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Curr Pharm Des. 2019 Dec 27. doi: 10.2174/1381612826666191227153150. [Epub ahead of print]

Postoperative serum albumin decrease independently predicts delirium in elderly subjects after total joint arthroplasty.

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Department and institution: Department of anesthesiology, HwaMei Hospital, University Of Chinese Academy Of Sciences,No.41 Xibei Road, Haishu District, Ningbo, Zhejiang Province. China.



Postoperative delirium (POD), as a neurobehavioral syndrome which is induced by dysfunction of neural activity, is a common and serious complication. This current study aimed to investigate independent predictors for POD in elderly subjects after total joint arthroplasty (TJA).


Eligible elderly patients (≥65 years) who underwent elective unilateral primary hip or knee arthroplasty under epidural anesthesia from October 2016 to January 2019 were consecutively enrolled. POD was diagnosed following the guidance of the 5th edition of Diagnostic and Statistical Manual of Mental Disorders, (DSM V, 2013). The relative change of serum Alb (∆Alb) was defined as the absolute value of (preoperative Alb value-nadir value within postoperative day 2)/preoperative Alb ×100%. The predictive and cut-off value of ∆Alb for POD was evaluated by receiver operating characteristic (ROC) curve analysis. Univariate and multivariate logistic regression analyses were used for evaluating assessing risk factors for POD.


A total of 328 patients were enrolled into the analysis, of which 68 (20.7%, 68/328) patients developed POD within postoperative 7 days. ∆Alb was an effective predictor for POD with an area under the curve (AUC) of 0.821, a sensitivity of 76.15% and a specificity of 70.59%, respectively (P<0.001). Univariate and multivariate logistic regression analyses indicated that ∆Alb was the only independent risk factor predictor for POD (OR: 2.43, 95%CI: 1.17-4.86, P=0.015).


∆Alb was an independent risk factor for POD in elderly subjects after undergoing TJA.


Postoperative delirium; albumin; elderly; risk factor; total joint arthroplasty

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