Frequency, Risk Factors, and Prognosis of Prolonged Delirium in Elderly Patients After Hip Fracture Surgery

Abstract

Background Delirium in elderly patients after hip fracture surgery is believed to be a transient event, although it frequently lasts for more than 4 weeks. Questions/purposes We determined the incidence, risk factors, morbidity, and mortality of prolonged delirium in elderly patients after hip fracture surgery. Patients and Methods We evaluated 232 elderly patients (older than 65 years) (232 hips) who underwent hip fracture surgery for the development and duration of delirium and categorized them into three groups; nondelirium group, transient (B 4 weeks) delirium group, and prolonged ([ 4 weeks) delirium group. Patients underwent a global geriatric evaluation, which included postoperative complications, mortality, and functional and mental status evaluations. The three groups were compared with respect to these variables. Results Seventy patients (30.2%) had delirium develop, and among these, 14 (20%) had prolonged delirium with a total incidence of 6%. Multivariate analysis showed preinjury dementia was a risk factor of prolonged delirium. At the final followup, five (62.5%) of the eight patients who were ambulatory outdoors in the prolonged delirium group became housebound, whereas only 18 (16.4%) of the 110 patients who were ambulatory outdoors in the nondelirium group became housebound. Survival at 40 months was 81.0% (95% confidence interval, 72.6%-89.3%) in the nondelirium group and 63.6% (95% confidence interval, 35.2%-92.

Risk factors of delirium in elderly patients with hip fracture

“…The hip fracture studies that met the inclusion criteria are presented in Table 1. [3], N = 120 52% Age, gender, cognitive*,physical impairment, polymedicine, IL-6,IL-8, length of stay Juliebo et al 2009 [29], N = 364 58% Age, gender*, cognitive*, function*impairment, 21% preop comorbidity, health problem, BMI*, hemoglobin* 36.4% postop sodium, potassium, BUN/Cr ratio, polypharmacy*, Arrhythmia, medication use (psychotropic, selective serotonin reuptake inhibitor, zopiclone, aspirin, betablocker, diuretic, statin) fentanyl* Juliebo et al 2010 [30], N = 331 43.2% Kat et al 2011 [31], N = 603 12.3% postop Bisschop et al 2011 [32], N = 143 34% Age*, gender, preexisting cognitive* and functional* impairment, comorbidity*, laboratory abnormalities*, glucose Lee et al 2011 [33], N = 232 30.2% Age, gender, comorbidity, health problem*, BMI Vochteloo et al 2011 [34], N = 378 27% Age*, gender*,dementia, health problem*, psychotropic drug use*, length of stay* Sieber et al 2011 [35], N = 236…”

Does Preoperative American Society of Anesthesiologists Score Relate to Complications After Total Shoulder Arthroplasty?

“…High ASA scores have been shown to be associated with an increased risk of medical complications [30,36], prosthesis dislocation [2,23,26,28], infection [4,9,25,27,33,41,43,45,50,57], prolonged hospital stay [6,17,29], and discharge to a rehabilitation service [15] after hip and knee arthroplasties.…”

Sobrevida postoperatoria en pacientes nonagenarios: Estudio pronóstico en cohorte retrospectiva 2001-2010, Clínica Dávila

“…La alteración de conciencia también ha sido asociada por otros autores con una menor sobrevida; sin embargo, Dolan 22 no encontró que el delirio en la admisión fuera un predictor significativo de mortalidad después de ajustar por otros confusores. Lee 23 , por otra parte, detectó menor sobrevida a 40 meses post cirugía de cadera en pacientes que presentaron delirio. Robinson 24 también encontró mayor mortalidad después de una cirugía mayor en pacientes que habían presentado delirio.…”