Early postoperative delirium after hemiarthroplasty in elderly patients aged over 70 years with displaced femoral neck fracture

Abstract

PurposePostoperative delirium is a risk factor for worse outcome after hip fracture surgery in elderly patients. Postoperative delirium is associated with anesthesia, postoperative pain, and patient factors. We investigated the incidence, predictors, and prognostic implications of post-operative delirium after hemiarthroplasty (HA) in elderly patients with femoral neck fracture.Patients and methodsA total of 356 consecutive patients aged >70 years who underwent HA for femoral neck fracture were enrolled. Diagnosis of delirium was made by a psychiatrist based on patient status and an objective scoring system. The patients were divided into 2 categories according to the HA onset time (immediate [≤24 h after surgery] vs delayed delirium [>24 h after surgery]) and its incidence, predictors and mortality were evaluated.ResultsPostoperative delirium was diagnosed in 110 patients (30.9%) during hospitalization. Immediate and delayed delirium occurred in 59 (53.6%), and 51 (46.4%) patients, respectively. The independent predictors of immediate delirium included age (odds ratio [OR] 1.47, 95% CI 0.98–2.23, p=0.066), and general anesthesia (OR 2.25, 95% CI 1.17–4.43, p=0.015). The independent predictors of delayed delirium were parkinsonism (OR 5.75, 95% CI 1.66–19.96, p=0.006), intensive care unit stay (OR 1.85, 95% CI 0.97–3.56, p=0.064), and higher American Society of Anesthesiologists grade (OR 2.33, 95% CI 0.90–6.07, p=0.083). On Kaplan–Meier survival analysis, the 2-year survival rate was significantly lower in the immediate delirium group than those in the delayed and control groups (71.0% vs 83.6% vs 87.8%, respectively; p=0.031).ConclusionImmediate and delayed delirium after HA for femoral neck fracture had different predictors and immediate delirium was associated with worse prognosis.

Early delirium after cardiac surgery: an analysis of incidence and risk factors in elderly (≥65 years) and very elderly (≥80 years) patients

“…The incidence of delirium in our dataset is similar to results obtained from other studies concentrating on cardiac surgery; however, it is still lower than in the general ICU setting 2 , 9 , 10 , 20 , 21 or after other types of major surgery. 22 This may be related to factors not measured such as postoperative ICU design, patient preparation prior to surgery, or population differences in different geographical settings around the world. To our knowledge this is the first analysis reporting data specifically on elderly and very elderly patients.…”

Incidence and risk factors associated with postoperative stroke in the elderly patients undergoing hip fracture surgery

“…Previous studies have made various attempts to investigate the incidence and risk factors for postoperative delirium after hip fracture surgeries [11][12][13][14], or incident hip fracture after the stroke [8,9,15]. However, there is still a lack of epidemiologic data on postoperative stroke following surgery of hip fractures.…”

The Effect of Regional Versus General Anaesthesia on Post-Operative Delirium in Elderly Patients Undergoing Surgery for Hip Fracture: A Systematic Review

“…Twenty-two studies reported delirium (5 RCTs, 35-39 9 prospective 18 40-47 and 8 retrospective studies [48][49][50][51][52][53][54][55] ); 58 studies reported mortality (2 RCTs, 35 38 12 prospective 42 45 96 109 110 ); 11 studies reported functional outcome (3 RCTs, 35 36 111 4 prospective 42 45 103 112 and 4 retrospective studies 62 73 105 113 ); 5 studies reported discharge location (2 prospective 43 114 and 3 retrospective studies 21 48 99 ).…”