Development and Validation of a Nomogram for Predicting Postoperative Delirium in Patients With Elderly Hip Fracture Based on Data Collected on Admission

Abstract

Delirium is a common postoperative complication in elderly hip fracture patients that seriously affects patients’ lives and health, and early delirium risk prediction, and targeted measures can significantly reduce the incidence of delirium. The purpose of this study was to develop and validate a nomogram for the prediction of postoperative delirium (POD) in elderly hip fracture patients. A total of 328 elderly patients with hip fractures enrolled retrospectively in department 1 of our hospital were randomly divided into the training set (n = 230) and the internal validation set (n = 98). The least absolute shrinkage and selection operator (LASSO) regression analysis was used for feature variable selection, and multivariate logistic regression with a backward stepwise method was used to construct a nomogram in the training set. The discrimination efficacy and calibration efficacy of the nomogram were evaluated through the receiver operating characteristic (ROC) curve and calibration curve, respectively. The clinical usefulness was estimated through decision curve analysis (DCA) and clinical impact curve (CIC) analysis. Another validation set from department 2 of our hospital, containing 76 elderly patients with hip fractures, was used for external validation of the nomogram. A total of 43 (13.1%) and 12 (15.8%) patients had POD in department 1 and department 2, respectively. The nomogram was constructed by three predictors, including dementia, chronic obstructive pulmonary disease (COPD), and albumin level. The nomogram showed good discrimination efficacy and calibration efficacy, with the AUC of 0.791 (95% CI, 0.708–0.873), 0.820 (95% CI, 0.676–0.964), and 0.841 (95% CI, 0.717–0.966) in the training set, the internal validation set, and the external validation set, respectively. Both DCA and CIC demonstrated that this nomogram has good clinical usefulness. The nomogram constructed by dementia, COPD, and albumin level can be conveniently used to predict POD in patients with elderly hip fractures.

Risk prediction models for postoperative delirium in elderly patients with hip fracture: a systematic review

“…Initially, the researchers identified 2,409 studies. After screening, the final analysis included 8 studies (7,(10)(11)(12)(13)(14)(15)(16). In the evaluation of literature quality, 8 (≥7 points) were of high-quality.…”

“…A total of eight risk prediction models for postoperative delirium in older adult hip fracture patients were included, including three studies conducted in the United States of America (USA), four in China, and one in Australia and New Zealand (7,(10)(11)(12)(13)(14)(15)(16). In terms of research type, one was a prospective cohort study (10), one was a case-control study (16), and the other six were retrospective cohort studies (10).…”

“…In terms of research type, one was a prospective cohort study (10), one was a case-control study (16), and the other six were retrospective cohort studies (10). The earliest risk prediction model was published in 2006 (10), and six articles were published in the last 3 years (7,(11)(12)(13)(14)16). Five studies (10,12,13,15,16) defined the participants as patients with hip fracture or proximal femur fracture aged 65 years or older, and the other three studies (7,11,14) defined age as 60 years or older, resulting in a high level of homogeneity (Table 1).…”

“…In the present systematic review, the most common predictors of postoperative delirium in older adult hip fracture patients were preoperative dementia or history of dementia (n = 5), ASA classification (n = 4), and age (n = 3). In terms of the risk factor assignment, three studies (10,12,14). The last two studies generated specific delirium prediction models based on machine learning to determine the weights of prediction factors, and then predicted the probability of delirium occurrence (7,16), as detailed in Table 3.…”

Nomogram for predicting of postoperative delirium in elderly patients undergoing radical esophagectomy

“…Therefore, it is crucial to develop an individual predictive model and early identi cation of patients at high risk for delirium. In recent years, some prediction models of POD had been established in hip replacement [23,24], laparoscopic surgery for gynecologic cancers [25], thoracic endovascular aortic repair[26], cardiovascular surgery [27], free ap reconstruction for head and neck cancer[28] and laparoscopic gastrectomy [29]. However, the predictive effect of each prediction model differ sharply, and there is no model to predict the risk of POD in esophageal cancer surgery.…”