General anesthesia and intraoperative opioids do not affect postoperative delirium in femoral neck surgery

Abstract

Objective: Both, general anesthesia (GA) and the amount of opioids used have been reported to be
factors in the development of postoperative delirium (POD) in some studies, it remains unknown whether
they affect delirium after hip surgery.
The aim of this study was to investigate whether GA and the amount of intraoperative opioid increase
delirium after femoral neck surgery.
Methodology: This study included 188 patients who underwent for hip surgery between January 2009
and July 2013. The patients with POD (delirium group) were diagnosed using the Confusion Assessment
Method (CAM) based on a review of electronic medical records were included in Group D, and rest of the
patients in Group ND. Preoperative comorbidities, method of anesthesia, and method of intraoperative
analgesia were retrospectively compared between the groups. Univariate analysis was performed to
examine factors in the two groups. Then, variables with p<0.05 on univariate analysis were examined
by multivariate analysis. Multivariate analysis was performed using logistic regression to determine the
adjusted odds ratio and 95% confidence interval.
Results: 43 (22.87%) patients were diagnosed with POD (Group D). No significant differences were
observed between groups in the method of anesthesia (spinal anesthesia, GA, combined spinal-epidural
anesthesia ), the amount of intraoperative opioid (dose of remifentanil or fentanyl). The only independent
risk factor for POD found was the old age (95% CI 1.021-1.126, P=0.005).
Conclusion: This study demonstrated that general anesthesia and the amount of intraoperative opioid
did not affect delirium after femoral neck surgery