Identification of risk factors for postoperative delirium in elderly patients with hip fractures by a risk stratification index model: A retrospective study

Abstract

Introduction:Postoperative delirium is one of the most common and dangerous psychiatric complications after hip surgery. The aim of this study was to investigate the incidence of postoperative delirium in elderly patients after hip fracture surgery and to identify risk factors for such, as part of developing a risk stratification index (RSI) system to predict a patient's risk of postoperative delirium. Methods: Elderly patients (aged 65 years or older) with hip fractures who had received surgical treatment in our hospital between March 2018 and December 2019 were retrospectively included. Clinical data were collected, and multivariate logistic regression analysis was performed to investigate the relevant risk factors of postoperative delirium. An RSI system was developed based on factors identified in the regression analysis. Results: Of 272 patients included, 52 (19.12%) experienced postoperative delirium.Drinking history (> 3/ week), the perioperative lactic acid level (Lac > 2 mmol/L), postoperative visual analog score (VAS) > 3, American Society of Anesthesiologists (ASA) physical status > II, application of the bispectral index, and preoperative diabetes were independent risk factors of postoperative delirium. When RSI ≥ 5, the rate of postoperative delirium significantly increased (p < .05). Conclusion:The RSI system developed here can safely guide postoperative outcomes of elderly patients with hip fractures, and RSI ≥ 5 may be able to predict the onset of postoperative delirium.

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

“…The clinical data of 404 patients were included in the present study. The incidence of POD in elderly hip fracture patients was 13.6% (55/404), which was consistent with Zhang’s study (14.3%; Zhang et al, 2019 ) and Zhao’s study (12.2%; Zhao et al, 2021 ), but lower than Wang’s study (19.12%; Wang Y. et al, 2021 ) and Guo’s study (21%; Guo et al, 2016 ). This may be related to delirium diagnostic strategies.…”

“…Studies have demonstrated that 30%–40% of delirium cases can be prevented, and applying targeted measures have a positive effect on reducing the incidence of delirium and the harm caused by delirium (Olofsson et al, 2018 ; Wang G. et al, 2021 ; Wang Y. et al, 2021 ). At present, the diagnosis of POD is mainly based on clinical observation (Inouye et al, 2014 ).…”

Risk factors for postoperative delirium in geriatric patients with hip fracture: A systematic review and meta-analysis

“…Next, the 87 remained studies were carefully full-text-reviewed to recognize those which could reach the inclusion criteria. At last 37 citations (Kagansky et al, 2004 ; Goldenberg et al, 2006 ; Juliebø et al, 2009 ; Chrispal et al, 2010 ; Lee et al, 2011 ; Vochteloo et al, 2011 ; Nie et al, 2012 ; Kim et al, 2013 , 2020 ; Chen et al, 2014 ; Guo et al, 2016 ; Oh et al, 2016 ; Shin et al, 2016 ; van der Zanden et al, 2016 ; Zheng et al, 2016 ; Choi et al, 2017 ; Koskderelioglu et al, 2017 ; Mazzola et al, 2017 ; Arshi et al, 2018 ; Flikweert et al, 2018 ; Levinoff et al, 2018 ; Wang et al, 2018 , 2021 ; Agrawal et al, 2019 ; Harris et al, 2019 ; Ravi et al, 2019 ; Zhang et al, 2019 ; Aldwikat et al, 2020 ; Cho et al, 2020 ; He et al, 2020 ; Uzoigwe et al, 2020 ; Xing et al, 2020 ; Davani et al, 2021 ; Haynes et al, 2021 ; Jeon and Sohng, 2021 ; Oberai et al, 2021 ; Ahn and Bang, 2022 ) were included for further qualitative and quantitative synthesis ( Figure 1 ).…”

“…Five papers (Wang et al, 2018 , 2021 ; He et al, 2020 ; Haynes et al, 2021 ; Ahn and Bang, 2022 ) reported preoperative diabetes as a significant risk factor for POD. A random-effects model was applied because significant heterogeneity was found among these studies ( P < 0.00001, I 2 = 87%).…”

“…Risk factors in terms of delirium after hip fracture surgeries have been researched in many studies, while they have not reached an agreement (Kim et al, 2020 ; Wang et al, 2021 ; Ahn and Bang, 2022 ). Former meta-analysis have explored some potential risk factors for delirium in hip fracture patients (Yang et al, 2017 ; Wu et al, 2021 ), however, the patients in some included studies are not all geriatric patients, and the risk factors reported in some included studies are not merely for postoperative delirium, but for preoperative or perioperative delirium.…”