Postoperative delirium and pre-fracture disability predict 6-month mortality among the oldest old hip fracture patients

Mazzola, Paolo; Bellelli, Giuseppe; Broggini, Valentina; Anzuini, Alessandra; Corsi, Maurizio; Berruti, D.; Filippi, Francesco De; Zatti, Giovanni; Annoni, Giorgio

doi:10.1007/s40520-014-0242-y

Cited by 41 publications

(42 citation statements)

References 43 publications

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“…Also, prefracture disability was an independent predictor of increased mortality in an observational prospective cohort study with 6-month follow-up [37]. Frailty, a state of decreased age-associated functional reserve [20 && ] resulted in a three-to eight-fold higher risk of POD in a prospective observational study in elective cardiac surgery patients [38].…”

Section: Psychomotoric Subtypes Of Deliriummentioning

confidence: 99%

“…Considering that nearly half of the elderly will require surgery after the age of 65 years [47], and almost half of hip fracture patients are occurring among the 'oldest old' with an increasing trend [37], POD will be a more frequent devastating complication in the future [48]. Consequently, monitoring of POD has already become a quality marker in some health care policies [49].…”

Section: Psychomotoric Subtypes Of Deliriummentioning

confidence: 99%

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Patients prone for postoperative delirium

Guenther

Riedel

Radtke

2016

Current Opinion in Anaesthesiology

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An increase of the proportion of elderly patients undergoing surgery will lead to a higher incidence of POD. Preoperative assessment should facilitate identification of patients at high risk. Perioperative management should include monitoring depth of anesthesia, preference for nonopioid pain therapy, early regular delirium monitoring starting in the recovery room, avoiding ICU-sedation, early mobilization and exercise, and cognitive training.

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Section: Psychomotoric Subtypes Of Deliriummentioning

confidence: 99%

Section: Psychomotoric Subtypes Of Deliriummentioning

confidence: 99%

Patients prone for postoperative delirium

Guenther

Riedel

Radtke

2016

Current Opinion in Anaesthesiology

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“…This surgical complication is characterized by a transient global disturbance in attention, consciousness and cognition 1 . POD has been associated with increased morbidity and mortality, prolonged hospital stay and additional healthcare expenses 2,3 . While POD has been reported to affect 11%‐51% of surgical patients, 4 its pathophysiology has not been fully understood.…”

Section: Introductionmentioning

confidence: 99%

Melatonin and its analogues for the prevention of postoperative delirium: A systematic review and meta‐analysis

Han

Qin

et al. 2020

Journal of Pineal Research

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It remains unclear whether melatonin and its analogues prevent postoperative delirium (POD). Therefore, we conducted a systematic review and meta-analysis to evaluate the effect of melatonin and its analogues on POD prevention. PubMed, Cochrane Library, Web of Science, Embase and CINAHL databases were searched.Primary outcome was the incidence of POD. Six randomized controlled trials, 2 cohort studies and 1 case-control study were included in this meta-analysis. Results showed that melatonin and its analogue ramelteon decreased the incidence of POD in the entire adult surgical population (odds ratio [OR] = 0.45, 95% confidence interval[CI] 0.24-0.84, P = .01). When administered at a higher dose (5 mg), melatonin was effective in reducing the POD incidence (OR = 0.32, 95% CI 0.20-0.52, P < .00001).Melatonin administered less than 5 elimination half-lives before the surgery significantly reduced the POD incidence (OR = 0.31, 95% CI 0.19-0.49, P < .00001).Current literature supports the effectiveness of melatonin and its analogue ramelteon in POD prevention. However, the present study was limited by the significant heterogeneity of the included studies. More studies are needed to ascertain the preventive effect of melatonin and its analogues on the incidence of delirium after cardiac and noncardiac surgeries. K E Y W O R D S melatonin, meta-analysis, postoperative delirium, ramelteon, systematic review How to cite this article: Han Y, Wu J, Qin Z, et al. Melatonin and its analogues for the prevention of postoperative delirium: A systematic review and meta-analysis. J Pineal Res. 2020;68:e12644.

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“…Among the oldest old (i.e. people aged ≥85 years), functional disability is common both pre-operatively and as a result of failure in post-operative rehabilitation following hip fracture surgery, and represents a risk factor for poor survival [17,18]. Furthermore, comorbidity and limited organ reserve frequently lead to short-term postoperative complications following emergency surgery, in particular to cardiovascular complications such as hypotension [1].…”

Section: Discussionmentioning

confidence: 99%

Hip fracture in centenarians: Retrospective analysis of an orthogeriatric unit reveals the limitations of the current research

Mazzola¹,

Perego²,

Picone³

et al. 2015

Glob Anesth Perioper Med

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Life expectancy of Italian people is among the highest in the world, at 80 years for males and 85 years for females. Estimates from the National Institute of Statistics show that people aged 65 years and older represent more than 21% of the Italian population. Among them, centenarians represent the age group with the highest growing rate. Hip fracture incidence increases with advancing age, and currently represents one of the major causes of hospitalization in the elderly. Many studies regarding hip fracture in the elderly have been published, but research focusing on centenarians is still very limited despite their growing trend. This manuscript reviews the activity of the Orthogeriatric Unit at San Gerardo University Hospital (Northern Italy) from its establishment in 2007 until the present, and enlightens the limitations of the research in this area reviewing the literature currently available.Over a 7-year period, we admitted a small population of 10 centenarian female patients, all of whom underwent surgery. Their in-hospital (1 out of 10) and 1-year mortality rates (8 out of 10) are consistent with the existing literature.Centenarians pose an increasing challenge to physicians and surgeons. Rates of recovery of the pre-fracture condition are undoubtedly lower than those in younger geriatric patients, but surgery and early rehabilitation should not be denied solely due to the extreme age of these subjects. However, the research in this area presents several limitations up to now. The available studies are sparse, describe small populations, and are generally a single-center retrospective review of the local hospital admissions registry. Moreover, the objectives and outcome measurements vary considerably between studies, making a statistical comparison unfeasible.In this scenario, the implementation and analysis of large-scale databases would allow appropriate research among centenarians, including cost-effectiveness of specific surgical treatments.

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Postoperative delirium and pre-fracture disability predict 6-month mortality among the oldest old hip fracture patients

Abstract: Patients aged >90 years who underwent hip fracture surgery are more likely to die at 6 months than those aged 85-89 years. Pre-fracture disability and POD are predictors of this excess of mortality.

Cited by 41 publications

References 43 publications

Patients prone for postoperative delirium

Patients prone for postoperative delirium

Melatonin and its analogues for the prevention of postoperative delirium: A systematic review and meta‐analysis

Hip fracture in centenarians: Retrospective analysis of an orthogeriatric unit reveals the limitations of the current research

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