Hostname: page-component-7479d7b7d-jwnkl Total loading time: 0 Render date: 2024-07-12T14:15:15.809Z Has data issue: false hasContentIssue false
  • English
  • Français

Association of joint replacement surgery with incident dementia diagnosis in German claims data

Published online by Cambridge University Press:  21 March 2018

Stefan J. Teipel ,
Thomas Fritze ,
Martin Ellenrieder ,
Britta Haenisch ,
Wolfram Mittelmeier  and
Gabriele Doblhammer
Stefan J. Teipel*
Affiliation:
Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
Thomas Fritze
Affiliation:
Rostock Center for the Study of Demographic Change, Rostock, Germany German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
Martin Ellenrieder
Affiliation:
Department of Orthopedics, University Medicine Rostock, Rostock, Germany
Britta Haenisch
Affiliation:
German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
Wolfram Mittelmeier
Affiliation:
Department of Orthopedics, University Medicine Rostock, Rostock, Germany
Gabriele Doblhammer
Affiliation:
Rostock Center for the Study of Demographic Change, Rostock, Germany German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany Institute for Sociology and Demography, University of Rostock, Rostock, Germany Max Planck Institute for Demographic Research, Rostock, Germany
*
Correspondence should be addressed to: Stefan J. Teipel, M.D., Department of Psychosomatic Medicine, University of Rostock, and DZNE Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany. Phone: +01149-381-494-9470; Fax: +01149-381-494-9472. E-mail: stefan.teipel@med.uni-rostock.de.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Cognitive decline is an important complication of joint replacement surgeries in senior people.

Methods:

We determined incidence rates of dementia diagnosis following endoprosthetic joint replacement surgery (upper and lower extremities). The observation period covered up to 28 quarters using German claims data comprising 154,604 cases 65 years and older. Effects were controlled for cerebrovascular and vascular risk factors, age, sex, the presence of a diagnosis of delirium, and regular prescription of sedative or analgesic drugs (SAD).

Results:

The rate of incident dementia diagnoses in people without joint replacement surgery was 21.34 per 1,000 person years, compared with 80.76 incident cases when joint replacement surgery was conducted during the quarter of the incident dementia diagnosis; rates declined to 21.77 incident cases 7 and more quarters after joint replacement surgery had taken place. This pattern was maintained when controlling for delirium diagnosis and regular prescription of SAD. Among 10,563 patients with at least one joint replacement surgery, patients with a diagnosis of delirium in the quarter of the surgery were at increased risk of a dementia diagnosis compared to patients without such a diagnosis (HR=2.00, p < 0.001).

Conclusion:

In people surviving the high-risk phase for dementia immediately after surgery, long-term risk of dementia may reach the level of those without surgery. These findings encourage consequent perioperative management to reduce the risk of dementia as well as prospective studies of potentially beneficial effects of joint replacement surgery on mid- to long-term recovery of mobility and cognition in geriatric patients.

Keywords

deliriumhip fracturecognitionanalgesicssedatives
Type
Original Research Article
Information
International Psychogeriatrics , Volume 30 , Issue 9: Issue Theme: Quality of Care for Frail Older Adults , September 2018 , pp. 1375 - 1383
Copyright
Copyright © International Psychogeriatric Association 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Both authors contributed equally

References

Aranake-Chrisinger, A. and Avidan, M. S. (2017). Postoperative delirium portends descent to dementia. British Journal of Anaesthesia, 119, 285–288.Google Scholar
Bellelli, G. et al. (2015). Under-detection of delirium and impact of neurocognitive deficits on in-hospital mortality among acute geriatric and medical wards. European Journal of Internal Medicine, 26, 696–704.Google Scholar
Berger, M. et al. (2015). Postoperative cognitive dysfunction: minding the gaps in our knowledge of a common postoperative complication in the elderly. Anesthesiology Clinics, 33, 517–550.Google Scholar
Bilotta, F. et al. (2010). Postoperative cognitive dysfunction: toward the Alzheimer's disease pathomechanism hypothesis. Journal of Alzheimer's Disease, 22 (Suppl. 3), S81–S89.Google Scholar
Bitsch, M., Foss, N., Kristensen, B. and Kehlet, H. (2004). Pathogenesis of and management strategies for postoperative delirium after hip fracture: a review. Acta Orthopaedica, 75, 378–389.Google Scholar
Casey, J. E., Ferguson, G. G., Kimura, D. and Hachinski, V. C. (1989). Neuropsychological improvement versus practice effect following unilateral carotid endarterectomy in patients without stroke. Journal of Clinical and Experimental Neuropsychology, 11, 461–470.Google Scholar
Chaudhry, H., Devereaux, P. J. and Bhandari, M. (2013). Cognitive dysfunction in hip fracture patients. The Orthopedic Clinics of North America, 44, 153–162.Google Scholar
Cote, S., Carmichael, P. H., Verreault, R., Lindsay, J., Lefebvre, J. and Laurin, D. (2012). Nonsteroidal anti-inflammatory drug use and the risk of cognitive impairment and Alzheimer's disease. Alzheimer's Dementia, 8, 219–226.Google Scholar
Davis, D. H. et al. (2012). Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. Brain, 135, 2809–2816.Google Scholar
Devore, E. E. et al. (2017). Prediction of long-term cognitive decline following postoperative delirium in older adults. The Journal of Gerontology Series A: Biological Sciences and Medical Sciences.Google Scholar
Doblhammer, G., Fink, A. and Fritze, T. (2015). Short-term trends in dementia prevalence in Germany between the years 2007 and 2009. Alzheimer's & Dementia, 11, 291–299.Google Scholar
Doblhammer, G., Fink, A., Fritze, T. and Günster, C. (2013). The demography and epidemiology of dementia. Geriatric Mental Health Care, 1, 29–33.Google Scholar
Doblhammer, G., Schulz, A., Steinberg, J. and Ziegler, U. (2012). Demografie der Demenz. Bern: Verlag Hans Huber, Hofgrefe AG.Google Scholar
Dublin, S. et al. (2015). Prescription opioids and risk of dementia or cognitive decline: a prospective cohort study. Journal of the American Geriatrics Society, 63, 1519–1526.Google Scholar
Evered, L., Eckenhoff, R. G. and International Perioperative Cognition Nomenclature Working, G. (2017a). Perioperative cognitive disorders. Response to: postoperative delirium portends descent to dementia. The British Journal of Anaesthesia, 119, 1241.Google Scholar
Evered, L., Scott, D. A. and Silbert, B. (2017b). Cognitive decline associated with anesthesia and surgery in the elderly: does this contribute to dementia prevalence? Current Opinion in Psychiatry, 30, 220–226.Google Scholar
Feng, L., Scherer, S. C., Tan, B. Y., Chan, G., Fong, N. P. and Ng, T. P. (2010). Comorbid cognitive impairment and depression is a significant predictor of poor outcomes in hip fracture rehabilitation. International Psychogeriatrics, 22, 246–253.Google Scholar
Fontes, M. T. et al. (2013). Predictors of cognitive recovery after cardiac surgery. Anesthesia & Analgesia, 116, 435–442.Google Scholar
Franck, M. et al. (2016). No convincing association between post-operative delirium and post-operative cognitive dysfunction: a secondary analysis. Acta Anaesthesiologica Scandinavica, 60, 1404–1414.Google Scholar
Freter, S., Koller, K., Dunbar, M., MacKnight, C. and Rockwood, K. (2017). Translating delirium prevention strategies for elderly adults with hip fracture into routine clinical care: a pragmatic clinical trial. Journal of the American Geriatrics Society, 65, 567–573.Google Scholar
Gomm, W. et al. (2016). Regular benzodiazepine and z-substance use and risk of dementia: an analysis of German claims data. Journal of Alzheimer's disease, 54, 801–808.Google Scholar
Inouye, S. K. and Ferrucci, L. (2006). Elucidating the pathophysiology of delirium and the interrelationship of delirium and dementia. The Journal of Gerontology, Series A: Biological Sciences and Medical Sciences, 61, 1277–1280.Google Scholar
Jamsen, E., Peltola, M., Puolakka, T., Eskelinen, A. and Lehto, M. U. (2015). Surgical outcomes of hip and knee arthroplasties for primary osteoarthritis in patients with Alzheimer's disease: a nationwide registry-based case-controlled study. The Bone & Joint Journal, 97-B, 654–661.Google Scholar
Kazmierski, J. et al. (2010). The use of DSM-IV and ICD-10 criteria and diagnostic scales for delirium among cardiac surgery patients: results from the IPDACS study. The Journal of Neuropsychiatry and Clinical Neurosciences, 22, 426–432.Google Scholar
Mosk, C. A. et al. (2017). Dementia and delirium, the outcomes in elderly hip fracture patients. Clinical Interventions in Aging, 12, 421–430.Google Scholar
Nanjayan, S. K., Swamy, G. N., Yellu, S., Yallappa, S., Abuzakuk, T. and Straw, R. (2014). In-hospital complications following primary total hip and knee arthroplasty in octogenarian and nonagenarian patients. The journal of Orthopaedics and Traumatology, 15, 29–33.Google Scholar
Oh, E. S., Sieber, F. E., Leoutsakos, J. M., Inouye, S. K. and Lee, H. B. (2016). Sex differences in hip fracture surgery: preoperative risk factors for delirium and postoperative outcomes. Journal of the American Geriatrics Society, 64, 1616–1621.Google Scholar
Rasmussen, L. S. et al. (2001). The assessment of postoperative cognitive function. Acta Anaesthesiologica Scandinavica, 45, 275–289.Google Scholar
Rasmussen, L. S., Siersma, V. D. and Ispocd, G. (2004). Postoperative cognitive dysfunction: true deterioration versus random variation. Acta Anaesthesiologica Scandinavica, 48, 1137–1143.Google Scholar
Sauer, A. C., Veldhuijzen, D. S., Ottens, T. H., Slooter, A. J. C., Kalkman, C. J. and van Dijk, D. (2017). Association between delirium and cognitive change after cardiac surgery. The British Journal of Anaesthesia, 119, 308–315.Google Scholar
Schulz, A. and Doblhammer, G. (2012). Aktueller und zukünftiger Krankenbestand von Demenz in Deutschland auf Basis der Routinedaten der AOK – Current and future number of people suffering from dementia in Germany based on routine data from the AOK. In Günster, C., Klose, J. and Schmacke, N. (eds.), Versorgungs-Report 2012: Schwerpunkt: Gesundheit im Alter (pp. 161–175). Stuttgart: Schattauer.Google Scholar
Scott, J. E., Mathias, J. L., Kneebone, A. C. and Krishnan, J. (2016). Postoperative cognitive dysfunction and its relationship to cognitive reserve in elderly total joint replacement patients. Journal of Clinical and Experimental Neuropsychology, 1–14.Google Scholar
Shash, D. et al. (2016). Benzodiazepine, psychotropic medication, and dementia: a population-based cohort study. Journal of Clinical and Experimental Neuropsychology, 12, 604–613.Google Scholar
Simone, M. J. and Tan, Z. S. (2011). The role of inflammation in the pathogenesis of delirium and dementia in older adults: a review. CNS Neuroscience & Therapeutics, 17, 506–513.Google Scholar
Sprung, J. et al. (2017). Postoperative delirium in elderly patients is associated with subsequent cognitive impairment. The British Journal of Anaesthesia, 119, 316–323.Google Scholar
Terrando, N., Eriksson, L. I. and Eckenhoff, R. G. (2015). Perioperative neurotoxicity in the elderly: summary of the 4th international workshop. Anesthesia & Analgesia, 120, 649–652.Google Scholar
Tsuda, Y., Yasunaga, H., Horiguchi, H., Ogawa, S., Kawano, H. and Tanaka, S. (2015). Association between dementia and postoperative complications after hip fracture surgery in the elderly: analysis of 87,654 patients using a national administrative database. Archives of Orthopaedic and Trauma Surgery, 135, 1511–1517.Google Scholar
Wengler, A., Nimptsch, U. and Mansky, T. (2014). Hip and knee replacement in Germany and the USA: analysis of individual inpatient data from German and US hospitals for the years 2005 to 2011. Deutsches Ärzteblatt International, 111, 407–416.Google Scholar
Witlox, J. et al. (2013). The neuropsychological sequelae of delirium in elderly patients with hip fracture three months after hospital discharge. International Psychogeriatrics, 25, 1521–1531.Google Scholar
Yip, A. G., Green, R. C., Huyck, M., Cupples, L. A., Farrer, L. A. and Group, M. S. (2005). Nonsteroidal anti-inflammatory drug use and Alzheimer's disease risk: the MIRAGE study. BMC Geriatrics, 5, 2.Google Scholar
Zywiel, M. G., Prabhu, A., Perruccio, A. V. and Gandhi, R. (2014). The influence of anesthesia and pain management on cognitive dysfunction after joint arthroplasty: a systematic review. Clinical Orthopaedics and Related Research, 472, 1453–1466.Google Scholar