<p>Delirium after hip hemiarthroplasty for proximal femoral fractures in elderly patients: risk factors and clinical outcomes</p>

Abstract

Background The primary aim of the present study was to verify the potential risk factors for developing a delirium after hip fracture surgery. The secondary aim of this study was to examine the related clinical outcomes after a delirium developed post-hip fracture surgery. Patients and methods Data were extracted from a prospective hip fracture database and completed by retrospective review of the hospital records. A total of 463 patients undergoing hip fracture (hip hemiarthroplasty) surgery in a level II trauma teaching hospital between January 2011 and May 2016 were included. Delirium was measured using the Delirium Observation Screening Scale, the confusion assessment method, and an observatory judgment by geriatric medicine specialists. Results The results showed that 26% of the patients (n=121) developed a delirium during hospital stay with a median duration during admission of 5 days (IQR 3–7). The multivariable model showed that the development of delirium was significantly explained by dementia (OR 2.75, P =0.001), age (OR 1.06, P =0.005), and an infection during admission (pneumonia, deep surgical site infection, or urinary tract infection) (OR 1.23, P =0.046). After 1 year of follow-up, patients who developed delirium after hip fracture surgery were significantly more discharged to (semi-independent) nursing homes ( P <0.001) and had a significantly higher mortality rate ( P <0.001) compared to patients without delirium after hip fracture surgery. Conclusions The results showed that 26% of the patients undergoing hip fracture surgery developed a delirium. The risk factors including age, dementia, and infection during admission significantly predicted the development of the delirium. No association was confirmed between delirium and time of admission or time to surgery. The development of delirium after hip fracture surgery was subsequently found to be a significant predictor of admission to a nursing home and mortality after 1 year.

Incidence and Risk Factors of Postoperative Delirium Following Primary Elective Total Hip Arthroplasty: A Retrospective Nationwide Inpatient Sample Database Study

“…In terms of demographics, patients suffered from postoperative delirium were significantly older than those without. This was highly consistent with previous studies which had identified advanced age as a common independent predictor of postoperative delirium [1,9,20,21,22,23,24,25].Interestingly, there was significant difference of race distribution between the two groups, indicating a racial difference in occurrence of postoperative delirium. Our study found that the Whites occupying a larger proportion in the postoperative delirium group.…”

“…Thus, in order to prevent postoperative delirium, it is critical to understand the risk factors before surgery. Logistic regression was applied and the results were consistent with previous publications [1,9,20,21,22,23,24,25].…”

“…In order to optimize postoperative outcomes and prevent complications, it is critical to identify preoperatively whether patients are at high risk of postoperative delirium [1,19,20,21]. Several risk factors of postoperative delirium had been reported in previous literatures, among which advanced age is the most frequently acknowledged [1,9,19,20,21,22,23,24,25]. Other risk factors, including a history of dementia or psychiatric illness, cognitive impairment, polypharmacy, postoperative electrolyte disorders, and diabetes, had also been identified [1,9,20,21,22,23,24,25].…”

“…Several risk factors of postoperative delirium had been reported in previous literatures, among which advanced age is the most frequently acknowledged [1,9,19,20,21,22,23,24,25]. Other risk factors, including a history of dementia or psychiatric illness, cognitive impairment, polypharmacy, postoperative electrolyte disorders, and diabetes, had also been identified [1,9,20,21,22,23,24,25]. However, currently there is a paucity of studies about the incidence and risk factors of postoperative delirium associated with primary elective THA based on large-scale national database analysis [7,9,20,21,22,23,24,25].…”

<p>Performance of Comprehensive Risk Adjustment for the Prediction of In-Hospital Events Using Administrative Healthcare Data: The Queralt Indices</p>

“…Patients now often have multiple concurrent conditions, 4 and frequently develop complications during a hospital stay. 5,6 Comorbidity indices such as Charlson's 7 or Elixhauser's 8 have been widely used as standard methods for risk adjustment in a number of settings. 1,9,10 Importantly, although "comorbidities" and "risk" are often used as synonym terms, these actually refer to different concepts, the former being only one of the components of the latter.…”