Disturbances of consciousness in patients subjected to orthopaedic procedure

Disturbances of consciousness, defined as a syndrome of psychopathological symptoms characterised by narrowing or fatigue of consciousness streams, cognitive, behavioural, and biological rhythm impairment, is one of the important factors affecting the quality of patient functioning after surgery, including hospitalisation period, rehabilitation, and treatment costs. In orthopaedic surgery, they are most often seen after fractures of the proximal femur. Currently, almost 20,000 osteoporotic hip fractures are treated in Poland every year. This number will double over the next 15 years. The thesis discusses the pathomechanism of the formation of these fractures. Owing to the difficulty in collaborating with patients with these types of complications, it seems important to standardise the patient’s medical condition and to promptly introduce appropriate pharmacological treatment. Knowledge of the principles of diagnosis and the ability to treat postoperative delirium should be essential in any psychiatrist consulting for surgical departments, including orthopaedics. A significantly higher risk of postoperative delirium was seen in advanced-age patients with pre-operative cognitive impairment.

Recent reports on pathophysiology and risk factors for postoperative disorders of consciousness have been described in this thesis. The authors also presented the latest trends in prophylaxis and treatment of postoperative delirium. The aim of this paper is to review contemporary literature on this subject and to highlight the growing problem of postoperative awareness disturbances in the daily practice of counselling psychiatry, associated with the increasing number of surgical procedures of the femoral fracture and postoperative improvement of quality of life, including the reduction of mortality.