AB204. SOH22ABS105. The incidence of the post-operative delirium in orthoapedic patients (prospective audit)

Background: The incidence of delirium in elective extremities surgery is reported to be 2.5–3% and it’s increased with the age up to 20%. It is associated with increased costs of care, morbidity, delayed functional recovery, and prolonged hospital stay. There are many stratification tools available but the most common is the 4AT.

Methods: We conducted the prospective 1 month (from the 1st until 30th September 2021) audit study to investigate the incidence of postoperative delirium in elective orthopaedic patients over 60 years of age using 4AT scoring system. We included 162 patients in total and we documented all risk factors. The secondary aim was to identify the incidence of cognitive impairment and incorporate the standardized assessment to predict and prevent the delirium in elderly patients coming for elective orthopaedic surgery.

Results: The total incidence of postoperative delirium was reported 6.79% in our study increasing with the age. Zero percent in the age group of 60–69 years, 4.46% in 70–79 years old and up to 40% in patients over 80 years. The total incidence of cognitive impairment was 10.5% and it was the highest (26%) in age group over 80 years.

Conclusions: The total incidence of delirium in elective orthopaedic patients is 6.79%, which can be improved by the use of multi-modal Anaesthesia including regional technique and early ambulation. The incidence is higher in those with advanced age and per-existing brain disease. Both fixed and modifiable factors are identified such as opiate consumption as the main cause and the other possible factors included urinary catheterization and benzodiazepine use.

Keywords: Assessment test for delirium; cognitive impairment; elderly; postoperative delirium; prospective study