Comprehensive Geriatric Assessment for Prevention of Delirium After Hip Fracture: A Systematic Review of Randomized Controlled Trials

Shields, Lynn; Henderson, Victoria; Caslake, Robert

doi:10.1111/jgs.14846

Cited by 54 publications

(41 citation statements)

References 26 publications

(100 reference statements)

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“…Moreover, orthogeriatrician-led perioperative care has led to a notable reduction in morbidity and mortality amongst hip fracture patients. In our study, we found a much lower incidence of delirium than that found in previous studies [ 10 – 12 ]. This finding may in part be explained by the aforementioned improvements in care but there are several other possible explanations including variations in definition of delirium and diagnostic accuracy.…”

Section: Discussioncontrasting

confidence: 73%

Risk factors for onset of delirium after neck of femur fracture surgery: a prospective observational study

Tahir

Malik

Ahmed

et al. 2018

SICOT-J

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Background: Delirium is a common complication after surgery in the elderly that leads to increased length of stay and other adverse outcomes. The aim of this study was to better understand the exact causes of post-operative delirium in patients undergoing surgery for neck of femur (NOF) fractures.Methods: We performed a prospective cohort study of 381 consecutive patients undergoing surgery for NOF fractures at a single institution. Baseline cognitive status and risk factors were recorded on admission. Post-operative cognitive status was assessed at regular intervals until discharge. Binary logistic regression was performed to identify independent predictors of delirium.Results: Patients who developed post-operative delirium (n = 70) were significantly older (average age 83 vs. 78, p = 0.019) and more likely to be female (79% vs. 67%, p = 0.062) than non-affected patients. The presence of delirium was associated with increased length of stay (13 vs. 10 days, p = 0.001) and 1-year mortality (25.7% vs. 15% p = 0.03). Independent predictors of delirium included age ≥65 years (Odds Ratio = 5.8), presence of anaemia (OR = 2.9), hypoxia (OR = 2.86), cardiac disease (OR = 2.8), Chronic Obstructive Pulmonary Disease (OR = 2.5), new onset electrolyte imbalance (OR = 2.2) and renal failure (OR = 1.9).Conclusion: Overall analysis demonstrated an increased incidence of delirium in older females with greater comorbid conditions. It was also found to be associated with increased morbidity and mortality. We recommend clinicians put greater effort into recognising risk factors of delirium and diagnosing it in a timely manner to mitigate its effects.

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Section: Discussioncontrasting

confidence: 73%

Risk factors for onset of delirium after neck of femur fracture surgery: a prospective observational study

Tahir

Malik

Ahmed

et al. 2018

SICOT-J

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“…21,22 Similar to previous reports, we also identified functional impairment on admission and living in nursing homes as risk factors for developing new episodes of delirium in HF patients. 21,22 Similar to previous reports, we also identified functional impairment on admission and living in nursing homes as risk factors for developing new episodes of delirium in HF patients.…”

Section: Discussionsupporting

confidence: 87%

“…The exhaustive assessment of delirium carried out in the orthogeriatric service, the high prevalence of dementia and the high number of patients coming from nursing homes all might have contributed to the high incidence of delirium registered in our cohort, but nevertheless they are in line with other studies. 21,22 Similar to previous reports, we also identified functional impairment on admission and living in nursing homes as risk factors for developing new episodes of delirium in HF patients. 3 In Figure 1 Risk factors for delirium according to the multivariate logistic regression analysis.…”

Section: Discussionsupporting

confidence: 87%

Impact of delirium on short‐term outcomes in hip fracture patients under a program of approach to delirium

Bielza

Zambrana

Puente

et al. 2019

Geriatrics Gerontology Int

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Aim: We aimed to investigate the impact of delirium on short-term outcomes in hip fracture patients. Special attention was given to patients with delirium and dementia.Methods: A prospective observational cohort study was carried out in hip fracture patients aged ≥70 years who were admitted to a hospital unit where a multicomponents approach to delirium is established for all patients. Our population was split into delirium (n = 212) and non-delirium cohort (n = 171) according to the Confusion Assessment Method. Patients with a previous diagnosis of dementia in an outpatient appointment were also assessed within the delirium cohort. The utility of the rehabilitation was measured with the Absolute Functional Gain index.Results: A total of 383 patients were entered into the study. The median age was 86 years, and most patients were women (78.8%). Delirium patients were older, presented a lower previous Barthel Index (BI), had higher rates of dementia and came more frequently from nursing homes. Comparative analysis did not show differences in mortality, complications, length of stay or walking ability between the cohorts. However, lower BI on discharge, lower Absolute Functional Gain and the presence of nosocomial infections were found more frequently in the delirium cohort. In multivariate analysis, only the BI on discharge (P = 0.010) was lower in delirium patients. Within the delirium cohort, those suffering from dementia had worse BI on discharge (P = 0.017) and lower Absolute Functional Gain (P = 0.019).Conclusions: Delirium was not associated with mortality, walking ability, length of stay and clinical complications in hip fracture patients. BI on discharge was the only short-term outcome affected. In the delirium cohort, those suffering from dementia showed worse rehabilitation results. Geriatr Gerontol Int 2020; 20: 130-137.

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“…44 The CGA is used to determine the medical, psychological, and functional capabilities of elderly patients in order to develop an integrated plan for treatment and prevention of delirium. 42,45 Lundström et al found that in 199 geriatric hip fracture patients, CGA intervention reduced both the number of postoperative complications and length of total hospitalization by 10 days compared to those without intervention. 27 Thus, provider foreknowledge of delirium risk factors outlined in this study may help multidisciplinary teams develop integrated plans and policies for the prevention of delirium and reduce costs to patients, Medicare, and hospital systems going forward.…”

Section: Discussionmentioning

confidence: 99%

Predictors and Sequelae of Postoperative Delirium in Geriatric Hip Fracture Patients

Arshi

Lai

Chen

et al. 2018

Geriatr Orthop Surg Rehabil

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Introduction:Perioperative delirium in elderly hip fracture patients has been correlated with significant morbidity. The purpose of this study was to determine the preoperative risk factors for and short-term sequelae of postoperative delirium in geriatric hip fracture patients.Methods:We queried the American College of Surgeons National Surgical Quality Improvement Program to identify geriatric (≥65 years) patients who sustained operative hip fractures in 2016. Cohorts of patients with and without documented postoperative delirium were identified. Primary data on patient demographics and comorbidities were collected and correlated with postoperative complications and hip fracture outcome measures. Multivariate regression was used to compute risk-adjusted odds ratios (OR) of risk factors and sequelae of delirium.Results:In total, 8,439 geriatric hip fracture patients were identified of whom 2,569 patients (30.4%) had postoperative delirium. Age (OR 1.03 [1.02-1.04, p < 0.001), white race (OR 1.54 [1.19-2.00], p = 0.001), American Society of Anesthesiologists classification (OR 1.20 [1.07-1.36], p = 0.003), baseline dementia (OR 2.46 [2.11-2.86], p < 0.001), and preoperative delirium (OR 10.06 [8.12-12.45], p < 0.001) were independent risk factors for postoperative delirium in multivariate analysis. Patients with postoperative delirium had a significantly higher risk-adjusted 30-day mortality (12.0% vs. 4.8%, OR 2.22 [1.74-2.84], p < 0.001) and morbidity profile. Postoperative delirium was also independently associated with higher rates of discharge to (OR 1.65 [1.32-2.06], p < 0.001) and prolonged stay in (OR 1.79 [1.53-2.09], p < 0.001) an inpatient facility, hospital readmission (OR 1.94 [1.58-2.38], p < 0.001) and hospital length of stay (7.6 ± 5.0 vs. 6.1 ± 4.1 days, p < 0.001), as well as lower rates of immediate postoperative weight bearing (OR 0.73 [0.63-0.86], p < 0.001).Discussion:Postoperative delirium is a common occurrence in geriatric hip fractures with multiple risk factors. Delirium portends higher mortality and worse perioperative hospital-based outcomes.Conclusions:Multidisciplinary foreknowledge and management efforts are warranted to mitigate the risk of developing delirium, which strongly predicts perioperative morbidity, mortality, and hip fracture outcomes.

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Comprehensive Geriatric Assessment for Prevention of Delirium After Hip Fracture: A Systematic Review of Randomized Controlled Trials

Cited by 54 publications

References 26 publications

Risk factors for onset of delirium after neck of femur fracture surgery: a prospective observational study

Risk factors for onset of delirium after neck of femur fracture surgery: a prospective observational study

Impact of delirium on short‐term outcomes in hip fracture patients under a program of approach to delirium

Predictors and Sequelae of Postoperative Delirium in Geriatric Hip Fracture Patients

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