Delirium after fast-track hip and knee arthroplasty

Postoperative delirium (PD) is a serious complication after major surgery in elderly patients. PD is well defined and characterized by reduced attention and disorientation. Multimodal optimization of perioperative care (the fast-track methodology) enhances recovery, and reduces hospital stay and medical morbidity. No data on PD are available in fast-track surgery. The aim of this study was to evaluate the incidence of PD after fast-track hip (THA) and knee arthroplasty (TKA) with anticipated length of stay (LOS) of <3 days.

In a prospective multicentre study to evaluate postoperative cognitive dysfunction, we included 225 non-demented patients with a mean age of 70 yr undergoing either THA or TKA in a fast-track set-up. Anaesthesia and postoperative pain management were standardized with limited opioid use. Nursing staff were trained to look for symptoms of PD which was assessed during interaction with healthcare professionals. Patients were invited for a clinical follow-up 1-2 weeks after surgery.

Clinical follow-up was performed in 220 patients at a mean of 12.0 days after surgery while five patients were followed up by telephone. The mean LOS was 2.6 days (range 1-8 days). Twenty-two patients received general anaesthesia, and the rest had spinal anaesthesia. No patients developed PD (95% confidence interval 0.0-1.6%).

A fast-track set-up with multimodal opioid-sparing analgesia was associated with lack of PD after elective THA and TKA in elderly patients.