Perioperative Temporal Profile of Cognitive Function in Elderly Patients Undergoing Hip Surgery

Abstract

To test the hypothesis that elderly patients who have surgery for femoral neck fractures may have delirium not only after surgery but before surgery, we prospectively investigated the perioperative temporal profile of cognitive function in such patients. We performed the Abbreviated Mental Test (AMT) six times in each patient (on the day of admission, 3 days after admission, on the day before surgery, 2 days after surgery, 7 days after surgery, and on the day of discharge). Patients were given no premedication and were anesthetized with spinal anesthesia using 0.2% hypobaric tetracaine. Of the 68 patients who were admitted because of a diagnosis of fractured neck of the femur and were scheduled to have surgery, 27 patients were subjected to analysis. Four and three patients showed a significant decrease (3 or more points) in AMT score 2 and 7 days after surgery, respectively. We conclude that surgery may have a stronger impact on cognitive function than environmental change shortly after admission in elderly patients with femoral neck fractures.

Predicting post‐operative delirium in elderly patients undergoing surgery for hip fracture

“…Impaired performance on cognitive tests was a risk factor for delirium in our patients and is in accordance with data of other studies 9,10 , 14,15 , 31 . The MMSE score of 24 emphasizes that even mild dementia increases the risk for cognitive failure (delirium) with surgery.…”

“…Delirium can occur either before or after a surgical repair of the fracture 12,13 , 15 . Postoperative delirium was more common in some studies and had the same incidence prior to‐ and after surgery in other studies 12,13 , 15 . Delirium in patients with hip fracture not only affects functional outcome, but is also associated with prolonged hospital stay and higher rate of mortality, 9,13 , 16,17 being therefore an important determinant of the disease course.…”

“…The incidence of delirium in patients with fractures of the hip varies from 9 to 65% 9,11–14 . Delirium can occur either before or after a surgical repair of the fracture 12,13 , 15 . Postoperative delirium was more common in some studies and had the same incidence prior to‐ and after surgery in other studies 12,13 , 15 .…”

Pathogenesis of and management strategies for postoperative delirium after hip fractureA review

“…Of the remaining studies, 43 did not specifi cally consider delirium in hip fracture patients and 4 studies, all from nursing journals, were not available. Thus, from the initial data collection, we found 26 studies suitable for more detailed analysis (Billig et al 1986, Berggren et al 1987, Furstenberg and Mezey 1987, Gustafson et al 1991a, b, 1988, Krasheninnikoff et al 1993, Bowman 1997, Brauer et al 2000, Clayer and Bruckner 2000, Duppils and Wikblad 2000, Holmes and House 2000a, Marcantonio et al 2000, 2001, 2002, Sato et al 2000, Andersson et al 2001, Edlund et al 2001, Galanakis et al 2001, Milisen et al 1998, 2001, 2002, Zakriya et al 2002, Morrison et al 2003.…”

Postoperative cognitive function as an outcome of regional anesthesia and analgesia

“…23 In an observational study, use of intraoperative spinal anesthesia without any premedication or sedation, such as benzodiazepines or opioids, yielded a 0% incidence of delirium in elderly patients undergoing repair of femoral neck fractures, which typically is associated with a delirium rate of at least 25%. 36,82 However, other data did not demonstrate a correlation between serum benzodiazepine concentration and postoperative cognitive dysfunction 1 week after surgery. 83 Another area of potential concern is the general lack of control of postoperative analgesia in currently available trials.…”