Delirium after fast‐track hip and knee arthroplasty – a cohort study of 6331 elderly patients

Background Postoperative delirium ( PD ) is a well‐known complication among elderly surgical patients and associated with increased morbidity, mortality and length of stay ( LOS ). In elective orthopedic surgery, including hip and knee arthroplasty ( THA / TKA ), most studies report incidences between 5% and 10%. The multimodal optimization of perioperative care (fast‐track) aims to enhance recovery and reduce morbidity and LOS , but limited data are available on the effect on PD . Consequently, the study investigated signs of PD associated with LOS > 4 days. Methods Prospective risk assessment study with retrospective analysis of discharge notes or medical records of signs of PD in 6331 elective primary unilateral THA and TKA patients ≥ 70 years, and LOS > 4 days. Preoperative patient characteristics collected from eight high volume centers with similar standardized fast‐track protocols from January 2010 to November 2013. Results We identified 43 (0.7%) cases of PD symptoms mentioned as a reason for LOS > 4 days among the 789 patients with LOS > 4 days (12.5% of all THA and TKA ). PD patients had a mean age of 80.7 [[95% CI ] 79.3–82.1] years, being 4.0 [[95% CI ] 2.5–5.5] years older compared to patients without PD ( P  < 0.001). LOS was median 10 [[Q2–Q3] 7–14] days in the PD group vs. 3 [2–3] days in the non‐ PD group ( P  < 0.001), without differences in gender or site of arthroplasty ( P  = 0.139 and 0.499, respectively). Conclusion Postoperative delirium symptoms contributing to LOS > 4 days in fast‐track THA and TKA are rare in elderly patients.