Preoperative assessment of geriatric patients who are scheduled to undergo major orthopedic surgery

Purpose: We aimed to find the relation between preoperative variables and time interval before the surgery for delirium development in preoperative period in geriatric patients who were planned to undergo major orthopedic surgery.Material and Method: ASA (American Society of Anesthesiologist) class I-III 50 patients, aged 65 or more without any cognitive disorder who were hospitalized in Dokuz Eylul University Orthopedic Clinic for a major orthopedic surgery were selected for the study. Standardized Mini Mental Test (SMMT) was assessed for each patient daily. Test scores and preoperative variables (systemic diseases, medication, laboratory results, job, educational status, nursing relative, pain score) were recorded. Since no patient had SMMT score less than 23, none of patients was consulted by a psychiatrist. Delirium Rating Scale was not used.Results: There were statistically significant relationships between the diagnosis and the age of the patient (p=0.005), BUN/creatinine ratio (p=0.004) and change in VAS (p=0.000). In uneducated patients compared with educated patients there were statistically significant decrease in mean attention scores and mean orientation scores (p=0.000 and p=0.001 respectively). Mean orientation scores of patients who had retired from a job were significantly higher than housewives (p=0.033). There were statistically significant relationship between age of patients and multisystemic diseases; and multiple drug use (p=0.019 and p=0.019 respectively). Renal failure stages were rising with increasing age (p=0.001). There was a statistically significant increase in mean total score and change in attention score in patients who had no accompanying nursing relative(p=0.029 and p=0.003 respectively)Conclusion: In our study we determined well-known risk factors for development of delirium in our sample group. But none of our patients developed delirium. Renal failure, multisystemic diseases and multiple drug use were more frequent with increasing age. As a risk factor pain was more prevalent in patients with fractures.Key words: Delirium, Geriatric Patient, Major Orthopedic Surgery, Standardized Mini Mental Test