Perioperative hemodynamics and risk for delirium and new onset dementia in hip fracture patients; A prospective follow-up study

Abstract

BackgroundDelirium is common in hip fracture patients and many risk factors have been identified. Controversy exists regarding the possible impact of intraoperative control of blood pressure upon acute (delirium) and long term (dementia) cognitive decline. We explored possible associations between perioperative hemodynamic changes, use of vasopressor drugs, risk of delirium and risk of new-onset dementia.MethodsProspective follow-up study of 696 hip fracture patients, assessed for delirium pre- and postoperatively, using the Confusion Assessment Method. Pre-fracture cognitive function was assessed using the Informant Questionnaire of Cognitive Decline in the Elderly and by consensus diagnosis. The presence of new-onset dementia was determined at follow-up evaluation at six or twelve months after surgery. Blood pressure was recorded at admission, perioperatively and postoperatively.ResultsPreoperative delirium was present in 149 of 536 (28%) assessable patients, and 124 of 387 (32%) developed delirium postoperatively (incident delirium). The following risk factors for incident delirium in patients without pre-fracture cognitive impairment were identified: low body mass index, low level of functioning, severity of physical illness, and receipt of ≥ 2 blood transfusions. New-onset dementia was diagnosed at follow-up in 26 of 213 (12%) patients, associated with severity of physical illness, delirium, receipt of vasopressor drugs perioperatively and high mean arterial pressure postoperatively.ConclusionRisk factors for incident delirium seem to differ according to pre-fracture cognitive status. The use of vasopressors during surgery and/or postoperative hypertension is associated with new-onset dementia after hip fracture.

Investigating Association between Intraoperative Hypotension and Postoperative Neurocognitive Disorders in Non-Cardiac Surgery: A Comprehensive Review

“…Another interesting study was set up to verify the relationship between perioperative hemodynamic management and the risk of new-onset dementia [ 33 ]. The study was performed in 696 individuals averagely aged 84 years undergoing hip fracture surgery in either regional (8%) or general (92%) anesthesia.…”

Post-operative delirium: a review of diagnosis and treatment strategies

“…Several recent studies have looked at the risk factors for development of delirium in cardiac and non-cardiac surgeries ( Table 1). The risk factors found in both surgical groups are old age, cognitive impairment, decreased albumin, and weight loss (5,(20)(21)(22)(23)(24)(25).…”

Improving Perioperative Outcomes Through Minimally Invasive and Non-invasive Hemodynamic Monitoring Techniques

“…Delayed recovery of cognition, whether delirium (an acute attentional deficit which waxes and wanes), or the long-lasting phenotype termed postoperative cognitive decline (POCD), has been linked to intraoperative blood pressure fluctuations ( 23 ) or maintained hypotension in the intraoperative period ( 24 ). The use of vasopressors during surgery and/or postoperative hypertension is associated with new-onset dementia after surgery ( 25 ). With more than 46 million Americans over the age of 65, postoperative delirium is a major public health issue with an projected annual cost of over $150 billion.…”