Effect of Preexisting Cognitive Impairment on In-Patient Treatment and Discharge Management among Elderly Patients with Hip Fractures

Abstract

Objective: To examine the influence of cognitive impairment on the functional outcomes and complication rates of patients with hip fracture during in-patient treatment. Methods: A total of 402 patients who were surgically treated for hip fractures were consecutively enrolled at a single trauma center. The patients were grouped according to their results on the Mini-Mental State Examination (MMSE), i.e., ≥20 points (group I) and ≤19 points (group II). Complication and in-hospital mortality rates as well as postoperative functional outcomes according to the Barthel Index (BI) were compared between the groups. A multivariate regression analysis was performed to control for additional factors. Results: 33% of the patients had MMSE scores ≤19 points. The complication rates were similar between the groups (p > 0.05). Likewise, the overall in-hospital mortality rates were similar between the patients in group I (4.5%) and those in group II (9.8%; β = 0.218, p < 0.740). Functional outcomes, as assessed by the BI, were lower in group II (β = -0.266, p < 0.001). The patients in group II were transferred to a rehabilitation clinic less frequently (52.3 vs. 76.0%, p < 0.001). Conclusions: Patients with lower MMSE scores are at a higher risk for poorer functional outcomes. Perioperative care should focus on the preservation of functional abilities to protect these patients from an additional loss of independence and disadvantageous clinical course.

The prevalence of undiagnosed pre-surgical cognitive impairment and its post-surgical clinical impact in elderly patients undergoing surgery for adult spinal deformity

“…Similarly, in a prospective study of 186 elderly patients who underwent an elective surgery that required ICU admission, patients with CI had an increased rate of one or more postoperative complications (41% vs. 24%), a higher incidence of delirium (78% vs. 37%), longer hospital stays (15 vs. 9 days), a higher rate of institutionalization following discharge (42% vs. 18%), and higher 6-month mortality (13% vs. 5%) when compared to cognitively intact patients. Other studies have also demonstrated similar inferior postsurgical outcomes and longer LOS for patients with preexisting CI (11)(12)(13)(14). In our study, we observed that pre-operative CI was associated with increased rates post-operative complications such as pneumonia and UTI, as well as decreased post-surgical ambulatory status.…”

What Are the Risk Factors for Dislocation of Hip Bipolar Hemiarthroplasty Through the Anterolateral Approach? A Nested Case-control Study

“…We found that cognitive decline, including dementia and lower MMSE score, was associated with an increased risk of hip dislocations. It was difficult to maintain patients with impaired cognitive function in a suitable posture postoperatively, which may have led to dislocation of the hip during the early postoperative period [2]. In the current study, another factor significantly associated with an increased risk of hip dislocation was discrepancy of offset; this could give rise to poor soft tissue tension and therefore contribute to the increased risk of dislocation.…”

“…Questions/purposes We evaluated patients with bipolar hemiarthroplasty dislocation after surgery for femoral neck fracture treated through an anterolateral approach and asked: (1) What are the frequency, characteristics, and risk factors of bipolar hemiarthroplasty dislocations? (2) What are the frequency, characteristics, and risk factors of bipolar hemiarthroplasty dissociations?…”

“…(2) What are the frequency, characteristics, and risk factors of bipolar hemiarthroplasty dissociations?…”

Postoperative Treatment of Pain after Hip Fracture in Elderly Patients with Dementia

“…Furthermore, inadequate treatment of pain may lead to development of delirium [40,41]. Patients with dementia are more prone to develop delirium [6] and worse outcomes [42,43]. On the other hand, careful prescription of particular opioids may be appropriate, as adverse reactions increase with age, frailty, dementia, and higher doses [39,44,45].…”