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

The primary objective of this research was to investigate the occurrence rate and independent risk factors associated with emergence delirium (ED) in elderly patients undergoing orthopedic procedures with general anesthesia, providing a basis for clinical prevention and intervention.

Elderly individuals (age ≥65 years) undergoing orthopedic procedures under general anesthesia with subsequent post-anesthesia care unit (PACU) admission were included in this secondary analysis of a prospective observational study. ED was assessed at 10 and 30 min after PACU admission and immediately before discharge using the Nursing Delirium Screening Scale. Univariate logistic regression was first employed to screen potential risk factors, after which multivariate logistic regression analysis was conducted to determine independent risk factors.

ED was observed in 85 individuals, accounting for 35.1% of the 242 patients. Multivariate logistic regression analysis showed that the presence of urinary catheters (odds ratio [OR] 4.30, 95% confidence interval [CI] 2.08-8.91), age (OR 1.14, 95% CI 1.08-1.20), postoperative numerical rating scale score (OR 1.37, 95% CI 1.08-1.73), and fasting times for solids (OR 1.10, 95% CI 1.02-1.19) were independent risk factors for ED. The multivariate model demonstrated acceptable discrimination with an area under the curve of 0.77 and excellent calibration (Hosmer-Lemeshow test, p = 0.637).

ED represents a common complication following general anesthesia in elderly orthopedic patients. Some risk factors, including the presence of urinary catheters, prolonged fasting times for solids, advanced age, and postoperative pain, can increase the incidence of ED. Perhaps we can reduce the occurrence of ED through multimodal clinical strategies.