Identification of factors contributing to the development of postoperative delirium in geriatric patients with hip fractures- A prospective study

Abstract

Introduction: Geriatric hip fractures are a major cause of concern globally and often a frequent reason for morbidity and mortality. Postoperative delirium (POD) is a frequent but often under-diagnosed complication, especially after a major hip surgery. Some of the factors that have been associated with POD are diabetes, high American Society of Anesthesiologists (ASA) grading, electrolyte imbalance, and blood pressure fluctuations. Malnutrition as a risk factor is only recently being recognized. Although there are many possible risk factors reported, they are quite conflicting and not very clear. Therefore, we have attempted to conduct this study to identify the potential risk factors for the development of POD in patients with hip fractures. Materials and Methods: A prospective observational study was performed on 110 geriatric hip fracture patients admitted to tertiary health care in South India. Data regarding preoperative blood investigations, ASA grading, hypertension and diabetes status, MNA (mini nutritional assessments) status, serum albumin, and serum electrolytes values were recorded. The Confusion Assessment Method tool (CAM) was used to diagnose delirium in the postoperative period. Statistical analysis was done for various factors influencing the occurrence of POD. Results: Among the total of 110 cases of geriatric hip fractures patients, 44.5% of the patients developed postoperative delirium. Advancing age, hypoalbuminemia, malnourishment, and uncontrolled diabetes played an important role to the development of post operative delirium in patients with hip fractures. Conclusion: Advancing age, hypoalbuminemia, malnourishment, and uncontrolled diabetes are strong predictors for the development of postoperative delirium in geriatric hip fracture patients. Since age is a non-modifiable risk factor, interventional strategies aimed at correcting modifiable risk factors like nutrition, serum albumin levels, and diabetes control play an important part in preventing delirium in the postoperative period in elderly hip fracture patients. MeSH terms: Hip Fractures, Postoperative Complication, Delirium, Nutrition Assessment, Serum Albumin

Association between preoperative albumin levels and postoperative delirium in geriatric hip fracture patients

“…Therefore, it is crucial to comprehensively understand the varying levels of risk associated with different albumin levels. Doing so will provide valuable insights that can aid clinical doctors in identifying high-risk POD patients early and formulating targeted intervention measures ( 10 ).…”

“…Due to the progressive aging of the global population, it is anticipated that the number of hip fractures worldwide will increase to an estimated 6.1 million cases by 2050, with an annual escalation of 1 to 3% ( 1 ). Postoperative delirium (POD) is a frequent and severe complication in geriatric patients who have undergone hip fracture surgery, with an incidence rate ranging from 4 to 53% ( 2 – 10 ). POD is an acute cognitive dysfunction characterized by changes in consciousness or attention that cannot be attributed to pre-existing cognitive impairment ( 2 , 8 , 9 ).…”

“…Multiple prospective studies have demonstrated that hypoalbuminemia can contribute to the occurrence of POD. In one such study, Venkatakrishnaiah et al ( 10 ) prospectively evaluated 110 geriatric hip fracture patients and found that hypoalbuminemia was a strong predictor of POD. Similarly, Ishihara et al ( 12 ) conducted a multicenter prospective study and showed that serum albumin concentration ≤ 37 g/L was an independent risk factor for POD in patients undergoing initial hepatectomy.…”

“…While several studies ( 2 , 5 – 10 , 15 ) have confirmed the relationship between preoperative serum albumin levels and POD, the general and oversimplified conclusions have limited the specificity of clinical practices and hindered the promotion of preoperative albumin management. Currently, focusing on modifiable risk factors for intervention represents the most effective approach to prevent adverse outcomes of POD ( 6 , 16 ).…”

Delirium in hip fracture patients admitted from home during the COVID-19 pandemic is associated with higher mortality, longer total length of stay, need for post-acute inpatient rehabilitation, and readmission to acute services

“…23 Higher rates of delirium were observed in older patients and those with higher ASA grade, consistent with previous studies. 37,38 The effect size of delirium was reduced by inclusion of ASA grade in multivariable models, suggesting that observed outcomes of delirium may partly reflect its associations with comorbidity. However, effects of delirium remained significant, suggesting either an independent effect of delirium, or the presence of unmeasured factors.…”