2024 Volume 15 Issue 6 Pages 907-913
Introduction: The incidence of postoperative delirium in spine surgery ranges from 12% to 24%. Whereas postoperative delirium is associated with longer hospital stays, increased medical costs, higher readmission rates, and higher mortality rates, there are few reports of risk factors and prevention methods for delirium in spine surgery. This study investigated the incidence and prognostic factors of delirium after kyphoplasty for osteoporotic vertebral fractures, and the effectiveness of our early mobilization program for delirium.
Methods: This retrospective study included 327 patients (241 women, 86 men; mean age, 80.0±7.4 years; range, 65-99 years) who underwent kyphoplasty for osteoporotic vertebral fractures between January 2018 and May 2023. The Kihoku Super Early Ambulation Program (K-SEAP) initiated in April 2021 is a program in which patients walk under supervision by a physical therapist three hours after surgery to prevent postoperative delirium and to facilitate early acquisition of activities of daily living (ADL). Data were compared between the groups using the chi-square test and the Mann-Whitney U test. Binary logistic regression analysis using the forward stepwise likelihood ratio method was used to investigate risk factors for delirium. Variables with P values < 0.05 on the univariate analyses were entered as independent variables into the regression analysis.
Results: Postoperative delirium occurred in 23 of 327 patients (7%). Compared with the non-delirium group, the delirium group included older patients (delirium vs. non-delirium group; 84.0 vs. 79.7 years), who were mostly male (52% vs. 24%), more often had weekend surgery (39 vs. 18%), had lower MMSE (16 vs. 24 points), and received K-SEAP less (21 vs. 45%) (P < 0.05). Delirium was significantly associated with K-SEAP (odds ratio (OR) 0.21, 95% confidence interval (CI) 0.06-0.74), male sex (OR 3.55, 95%CI 1.24-10.2) and MMSE (OR 0.83, 95%CI 0.76-0.90).
Conclusions: The incidence of delirium after kyphoplasty for elderly patients was 7%. K-SEAP was the strongest predictor to prevent postoperative delirium in patients undergoing kyphoplasty. Future studies are needed to assess the effectiveness of early mobilization on clinical outcomes, including costs, in elderly patients with osteoporotic vertebral fractures undergoing kyphoplasty.
