Developing a predictive tool for post-operative delirium in orthopaedic settings in Hong Kong

SummaryAimsA prospective study was conducted to develop a Common Risk-factor Assessment Predictive Tool (CAP) for identifying factors associated with post-operative delirium (POD) in orthopaedic surgery. A high, moderate and low risk score system was developed. The incidence rate of POD was also determined.BackgroundPOD has been reported as contributing to complications and poor outcomes, consequently affecting recovery and health-care provision.MethodsThirteen risk factors were evaluated. Regression coefficient and odds ratios were used to determine the association of the risk factors with POD. These were then used to develop a tool. Validation of these associated risk factors was carried out to check their effectiveness in predicting the development of POD.FindingsFifty nine of 277 patients developed POD. Four major risk factors were identified: visual impairment (p = 0.011; scored as 2), cognitive impairment (p < 0.001; scored as 4), urinary tract or respiratory tract infection (p = 0.028; scored as 3) and use of urinary catheterisation (p = 0.046; scored as 3). Using a 12-point score system the cut-off values were 4.5 (61.0% sensitivity and 85.8% specificity) and 7 (11.9% sensitivity and 95% specificity) respectively.ConclusionThe tool can predict different levels of risk for POD. Nurses can use the tool to communicate patients’ risk of POD and identify potential preventive strategies.