Risk Factors for Emergence Delirium in Elderly Orthopedic Patients After General Anesthesia

Area of Science:

• Anesthesiology
• Geriatric Medicine
• Surgical Care

Background:

• Emergence delirium (ED) is a common post-anesthesia complication in elderly patients.
• Orthopedic procedures under general anesthesia pose specific risks for ED in this demographic.

Purpose of the Study:

• To determine the incidence rate of ED in elderly patients undergoing orthopedic surgery.
• To identify independent risk factors associated with ED in this patient population.

Main Methods:

• Secondary analysis of a prospective observational study involving elderly patients (≥65 years) undergoing orthopedic procedures.
• ED assessment using the Nursing Delirium Screening Scale at multiple time points post-anesthesia care unit (PACU) admission.
• Univariate and multivariate logistic regression analyses to identify independent risk factors.

Main Results:

• The incidence of ED was 35.1% (85 out of 242 patients).
• Independent risk factors identified include urinary catheter presence (OR 4.30), advanced age (OR 1.14), postoperative pain scores (OR 1.37), and prolonged solid fasting times (OR 1.10).
• The predictive model showed good discrimination (AUC 0.77) and calibration.

Conclusions:

• Emergence delirium is a frequent complication in elderly orthopedic patients after general anesthesia.
• Urinary catheterization, prolonged fasting, advanced age, and postoperative pain are significant risk factors for ED.
• Multimodal clinical strategies may effectively reduce the incidence of ED.