Short-Form Mini Nutritional Assessment as a useful method of predicting the development of postoperative delirium in elderly patients undergoing orthopedic surgery ☆ Che-Sheng Chu, M.D. a , Chih-Kuang Liang, M.D. b, c, g , Ming-Yueh Chou, M.D. b, g , Yu-Te Lin, Ph.D., M.D. b, c , Chien-Jen Hsu, M.D. d , Po-Han Chou, M.D. e, h, ⁎, Chin-Liang Chu, M.D. b, f, ⁎⁎ a Department of Psychiatry, Puli Branch, Taichung Veterans General Hospital, Taichung, Taiwan b Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan c Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan d Department of Medical Education, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan e Department of Psychiatry, Taichung Veterans General Hospital, Taichung City, Taiwan f Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan g School of Medicine, National Yang-Ming University, Taipei, Taiwan h Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan abstract article info Article history: Received 15 May 2015 Revised 25 August 2015 Accepted 26 August 2015 Available online xxxx Keywords: Short-form Mini Nutritional Assessment Delirium Aged Orthopedic surgery Objective: Postoperative delirium (POD) is a major cause for concern among elderly patients undergoing surgery, often resulting in poor outcome. It is therefore important to predict and prevent POD. The aim of this study was to evaluate the Mini Nutritional Assessment Short-Form (MNA-SF) as a predictor of POD after orthopedic surgery. Methods: Elderly patients undergoing orthopedic surgery between April 2011 and March 2013 were included in the study (n=544; mean age, 74.24±7.92 years). The MNA-SF was used to evaluate preoperative nutritional sta- tus. Delirium was assessed daily after surgery using the confusion assessment method. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria were used to confirm delirium diagnosis. Univar- iate and multivariate logistic regression analyses were performed to identify key factors associated with POD. Results: POD occurred in 52 patients (9.6%). According to the MNA-SF, 17.5% of subjects were at risk of undernu- trition. Adjusting for all potential factors in the final model, age, male gender and lower Mini-Mental State Exam- ination and higher Charlson Comorbidity Index scores were associated with significantly increased likelihood of POD. Subjects who were identified preoperatively as at risk of undernutrition were 2.85 times more likely to de- velop POD compared to normally nourished subjects (odds ratio: 2.85, 95% confidence interval: 1.19–6.87). Conclusions: These results suggest that the MNA-SF is a simple and effective tool that can be used to predict inci- dent delirium in elderly patients after orthopedic surgery. © 2015 Elsevier Inc. All rights reserved. 1. Introduction The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) defines delirium or acute confusional state as a clinical neuropsychiatric syndrome characterized by acute and fluctuating disturbance of consciousness; reduced ability to focus, maintain or shift at- tention; and change in cognition secondary to a general medical condi- tion [1, 2]. The reported incidence of delirium in hospitalized older patients ranges from 14% to 56% [3]. Postoperative delirium (POD) is a form of delirium that appears in patients undergoing surgical procedures and anesthesia, usually emerging 1 to 3 days after surgery [4]. POD inci- dence rates vary widely, depending on the patient population and type of surgery [5, 6]. For example, delirium is estimated to occur in 17% of patients after total joint replacement of the hip and knee and in 40 to 60% of patients after vascular surgery [5, 6]. In elderly patients (aged 60 years or over), the incidence of POD after orthopedic surgery ranges from 5 to 14.3% [7]. The causes of POD are complex. Multiple risk factors for POD have been documented, including cognitive and functional impairment, polypharmacy and multiple comorbidities [8, 9]. Malnutrition, as indicat- ed by low-serum albumin level, has recently been regarded as a key risk factor for POD in surgical patients [8, 10–12]. Several studies have found that poor nutrition is associated with functional and cognitive General Hospital Psychiatry xxx (2015) xxx–xxx ☆ Authors' contributions: CCS and CCL acquired the follow-up data, performed the main analysis and interpretation of data and wrote the main paper. CPH, LCK and LYT have been involved in study concept and design. CCL, CMY and HCJ initiated the study and obtained funding support. CCL and CPH supervised all stages of the project, supported and advised the data collection process and commented on drafts of the paper. ⁎ Correspondence to: P.H. Chou, Department of Psychiatry, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Boulevard, Taichung City, 20705, Taiwan, ROC. Tel.: +886-4-23592525. ⁎⁎ Correspondence to: C.L. Chu, Department of Psychiatry, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung, 81362, Taiwan, ROC. Tel.: +886-7- 3422121x2067; fax: +886-7-3468346. E-mail addresses: phchou1980@gmail.com (P.-H. Chou), mdjim0814@gmail.com (C.-L. Chu). http://dx.doi.org/10.1016/j.genhosppsych.2015.08.006 0163-8343/© 2015 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect General Hospital Psychiatry journal homepage: http://www.ghpjournal.com Please cite this article as: Chu C.-S., et al, Short-Form Mini Nutritional Assessment as a useful method of predicting the development of postoper- ative delirium in elderly patients undergoing orthopedic..., Gen Hosp Psychiatry (2015), http://dx.doi.org/10.1016/j.genhosppsych.2015.08.006