Sex Differences in Hip Fracture Surgery: Preoperative Risk Factors for Delirium and Postoperative Outcomes

Oh, Esther S.; Sieber, Frederick E.; Leoutsakos, Jeannie‐Marie; Inouye, Sharon K.; Lee, Ho-Chang

doi:10.1111/jgs.14243

Cited by 76 publications

(87 citation statements)

References 33 publications

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“…A study done by Chung et al shows that an increase in age by 1 year increased the risk of delirium by 1.15 times (12). Similarly, while the present study shows that men are at higher risk of developing postoperative delirium, there is no current literature to support this except a recently published a paper by Oh et al which concluded that men are at higher risk of postoperative delirium after hip fracture surgery in a prospective cohort study (13). They attributed this to their underlying preoperative disease severity.…”

Section: Table 2 Diagnostic Criteria For Deliriumcontrasting

confidence: 42%

Incidence of postoperative delirium in patients undergoing total knee arthroplasty—an Asian perspective

Huang¹,

Razak²,

Yeo³

2017

Ann. Transl. Med.

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Background: Very little is known in the literature with regards to the incidence of postoperative delirium following total knee arthroplasty (TKA) in Asians and the associated surgical factors. We conducted a retrospective study on incidence of postoperative delirium following TKA in Asians. Methods:One thousand sixteen knees of 954 consecutive patients who underwent TKA by the senior author of this study in the year 2006 were included in this review. All written and electronic medical records for patients were screened. Delirium was recorded to be present based on clinical entry onto the patients' inpatient hospital notes and a diagnosis made by psychiatrist based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). All statistical analysis was performed using SPSS v.18.0 (IBM Corp., Armonk, NY, USA). Results:The incidence of postoperative delirium in our patients undergoing TKA was 0.59%. Six patients had a confirmed diagnosis of delirium postoperatively. We noted an association between a higher mean age (P<0.0001), a lower body mass index (P<0.0001), Chinese ethnicity (P=0.002), male gender (P=0.002) and chronic opioid use (P<0.0001) with incidence of post-operative delirium. We also noted a higher proportion of post-operative DVT (P<0.0001) and wound infection (P<0.0001) in the delirium group. Conclusions:The incidence of postoperative delirium in Asians undergoing TKA in our institution is very low at 0.59%. Advanced age, lower body mass index, Chinese ethnicity, male gender and preoperative chronic opioid use may be associated with developing postoperative delirium.

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Section: Table 2 Diagnostic Criteria For Deliriumcontrasting

confidence: 42%

Incidence of postoperative delirium in patients undergoing total knee arthroplasty—an Asian perspective

Huang¹,

Razak²,

Yeo³

2017

Ann. Transl. Med.

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“…The yearly incidences of pneumonia or UTIs in our study are lower compared to previous studies (with exception of UTI in one study (8) ), evaluating the risk after hip fracture surgery. (8)(9)(10)(11) However, these studies have several limitations; including only descriptive analysis and small study populations, (8)(9)(10)(11) measuring outcome as patient-reported, (11) or restricted to patients treated at a single institution or a selected university hospital. (8,9,11) We extended the knowledge by including community-based infections, evaluating trends over time, and considered death as competing risk to minimize potential bias.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

“…About 9% to 11% of hip fracture patients have been reported to develop hospital‐acquired pneumonia and 4% to 17.9% to develop urinary tract infection, within a varying follow‐up time window spanning from during admission to 6 months of follow‐up. Pneumonia is a leading cause of death among hip fracture patients, and is associated with an excess mortality risk among hip fracture patients .…”

Section: Introductionmentioning

confidence: 99%

“…(7) Although 1-year mortality decreased by 40% from 1980 through 2014, (5) despite an increase in the proportion of patients with severe comorbidity, hip fracture is still associated with a 10% mortality within 30 days and up to 30% within 1 year of surgery. (5,8) About 9% to 11% of hip fracture patients have been reported to develop hospital-acquired pneumonia and 4% to 17.9% to develop urinary tract infection, (8)(9)(10)(11) within a varying follow-up time window spanning from during admission to 6 months of follow-up. Pneumonia is a leading cause of death among hip fracture patients, (12,13) and is associated with an excess mortality risk among hip fracture patients.…”

Section: Introductionmentioning

confidence: 99%

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Increasing Risk of Hospital-Treated Infections and Community-Based Antibiotic Use After Hip Fracture Surgery: A Nationwide Study 2005–2016

Kjørholt

Johnsen

Kristensen

et al. 2018

Journal of Bone and Mineral Research

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We aimed to examine trends in the incidence of treated infections following hip fracture surgery in Denmark from 2005 to 2016. We conducted a nationwide cohort study using individual‐level linked data from Danish population‐based registries. We calculated cumulative incidence considering death as competing risk and, based on the pseudo‐observation method, risk ratios (RRs) with 95% confidence interval (CI) using the period 2005–2006 as a reference. RRs were adjusted for age, sex, and comorbidity. A total of 74,771 patients aged 65 years or older with first‐time hip fracture surgery were included. The risk of postoperative (at 15, 30, 90, and 365 days) infections increased during 2005–2016. The 30‐day cumulative incidence of all hospital‐treated infections increased from 10.8% (95% CI, 10.2% to 11.3%) in 2005–2006 to 14.3% (95% CI, 13.7% to 15.0%) in 2015–2016 (adjusted RR 1.32; 95% CI, 1.23 to 1.42). Adjusted RR for 30‐day hospital‐treated pneumonia was 1.70 (95% CI, 1.49 to 1.92). The 30‐day cumulative incidence of redeeming community‐based antibiotic prescriptions increased from 17.5% (95% CI, 16.8% to 18.2%) in 2005–2006 to 27.1% (95% CI, 26.3% to 27.9%) in 2015–2016 (adjusted RR 1.54; 95% CI, 1.47 to 1.62). The largest increase was observed for broad‐spectrum antibiotic use (adjusted RR 1.79; 95% CI, 1.68 to 1.90). During 2005–2016, risk of infections was substantially higher in hip fracture patients than in the general population. The risk of hospital‐treated pneumonia and antibiotic prescriptions increased more over time among hip fracture patients. We found increased risks of postoperative treated infections following hip fracture surgery during the 12‐year study period, which could not entirely be explained by similar infection trends in the general population. Given the high mortality following infections in the elderly, further research is needed to identify patients at increased risk to target preventive treatment and potentially reduce complications and mortality in hip fracture patients. © 2018 American Society for Bone and Mineral Research.

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“…Warum männliches Geschlecht zu einem erhöhten Behandlungsrate führt, ist nicht geklärt. Es gibt Hinweise, dass Männer häufiger nach der operativen Versorgung von Hüftfrakturen Delir entwickeln, ohne dass eine eindeutige Erklärung für diesen Geschlechtseffekt gefunden wurde [36]. Möglicherweise befanden sich in der Stichprobe, besonders viele Männer mit einem bei Männern häufiger vorkommenden Alkohol bedingten Delir, das aber falsch kodiert wurde [37].…”

Section: Einflussfaktoren Auf Die Verordnung Delirspezifischer Medikaunclassified

Inzidenz und Behandlung des nicht stoffgebundenen Delirs in deutschen Haus- und Facharztpraxen

Bohlken

Hewer

Kostev³

2018

Fortschr Neurol Psychiatr

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Zusammenfassung Ziel Über die Häufigkeit und die medikamentöse Behandlung des nicht stoffgebundenen Delirs in deutschen Haus- (HA) und Facharzt-Praxen (FA) ist wenig bekannt. Ziel der Studie war die Bestimmung der Delir-Inzidenz und der Delir-Behandlung mit Neuroleptika und Benzodiazepinen in HA.- und FA-Praxen. Methoden In dem Zeitraum von 2012 bis 2015 wurden 2.999 Patienten > 65 Jahre in 1.262 HA- und 1.425 Patienten in 203 FA-Praxen mit erstmaliger Delir-Diagnose (ICD 10: F05) ausgewählt und hinsichtlich der Verordnung von Neuroleptika (EphMRA ATC: N05A) und Benzodiazepine (N06C) untersucht, die direkt nach der Diagnosestellung des Delirs erfolgte. Ergebnisse Die kumulative 1-Jahres-Inzidenz des Delirs betrug in HA-Praxen 0,6 und in FA-Praxen 1,9 Patienten pro Praxis. Keine Delir-Diagnose wurde in mehr als 40 % der Praxen gestellt. Im Heim erfolgte die Behandlung bei 31 % der HA- und 21 % der FA Patienten. Häufigste HA-Verordnung: Melperon (9,4 % zu Hause bzw. 13,7 % im Heim), FA: Risperidon (4,3 % zu Hause bzw. 13,4 % im Heim). Die antidelirante Medikation war positiv mit männlichem Geschlecht (OR = 1.26), Wohnen im Seniorenheim (OR = 1,74) Demenz (OR = 1.55) und Depression (OR = 1.32), und negativ mit FA-Behandlung (OR = 0.73) assoziiert. Schlussfolgerung Die Delir-Diagnose und seine medikamentöse Behandlung ist in deutschen Arzt-Praxen ein relativ seltenes Ereignis. Die Ursachen für die im internationalen Vergleich niedrige Prävalenzrate im ambulanten Versorgungsbereich sollte intensiver untersucht werden.

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Sex Differences in Hip Fracture Surgery: Preoperative Risk Factors for Delirium and Postoperative Outcomes

Cited by 76 publications

References 33 publications

Incidence of postoperative delirium in patients undergoing total knee arthroplasty—an Asian perspective

Incidence of postoperative delirium in patients undergoing total knee arthroplasty—an Asian perspective

Increasing Risk of Hospital-Treated Infections and Community-Based Antibiotic Use After Hip Fracture Surgery: A Nationwide Study 2005–2016

Inzidenz und Behandlung des nicht stoffgebundenen Delirs in deutschen Haus- und Facharztpraxen

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