Lack of Association Between Perioperative Medication and Postoperative Delirium in Hip Fracture Patients in an Orthogeriatric Care Pathway

Genet, Bastien; Lamy, Tina; Cohen-Bittan, Judith; Glasman, Pauline; Verny, Marc; Riou, Bruno; Boddaert, Jacques; Zerah, Lorène

doi:10.1016/j.jamda.2021.09.022

Cited by 5 publications

(2 citation statements)

References 37 publications

(51 reference statements)

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“…We did, however, use a matched study to minimize the effect of confounding factors such as selection bias. Pairing characteristics were carefully selected, including age, sex, and anesthesia type, which have a strong relationship with POD [34][35][36][37]. We improved upon a chart-based method which had been previously validated for identifying POD from medical records [13].…”

Section: Discussionmentioning

confidence: 99%

Lower preoperative serum uric acid level may be a risk factor for postoperative delirium in older patients undergoing hip fracture surgery: a matched retrospective case-control study

Lyu

Wei

et al. 2022

BMC Anesthesiol

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Background Postoperative delirium (POD) is a common complication after hip fracture surgery that is associated with various short- and long-term outcomes. The mechanism of POD may be associated with the oxidative stress process. Uric acid has been shown to provide a neuroprotective effect in various neurodegenerative diseases through its antioxidant properties. However, it is unclear whether lower preoperative serum uric acid levels are associated with the development of POD after hip fracture surgery. Therefore, this study assessed the association of lower preoperative uric acid levels in patients with POD during hospitalization. Methods This is a matched retrospective case-control study that included 96 older patients (≥65 y) who underwent hip fracture surgery. POD was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Patients diagnosed with POD (cases) were matched 1:1 with patients without POD (controls) on the basis of age, sex, and anesthesia type. The relationship between preoperative uric acid and POD was analyzed by multivariable analysis. Results The POD and non-POD groups each had 48 patients. In the univariate analysis, lower log preoperative serum uric acid value, higher neutrophil-to-lymphocyte ratio, and cerebrovascular disease were more likely in patients with POD than in those with no POD. Multivariable conditional logistic regression analysis showed that lower log preoperative serum uric acid (adjusted odds ratio [aOR], 0.028; confidence interval [CI], 0.001–0.844; p = 0.040), higher neutrophil-to-lymphocyte ratio (aOR, 1.314; 95% CI, 1.053–1.638; p = 0.015), and increased surgery duration (aOR, 1.034; 95% CI, 1.004–1.065; p = 0.024) were associated with increased risk of POD. Conclusions Lower preoperative serum uric acid levels may be an independent risk factor for POD after adjustment for possible confounding factors. However, large prospective studies are needed to confirm this finding.

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Section: Discussionmentioning

confidence: 99%

Lower preoperative serum uric acid level may be a risk factor for postoperative delirium in older patients undergoing hip fracture surgery: a matched retrospective case-control study

Lyu

Wei

et al. 2022

BMC Anesthesiol

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“…13 Becaues of the importance of preventing delirium after hip fracture surgery, and other types of surgical interventions, numerous studies have been dedicated to treatment strategies to prevent and/or reduce the incidence and severity of postoperative delirium. [8][9][10][11][14][15][16] One such strategy is the use of preoperative steroids to reduce the incidence and severity of postoperative delirium. 9,[13][14][15][17][18][19] To date, numerous systematic reviews and/or metaanalyses have examined the topic of preoperative steroid usage to improve delirium outcomes.…”

Section: Introductionmentioning

confidence: 99%

The Utilization of Preoperative Steroids Safely Decreases the Risk of Postoperative Delirium in Geriatric Patients after Hip Fracture Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Baumann,

Talaski,

Uhler

et al. 2024

Journal of Orthopaedic Trauma

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OBJECTIVES: Postoperative delirium is an acute neurocognitive complication that can have adverse effects on outcomes of geriatric patients after undergoing hip fracture surgery. The objective of this study was to examine the efficacy of preoperative steroids in preventing postoperative delirium after hip fracture surgery. METHODS: Data Sources: A systematic review and meta-analysis was performed using PubMed, SPORTDiscus, CINAHL, MEDLINE, and Web of Science from database inception until September 28th, 2023. Study Selection: Inclusion criteria were randomized controlled trials (RCTs) of patients who underwent surgical intervention for hip fracture, were examined for postoperative delirium, and utilized preoperative steroids. Data Extraction: Data included the risk of postoperative delirium, postoperative all-cause infection, and postoperative hyperglycemia. Articles were graded via the Cochrane Collaboration’s tool. Data Synthesis: Statistical analysis included a random-effects binary model with relative risk (RR), 95% confidence intervals (CI) along with a defined “number needed to treat” threshold (NNT). RESULTS: Four RCTs were included from 128 articles initially retrieved. Patients (n=416; average age: 82.2 ± 2.2 years old) underwent surgical intervention for hip fracture after receiving either preoperative steroids (n=209) or control interventions (n=207). There was a statistically significant decrease in the incidence of postoperative delirium among patients who received preoperative steroids (12.9%; 27 cases) as compared to patients who received control interventions (26.7%; 55 cases) after hip fracture surgery (p<0.001; RR: 0.84). The absolute risk difference was 13.8% and the NNT was 7.2 patients. There was no statistically significant difference in the risk of postoperative all-cause infection among patients who received preoperative steroids as compared to patients who received normal saline as placebo after hip fracture surgery (p=0.850; RR: 0.96). CONCLUSIONS: The utilization of preoperative steroids appears to decrease the risk of postoperative delirium after hip fracture surgery in elderly adults. Furthermore, this decreased risk of postoperative delirium was not associated with a significant increase in postoperative infection, indicating possible safety of preoperative steroid administration. LEVEL OF EVIDENCE: Level I. See Instructions for Authors for a complete description of levels of evidence.

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Surgery and Geriatric Medicine: Toward Greater Integration and Collaboration

Sloane

Tremont

Brasel

et al. 2022

Journal of the American Medical Directors Association

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Lack of Association Between Perioperative Medication and Postoperative Delirium in Hip Fracture Patients in an Orthogeriatric Care Pathway

Cited by 5 publications

References 37 publications

Lower preoperative serum uric acid level may be a risk factor for postoperative delirium in older patients undergoing hip fracture surgery: a matched retrospective case-control study

Lower preoperative serum uric acid level may be a risk factor for postoperative delirium in older patients undergoing hip fracture surgery: a matched retrospective case-control study

The Utilization of Preoperative Steroids Safely Decreases the Risk of Postoperative Delirium in Geriatric Patients after Hip Fracture Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Surgery and Geriatric Medicine: Toward Greater Integration and Collaboration

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