Post-operative delirium in older hip fracture patients: a new onset or was it already there?

Costa-Martins, Isabel; Carreteiro, Joana; Santos, Ana Coutinho; Costa-Martins, Mariana; Artilheiro, Vanessa; Duque, Sofía; Campos, Luís; Chedas, Manuel

doi:10.1007/s41999-021-00456-w

Cited by 7 publications

(8 citation statements)

References 41 publications

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“…1,6,7 A smaller group of studies have reported preoperative delirium prevalences, of 19% (only home-dwelling patients included), 58%, and 18%. 8-10…”

Section: Introductionmentioning

confidence: 99%

“…1,6,7 A smaller group of studies have reported preoperative delirium prevalences, of 19% (only home-dwelling patients included), 58%, and 18%. [8][9][10] Another source of data on delirium in hip fracture is large clinical registries. However, according to the most recent published reports, delirium is prospectively assessed as part of routine care in a minority: the National Hip Fracture Database (NHFD; England, Wales and Northern Ireland), the Scottish Hip Fracture Audit (SHFA), the Irish Hip Fracture Database, and the Australian and New Zealand Hip Fracture Registry.…”

Section: Introductionmentioning

confidence: 99%

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Delirium in hip fracture patients admitted from home during the COVID-19 pandemic is associated with higher mortality, longer total length of stay, need for post-acute inpatient rehabilitation, and readmission to acute services

et al. 2023

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AimsDelirium is associated with adverse outcomes following hip fracture, but the prevalence and significance of delirium for the prognosis and ongoing rehabilitation needs of patients admitted from home is less well studied. Here, we analyzed relationships between delirium in patients admitted from home with 1) mortality; 2) total length of hospital stay; 3) need for post-acute inpatient rehabilitation; and 4) hospital readmission within 180 days.MethodsThis observational study used routine clinical data in a consecutive sample of hip fracture patients aged ≥ 50 years admitted to a single large trauma centre during the COVID-19 pandemic between 1 March 2020 and 30 November 2021. Delirium was prospectively assessed as part of routine care by the 4 A’s Test (4AT), with most assessments performed in the emergency department. Associations were determined using logistic regression adjusted for age, sex, Scottish Index of Multiple Deprivation quintile, COVID-19 infection within 30 days, and American Society of Anesthesiologists grade.ResultsA total of 1,821 patients were admitted, with 1,383 (mean age 79.5 years; 72.1% female) directly from home. Overall, 87 patients (4.8%) were excluded due to missing 4AT scores. Delirium prevalence in the whole cohort was 26.5% (460/1,734): 14.1% (189/1,340) in the subgroup of patients admitted from home, and 68.8% (271/394) in the remaining patients (comprising care home residents and inpatients when fracture occurred). In patients admitted from home, delirium was associated with a 20-day longer total length of stay (p < 0.001). In multivariable analyses, delirium was associated with higher mortality at 180 days (odds ratio (OR) 1.69 (95% confidence interval (CI) 1.13 to 2.54); p = 0.013), requirement for post-acute inpatient rehabilitation (OR 2.80 (95% CI 1.97 to 3.96); p < 0.001), and readmission to hospital within 180 days (OR 1.79 (95% CI 1.02 to 3.15); p = 0.041).ConclusionDelirium affects one in seven patients with a hip fracture admitted directly from home, and is associated with adverse outcomes in these patients. Delirium assessment and effective management should be a mandatory part of standard hip fracture care.Cite this article: Bone Jt Open 2023;4(6):447–456.

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“…1,6,7 A smaller group of studies have reported preoperative delirium prevalences, of 19% (only home-dwelling patients included), 58%, and 18%. 8-10…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Delirium in hip fracture patients admitted from home during the COVID-19 pandemic is associated with higher mortality, longer total length of stay, need for post-acute inpatient rehabilitation, and readmission to acute services

et al. 2023

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“…In these patients, delirium usually occurs within the first 24–48 h after surgery with a frequency ranging between 20 and 50% 5 , 6 . However, most of the patients suffering from delirium already show it pre-operatively 7 . This may cause surgical delays which on turn increases delirium risk 8 – 10 .…”

Section: Introductionmentioning

confidence: 99%

“…It is also evident that etiology of delirium is likely multifactorial and linked to many other geriatric syndromes (e.g. falls, functional decline, frailty, dementia) 7 , 9 , 13 , 16 . Recently, it has been shown that the multidimensional prognostic index (MPI), a predictive tool of mortality, based on a standardized comprehensive geriatric assessment (CGA), is an independent predictor of 6-month mortality in older patients with hip fracture 17 .…”

Section: Introductionmentioning

confidence: 99%

Association between multidimensional prognostic index (MPI) and pre-operative delirium in older patients with hip fracture

Musacchio

Custodero

Razzano

et al. 2022

Sci Rep

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Pre-operative delirium may cause delay in surgical intervention in older patients hospitalized for hip fracture. Also it has been associated with higher risk of post-surgical complications and worst functional outcomes. Aim of this retrospective cohort study was to evaluate whether the multidimensional prognostic index (MPI) at hospital admission was associated with pre-operative delirium in older individuals with hip fracture who are deemed to require surgical intervention. Consecutive older patients (≥ 65 years) with hip fracture underwent a comprehensive geriatric assessment to calculate the MPI at hospital admission. According to previously established cut-offs, MPI was expressed in three grades, i.e. MPI-1 (low-risk), MPI-2 (moderate-risk) and MPI-3 (high risk of mortality). Pre-operative delirium was assessed using the four ‘A’s Test. Out of 244 older patients who underwent surgery for hip fracture, 104 subjects (43%) received a diagnosis of delirium. Overall, the incidence of delirium before surgery was significantly higher in patients with more severe MPI score at admission. Higher MPI grade (MPI-3) was independently associated with higher risk of pre-operative delirium (OR 2.45, CI 1.21–4.96). Therefore, the MPI at hospital admission might help in early identification of older patients with hip fracture at risk for pre-operative delirium.

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“…Delirium, an acute disturbance in cognitive functioning and attention, is common, especially in older patients (aged ≥65 years) during hospital care [4]. It may exist already on admission or it may develop in emergency settings or after treatment procedures [5]. By definition, delirium has an underlying cause, with many distinguishable predisposing and precipitating factors [6,7].…”

Section: Introductionmentioning

confidence: 99%

In-Hospital Delirium as a Prognostic Factor for New Cognitive Disorder in a 1-Year Post-Hip Fracture Follow-Up

Jaatinen

Luukkaala

Hongisto

et al. 2021

Dement Geriatr Cogn Disord

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Background: Older hip fracture patients are at high risk of delirium during acute hospital care. Pre-fracture dementia is known to increase the risk of in-hospital delirium. Data on the development of new cognitive disorders in patients with delirium are scarce. Objective: The objective of this study is to evaluate the prognostic significance of in-hospital delirium on the development of new cognitive disorders in a 1-year follow-up in older hip fracture patients. Material and Methods: Data consisted of 476 hip fracture patients aged 65 years or more with no known cognitive disorder on admission. Delirium was assessed using the Confusion Assessment Method (CAM). Cognitive disorders were diagnosed following the national guidelines. Information on the new diagnoses of cognitive disorders (NDCD) at 1-year follow-up was elicited in a telephone interview and confirmed from the electronic patient files. Logistic regression analyses were conducted to examine the association of delirium with NDCDs. Results: Of the 476 patients, 87 (18%) had delirium during hospital stay. Patients with delirium were older, they had poorer nutritional status, lower mobility level, and more supported living arrangements than did patients without delirium. At the 1-year time point, 205 (43%) had NDCDs or were strongly suspected of this. CAM result was statistically significantly associated with development of NDCD in multivariable-adjusted analysis (odds ratio [OR] 2.29; 95% confidence interval [CI]: 1.39–3.79). Also, poor nutritional status continued to be associated with NDCDs (multivariable-adjusted OR 1.58; 95% CI: 1.03–2.43). Conclusion: Delirium during hospitalization and poor nutritional status on admission are independent prognostic factors for development of subsequent cognitive disorders in older hip fracture patients.

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Post-operative delirium in older hip fracture patients: a new onset or was it already there?

Cited by 7 publications

References 41 publications

Delirium in hip fracture patients admitted from home during the COVID-19 pandemic is associated with higher mortality, longer total length of stay, need for post-acute inpatient rehabilitation, and readmission to acute services

Delirium in hip fracture patients admitted from home during the COVID-19 pandemic is associated with higher mortality, longer total length of stay, need for post-acute inpatient rehabilitation, and readmission to acute services

Association between multidimensional prognostic index (MPI) and pre-operative delirium in older patients with hip fracture

In-Hospital Delirium as a Prognostic Factor for New Cognitive Disorder in a 1-Year Post-Hip Fracture Follow-Up

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