Risk Factors for Preoperative and Postoperative Delirium in Elderly Patients with Hip Fracture

Juliebø, Vibeke; Bjøro, Karen; Krogseth, Maria; Skovlund, Eva; Ranhoff, Anette Hylen; Wyller, Torgeir Bruun

doi:10.1111/j.1532-5415.2009.02377.x

Cited by 231 publications

(212 citation statements)

References 37 publications

Supporting

Mentioning

178

Contrasting

Unclassified

Order By: Relevance

“…The hip fracture studies that met the inclusion criteria are presented in Table 1. [3], N = 120 52% Age, gender, cognitive*,physical impairment, polymedicine, IL-6,IL-8, length of stay Juliebo et al 2009 [29], N = 364 58% Age, gender*, cognitive*, function*impairment, 21% preop comorbidity, health problem, BMI*, hemoglobin* 36.4% postop sodium, potassium, BUN/Cr ratio, polypharmacy*, Arrhythmia, medication use (psychotropic, selective serotonin reuptake inhibitor, zopiclone, aspirin, betablocker, diuretic, statin) fentanyl* Juliebo et al 2010 [30], N = 331 43.2% Kat et al 2011 [31], N = 603 12.3% postop Bisschop et al 2011 [32], N = 143 34% Age*, gender, preexisting cognitive* and functional* impairment, comorbidity*, laboratory abnormalities*, glucose Lee et al 2011 [33], N = 232 30.2% Age, gender, comorbidity, health problem*, BMI Vochteloo et al 2011 [34], N = 378 27% Age*, gender*,dementia, health problem*, psychotropic drug use*, length of stay* Sieber et al 2011 [35], N = 236…”

Section: Resultsmentioning

confidence: 99%

Risk factors of delirium in elderly patients with hip fracture

Suwanpasu

Grinslade

et al. 2014

Asian Biomedicine

View full text Add to dashboard Cite

Background: Delirium is a leading cause of death and disability in the elderly with hip fracture. Identifying reliable risk factors for delirium is critical to support optimal outcomes for prevention and reducing delirium. Objective: To quantify the reported factors associated to delirium for patients with hip fracture. Methods: Electronic databases were searched (including Medline, Pub Med, CINAHL, EMBASE, Evidence Based Medicine Reviews, Cochrane Review, Web of Science, and PsycINFO) to identify all studies, published in English language that evaluated the risk factors of delirium hospitalized people with hip fracture. Two reviewers independently assessed methodology quality and extracted relevant data. The data from the included studies were summarized, and pooled estimates were calculated for 12 risk factors. Results: Thirty-seven studies were included in the review and 25 in the meta-analysis. The incidence of delirium was 32.4% (95% confidence interval [CI] = 25.9%-39.5%). Six predisposing and four precipitating factors predicted delirium among older patients with hip fracture confirmed. The predisposing factors included advanced age (ES = 1.06, 95% CI = 1.03-1.09), male sex (ES = 1.34, 95% CI = 1.08-1.68), impairment of cognition (ES = 2.91, 95% CI = 1.91-4.42), and function (ES = 1.75, 95% CI = 1.39-2.2), comorbidity (ES = 1.59, 95% CI = 1.30-1.96), and health problems (ES = 2.64, 95% CI = 2.04-3.42). Precipitating factors were hypo-or hypernatremia (ES = 1.73, 95% CI = 1.14-2.64), depression (ES = 4.07, 95% CI = 1.95-8.49), more than three prescribed drugs (ES = 1.28, 95% CI = 1.10-1.49), and drugs including opioids (ES = 2.13, 95% CI = 1.42-3.18) and anticholinergic agents (ES = 2.10, 95% CI = 1.60-2.75). Conclusion:This meta-analysis result provides evidence that these risk factors have a significant impact on delirium in elders with hip fracture during hospitalization. Developing formal screening, and effective preventive and management strategies for delirium is important.

show abstract

Section: Resultsmentioning

confidence: 99%

Risk factors of delirium in elderly patients with hip fracture

Suwanpasu

Grinslade

et al. 2014

Asian Biomedicine

View full text Add to dashboard Cite

show abstract

“…With regard to specific comorbid diseases, we had expected that patients with dementia would be more likely to develop delirium, as has been shown among hip fracture patients in usual care, [21][22][23] but this was not the case. This may be reflective of the standardized protocol-driven care to reduce the risk of delirium, including minimizing tethers and medications associated with causing delirium, and treating pain more aggressively.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Comorbidity on Perioperative Outcomes of Hip Fractures in a Geriatric Fracture Model

Menzies

Mendelson

Kates

et al. 2012

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

Background: Older adults who sustain hip fractures usually have multiple coexisting medical problems that may impact their treatment and outcomes. The geriatric fracture center (GFC) provides a model of care that standardizes treatment and optimizes outcomes. The purpose of this study is to determine whether GFC patients with a higher burden of comorbidity or specific comorbidities are at risk for worsened perioperative outcomes, such as increased time to surgery (TTS), postoperative complications, and longer length of hospital stay (LOS). Method: A total of 1077 patients aged 60 years and older who underwent surgery for a proximal femur fracture between April 15, 2005, and September 30, 2010, were evaluated. Comorbidities measured in the Charlson Comorbidity index were abstracted through chart review. Outcomes were TTS, postoperative complications, and LOS. Results: Most patients were white, with an average age of 85. One half lived in either a nursing home or an assisted living facility. The mean Charlson score was 3.06 and the nursing home residents had a significantly higher score compared to community dwellers (3.4 vs 2.8; P < .0001). Dementia was the most common comorbidity. There was no difference in the LOS or TTS based on Charlson score. The overall complication rate was 44% with delirium being the most common postoperative complication. Peripheral vascular disease, history of solid tumor, and peptic ulcer disease predicted delirium incidence. Charlson score predicted complication risk, with an odds ratio of 1.12 for each point increase. Conclusion: Frailty and comorbidity put this hip fracture population at high risk for adverse perioperative outcomes. This study shows that in the GFC model of care the comorbidity burden did not impact the TTS and LOS but did predict postoperative complication rate.

show abstract

“…It is believed that 32% of deaths of elderly trauma victims were the consequence of avoidable complications 25 . This diagnostic difficulty may be related to the increased number of neurological injuries, which make it difficult to diagnose other injuries, or because of the difficulty that some elderly patients have with expressing themselves 26 . It is important to stress the need to conduct a tertiary assessment of critical trauma patients, with those who have problems with verbalizing their complaints and with those who have neurological sequelae, since in these groups the number of unnoticed injuries increases significantly.…”

Section: Discussionmentioning

confidence: 99%

Análise comparativa das características do trauma entre pacientes idosos e não idosos

Parreira¹,

Soldá²,

Perlingeiro³

et al. 2010

Rev. Assoc. Med. Bras.

View full text Add to dashboard Cite

Risk Factors for Preoperative and Postoperative Delirium in Elderly Patients with Hip Fracture

Abstract: Time from admission to operation is a risk factor for preoperative delirium, whereas low BMI is an important risk factor for postoperative delirium in hip fracture patients. Cognitive impairment and indoor injury are independent risk factors for preoperative and postoperative delirium.

Cited by 231 publications

References 37 publications

Risk factors of delirium in elderly patients with hip fracture

Risk factors of delirium in elderly patients with hip fracture

The Impact of Comorbidity on Perioperative Outcomes of Hip Fractures in a Geriatric Fracture Model

Análise comparativa das características do trauma entre pacientes idosos e não idosos

Contact Info

Product

Resources

About