Delirium following total joint replacement surgery

  • Jeffrey Huang Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
  • Juraj Sprung Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
  • Toby N. Weingarten Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
Keywords: Delirium, surgery, outcomes, total joint arthroplasty


Postoperative delirium (POD) is a common complication associated with increased resource utilization, morbidity and mortality. Our institution screens all postsurgical patients for postoperative delirium. The study aim was to perform an automated interrogation of the electronic health records to estimate the incidence of and identify associated risk factors for POD following total joint arthroplasty (TJA). Adult patients who underwent TJA with a multimodal analgesia protocol, including peripheral nerve blockade, from 2008 through 2012, underwent automated chart review. POD was identified by routine nursing assessment and administrative billing codes. Of 11,970 patients, 181 (1.5%) were identified to have POD. Older age (odds ratio, 95% CI 2.20, 1.80–2.71 per decade, p < 0.001), dementia (7.44, 3.54–14.60, p < 0.001), diabetes mellitus (1.70, 1.1.5–2.47, p = 0.009), renal disease (1.68, 1.03–2.65, p = 0.039), blood transfusions (2.04, 1.14–3.52, p = 0.017), and sedation during anesthesia recovery (1.76, 1.23–2.51, p = 0.002) were associated with POD. Anesthetic management was not associated with POD risk. Patients who developed POD required greater healthcare resources. Dementia is strongly associated with POD. The association between POD and transfusions may reflect higher acuity patients or detrimental effect of blood. Postoperative sedation should be recognized as a warning sign of increased risk.


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Author Biographies

Jeffrey Huang, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
Department of Anesthesiology and Perioperative Medicine
Juraj Sprung, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
Department of Anesthesiology and Perioperative Medicine
Toby N. Weingarten, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
Department of Anesthesiology and Perioperative Medicine


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Delirium following total joint replacement surgery
How to Cite
Huang J, Sprung J, Weingarten TN. Delirium following total joint replacement surgery. Bosn J of Basic Med Sci [Internet]. 2019Feb.12 [cited 2020Aug.13];19(1):81-5. Available from:
Translational and Clinical Research