Ortopod CZ Pilot Study

Amnesia Light and Brief Assessment (ALBA) is an ultra-brief and universal cognitive test suitable for assessing cognitive impairment, dementia, and other conditions. Test consists of a one-time encoding of a six-word sentence "Indian summer brings the first morning frost.", sequential demonstration of six gestures and their immediate recall in any order (TEGEST) and finally recall of as many correct words as possible of the original sentence.

The ALBA score norm for the sum of recalled words and gestures is 6-12 points (at least 50% of the maximum), mild impairment is 4-5 points, and severe impairment is 0-3 points. For more educated individuals (with a high school diploma or more, or 15 years of education or more), the ALBA score norm is 8-12 points..

POBAV is an abbreviationof Czech title Picture naming and their recall. The test consists of two parts. The persons are to name each of the 20 picture in one word and remember these picture names. When they finish naming the pictures, then they are asked to recall and write as many picture names as they can during one minute.

Evaluation of Part 1: After completing the entire test, determine the number of naming errors (images not named at all and incorrectly named). Most older individuals should make a naming error in no more than one image.

Evaluation of Part 2: The number of correctly recalled images will be determined. The number of errors from the total number of written picture names will be substracted to get the number of correctly recalled image names. Most older individuals should recall 6 or more correct image names, while individuals with a high school diploma should recall 7 image names.

CAM-ICU scale:

FEATURE 1: Alteration/Fluctuation in Mental Status - Present/not present FEATURE 2: Inattention 1: Alteration/Fluctuation in Mental Status -If number of errors >2 = present /not present FEATURE 3: Altered Level of Consciousness (LOC) - present/not present FEATURE 4: Disorganized Thinking - present/not present

Features 1 and 2 are both present and either Features 3 or 4 are present:

Delirium present CAM-ICU is positive, delirium is present

The research question is: "Is the reduction in cognitive functions according to the ALBA and POBAV tests associated with the occurrence of postoperative delirium in the Czech Republic?

Clinical frailty scale is a way to summarize the overall level of fitness or frailty of an older adult after they had been evaluated by an experienced clinician.

Frailty score ranging from 1 (very fit) to 9 (terminally ill).

• = very fit
• = well
• = managing well
• = vulnerable
• = mildly frail
• = moderately frail
• = severely frail
• = very severely frail
• = terminally ill

Research questions:

Are higher values of the Clinical Frailty Scale before surgery (values 4, 5, or higher) associated with the occurrence of postoperative delirium in Czech Republic? Are higher values of the Clinical Frailty Scale before surgery (values 4, 5, or higher) associated with the worsening of cognitive functions

Age of the patients undergoing elective tottal hip arthroplasty, in years.

Amnesia Light and Brief Assessment (ALBA) is an ultra-brief and universal cognitive test suitable for assessing cognitive impairment, dementia, and other conditions. Test consists of a one-time encoding of a six-word sentence "Indian summer brings the first morning frost.", sequential demonstration of six gestures and their immediate recall in any order (TEGEST) and finally recall of as many correct words as possible of the original sentence.

The ALBA score norm for the sum of recalled words and gestures is 6-12 points (at least 50% of the maximum), mild impairment is 4-5 points, and severe impairment is 0-3 points. For more educated individuals (with a high school diploma or more, or 15 years of education or more), the ALBA score norm is 8-12 points..

POBAV is an abbreviationof Czech title Picture naming and their recall. The test consists of two parts. The persons are to name each of the 20 picture in one word and remember these picture names. When they finish naming the pictures, then they are asked to recall and write as many picture names as they can during one minute.

Evaluation of Part 1: After completing the entire test, determine the number of naming errors (images not named at all and incorrectly named). Most older individuals should make a naming error in no more than one image.

Evaluation of Part 2: The number of correctly recalled images will be determined. The number of errors from the total number of written picture names will be substracted to get the number of correctly recalled image names. Most older individuals should recall 6 or more correct image names, while individuals with a high school diploma should recall 7 image names.

Gender of the patient undergoing elective total hip arhroplasty. Women or men.

The American Society of Anesthesiologists (ASA) physical status classification system is a grading system to determine the health of a person before a surgical procedure that requires anesthesia ASA I = a normal healthy patient ASA II = a patient with mild systematic disease ASA III = a patient with severe systematic disease

The Geriatric Depression Scale (GDS) is a self-report measure of depression in older adults. Users respond in a "Yes/No" format. Scoring: 0 or 1 point (1 point is awarded for the presence of a depressive symptom). 10 questions indicate depression when answered "Yes," and 5 questions (Nos. 1, 5, 7, 11, 13) indicate depression when answered "No." The questionnaire can thus score a maximum of 15 points.0-5 normal mood, 6-10 mild depression, 11+ severe depression

Education of the patients in years.

Cumulatively in minutes. time will be indicated according to the operating protocol

Blood pressure values at the beginning and end of the procedure, in mmHg (in anesthesia record).

Hypotension blood pressure 30% lower than baseline pressure, reported cumulatively in minutes.

Value at the beginning and end of the procedure (%), desaturation yes/no (Spo2 94 and less%), duration (in minutes).

Blood loss cumulative for the procedure in milliliters.

Sample of blood glucose level taken as part of standard practice, mmol/l.

Yes or no. Yes when it is necessary to administer norepinephrine or ephedrine.

Highest dose of noradrenaline during operation, in µg/kg/min. Total duration of norepinephrine administration during surgery in minutes).

Cumulatively in milliliters, during the CAM-ICU screening period (postoperative day 0, postoperative day 1, postoperative day 2). In case of CAM-ICU positivity, the blood loss assessment continues during the CAM-ICU screening period. Blood loss assessment once a day.

Evaluated will be amount of transfusion units and , Types of blood derivatives given: Deleukocytized erythrocytes, Prothrombin Complex Concentrate (PCC), Pathogen-inactivated plasma, Fresh frozen plasma, fibrinogen, Platelets from buffy coat mixed deleukocytized in replacement solution.

Yes or no. Assessment 0. postoperative day.

Yes or no. During the CAM-ICU screening period (postoperative day 0, postoperative day 1, postoperative day 2.

Yes or no. Y (yes=when it is necessary to administer norepinephrine). During the CAM-ICU screening period (postoperative day 0, postoperative day 1, postoperative day 2.

Highest dose of noradrenaline during the day, in µg/kg/min. Total duration of norepinephrine administration after the procedure (in minutes). During the CAM-ICU screening period (postoperative day 0, postoperative day 1, postoperative day 2).

Yes or no.