Coroner's Finding: FRANKLIN Allen Henry

83y · Male·aspiration pneumonia and delirium complicating surgery for left total knee replacement on a background of dementia and ischaemic heart disease

An 83-year-old man with dementia and ischaemic heart disease underwent elective left total knee replacement under spinal anaesthesia to avoid general anaesthesia, as advised by geriatrician. Despite optimal anaesthetic technique, he developed post-operative delirium with agitation and aggression, requiring a Mental Health Act inpatient treatment order. He subsequently developed aspiration pneumonia and died. The coroner found the surgery was appropriate and reasonable on balance, with proper risk-benefit analysis and optimal anaesthetic technique employed. The multidisciplinary care was appropriate. Key clinical lesson: elderly patients with dementia face significant post-operative delirium risk even with regional anaesthesia; careful perioperative planning and early recognition of delirium complications are essential.