Surgical delay is a risk factor of delirium in hip fracture patients with mild–moderate cognitive impairment

Pioli, Giulio; Bendini, Chiara; Giusti, Andrea; Pignedoli, Paolo; Cappa, Michele; Iotti, E.; Ferri, Maria Alice; Bergonzini, Eleonora; E, Sabetta

doi:10.1007/s40520-018-0985-y

Cited by 26 publications

(28 citation statements)

References 31 publications

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“…In anesthetic and operative risk factors, we found that regional anesthesia is a potential risk factor for POD. However, we also found that the effect of general anesthesia on POD is significant after excluding Chrispal et al 14 and Pioli et al 41 to resolve heterogeneity. In fact, the contribution of the anesthetic method on POD was conflicting.…”

Section: Discussionmentioning

confidence: 45%

“…In this meta-analysis, we divided risk factors for POD into individual as well as anesthetic and operative factors, and detected that individual factors, including advanced age, male, ASA score≥III, lower BMI, smoking, function dependency, visual impairment, preoperative delirium, dementia, hypertension, and COPD, as well as anesthetic and operative factors, including regional anesthesia, transfusion, and elective surgery could promote the development of POD in adult patients after hip fracture surgery. Compared with previous published meta-analysis, 6,7 we add the latest clinical trials data 3,4,13,17,20,22,23,[27][28][29]34,37,38,41,43,50,51,53 and provided updated evidences for clinician.…”

Section: Discussionmentioning

confidence: 99%

“…Twenty papers 4,5,18,19,24,27,[29][30][31]33,37,39,41,42,44 reported the association between age and POD, and the meta-analysis of these studies suggests that advanced age (WMD:2.33, 95% CI: 1.64, 3.02, P<0.001, Figure 2A) is a significant risk factor for the development of POD in adult patients after hip fracture surgery, with marked heterogeneity(P<0.001, I 2 = 75.1%, Table 2), after the sensitivity analyses by excluding outlier study, the heterogeneity is resolved, but the significance does not change ( Table 3). The Egger's test shows that there is no publication bias (P =0.74, Table2).…”

Section: Individual Factors 241 | Age and Sexmentioning

confidence: 99%

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The risk factors for postoperative delirium in adult patients after hip fracture surgery: a systematic review and meta‐analysis

Yin

et al. 2020

Int J Geriat Psychiatry

103

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Objectives: Postoperative delirium (POD) is the most common complication in patients after hip fracture surgery, and the incidence of POD is associated with mortality and disability in patients following hip fracture surgery. Therefore, this study aimed to identify the individual as well as anesthetic and operative risk factors associated with the POD in adult patients after hip fracture surgery. Methods: We searched relevant articles published to February 2020 in Cochrane Library, PubMed, and Embase. Studies involving adult patients who underwent hip fracture surgery were regarded as relevant if the studies contained the individual or anesthetic and surgical characteristics of participants. The pooled relative risk ratios (RRs) or weight mean difference of the variables were estimated by the Mantel-Haenszel or Inverse-Variance methods. Results: A total of 44 studies were included, which altogether included 104572 participants with hip fracture surgery (17703 patients with POD and 86869 patients without POD) and the incidence of POD was 16.93%. A total of 14 risk factors, classified into two categories which were individual as well as anesthetic and operative factors, were identified originally, which included age (weight mean difference

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Section: Discussionmentioning

confidence: 45%

Section: Discussionmentioning

confidence: 99%

Section: Individual Factors 241 | Age and Sexmentioning

confidence: 99%

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The risk factors for postoperative delirium in adult patients after hip fracture surgery: a systematic review and meta‐analysis

Yin

et al. 2020

Int J Geriat Psychiatry

103

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“…The same applies to delirium. Many factors could contribute to the occurrence of postoperative delirium [42,47], including ambulatory status [8,28]. As a result, it is challenging to determine the effect of factors that contribute to the development of pressure sores and delirium.…”

Section: Medical Complicationsmentioning

confidence: 99%

Complications of external cerebrospinal fluid drainage in aneurysmal subarachnoid haemorrhage

et al. 2021

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Background The need for external cerebrospinal fluid (CSF) drains in aneurysmal subarachnoid haemorrhage (aSAH) patients is common and might lead to additional complications. Objective A relation between the presence of an external CSF drain and complication risk is investigated. Methods A prospective complication registry was analysed retrospectively. We included all adult aSAH patients admitted to our academic hospital between January 2016 and January 2018, treated with an external CSF drain. Demographic data, type of external drain used, the severity of the aSAH and complications, up to 30 days after drain placement, were registered. Complications were divided into (1) complications with a direct relation to the external CSF drain and (2) complications that could not be directly related to the use of an external CSF drain referred to as medical complications Results One hundred and forty drains were implanted in 100 aSAH patients. In total, 112 complications occurred in 59 patients. Thirty-six complications were drain related and 76 were medical complications. The most common complication was infection (n = 34). Drain dislodgement occurred 16 times, followed by meningitis (n = 11) and occlusion (n = 9). A Poisson model showed that the mean number of complications raised by 2.9% for each additional day of drainage (95% CI: 0.6–5.3% p = 0.01). Conclusion Complications are common in patients with aneurysmal subarachnoid haemorrhage of which 32% are drain-related. A correlation is present between drainage period and the number of complications. Therefore, reducing drainage period could be a target for further improvement of care.

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“…The results of this study showed that the delirium group had a longer injury-to-surgery time than the nondelirium group. Pioli et al 18 considered the delay of surgery to be a risk factor for delirium. For older adult hip fracture patients with mild to moderate cognitive impairment, early surgery should be one of the preoperative goals.…”

Section: Discussionmentioning

confidence: 99%

Impact of Delirium on Short-term Prognosis in Geriatric Patients with Hip Fracture

Feng

et al. 2020

Preprint

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Background: To explore the effect of delirium on postoperative early prognosis of geriatric patients with hip fracture. Methods: According to whether postoperative delirium (POD) appeared in elderly patients with hip fracture, all cases were divided into two groups: delirium and non-delirium. General parameters, operative parameters, length of stay (LOS), and perioperative complications were recorded. Recurrent fracture, new stroke, and mortality within 1 year postoperatively were followed up and compared between the two groups. Results: Of 358 cases, 55 (15.4%) developed delirium. Compared with the non-delirium group, the delirium group had longer operative times (P=0.031); increased platelet (P=0.002) and C-reactive protein (P<0.001) levels; and reduced hemoglobin (P<0.001), calcium (P=0.040), albumin (P<0.001), prealbumin (P<0.001), and total cholesterol (P=0.019) levels. Complications occurred to some extent in 196 cases (54.7%). In the delirium group, complication rates of pulmonary infection (P=0.005), hypoalbuminemia (P<0.001), electrolyte disorder (P<0.001), dyspepsia (P=0.027), bedsore (P=0.012) and anemia (P=0.007) were higher. In addition, LOS was significantly longer (15.71 ± 4.72 vs 14.00 ± 5.30 days; P=0.026) in the delirium group. Within 1 year postoperatively, 31 individuals (8.7%) had died, 13 were treated for recurrent fracture, and 42 had a new stroke. In the delirium group, mortality within 1 year postoperatively was higher (27.3% vs 5.3%, P<0.001). Conclusions: The morbidity of POD is high in geriatric patients with hip fractures. There was longer surgery delay, higher complication rate, longer LOS, and increased mortality in the delirium group. Early intervention of POD has important clinical significance.

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Surgical delay is a risk factor of delirium in hip fracture patients with mild–moderate cognitive impairment

Abstract: The study supports the concept that older adults with HF should undergo surgery quickly. Patients with mild-to-moderate cognitive impairment should be primarily considered as the best target for interventions aiming to reduce time to surgery.

Cited by 26 publications

References 31 publications

The risk factors for postoperative delirium in adult patients after hip fracture surgery: a systematic review and meta‐analysis

The risk factors for postoperative delirium in adult patients after hip fracture surgery: a systematic review and meta‐analysis

Complications of external cerebrospinal fluid drainage in aneurysmal subarachnoid haemorrhage

Impact of Delirium on Short-term Prognosis in Geriatric Patients with Hip Fracture

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