacaine (5 ml 0,5% isobaric) and morphine (1mg) was administered via epidural catheter. Hemodynamic and laboratory parameters, and delirium tests were repeated at 24th and 72nd hours postoperatively. In patients CAM positive and DRS-98 values were 17 it was considered severe delirium and haloperidol was applied. Results: Demographic values, operation time, preoperative and postoperative hemodynamic and laboratory parameters were similar in two groups. For all patients, delirium incidence was 12,5 %. Delirium was seen in 6 patients (8,6%) in general anesthesia group, and 9 patients (18%) in KSEA group. (p: 0,3). While hyperactive type was seen in 4 patients (3,3%), hypoactive type in 11 patients (9,1%). The most important risk factors for all patients of advanced age (>75 year) and polypharmacy was observed (p: 0,0001). Hospitalization time and cost were higher in patients severe delirium than the other patients. Conclusion: The study showed that, delirium was observed total 12.5% in elderly patients (older than 65 years) who underwent total hip or knee arthroplasty and femur fracture surgery. The incidence of delirum didn't show difference regional or general anesthesia. Advanced age and polipharmacy were determined risk factors of delirum. We concluded that, increased hospital costs and length of hospital stay in patients delirium.