Association between postoperative delirium and mortality in elderly patients undergoing hip fractures surgery: a meta-analysis

Bai, Jianzhong; Liang, Yuan; Zhang, P; Liang, Xianrong; He, Jing; Wang, J; Wang, Y

doi:10.1007/s00198-019-05172-7

Cited by 63 publications

(55 citation statements)

References 42 publications

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“…The incidence of delirium in hip fractures is significantly higher than that of other surgical patients. [ 12 , 16 ] Currently, the factors of delirium in patients after hip fracture surgery remain unclear, more studies are needed to further elucidate the potentially related factors. Therefore, we aimed to conduct this retrospective study to identify the risk factors of delirium in patients after hip fracture surgery, to provide insights into the development of measures targeted on those risk factors to reduce postoperative delirium in patients with hip fracture.…”

Section: Introductionmentioning

confidence: 99%

The risk factors of postoperative delirium in general anesthesia patients with hip fracture

Chu

Yi-xuan²,

Dai³

et al. 2021

Medicine

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Delirium is a common postoperative complication of patients with hip fracture, yet the risk factors for postoperative delirium in patients with hip fracture remain unclear. We aimed to evaluate the associated risk factors of postoperative delirium in patients with hip fracture, to provide evidence for formulating coping measures of postoperative delirium prevention and treatment in clinical practice. Patients undergoing surgery for hip fracture from March 1, 2018 to September 30, 2020 in our hospital were included. The related characteristics and related lab examination results were reviewed and collected. The univariate and logistic regression analyses were performed to identify the potential risk factors. A total of 462 patients were included, the incidence of postoperative delirium in patients with hip fracture was 16.02%. Logistic regression analyses indicated that history of delirium (OR = 4.38, 1.15–9.53), diabetes mellitus (OR = 5.31, 1.23–10.75), hypoalbuminemia (OR = 4.97, 1.37–9.86), postoperative hypoxemia (OR = 5.67, 2.24–13.42), and body mass index (BMI) (kg/m 2 ) (OR = 3.03, 1.36–6.18) were the independent risk factors for the delirium in patients with hip fracture surgery (all P < 0.05). The cutoff value of postoperative blood sugar, albumin, and BMI for delirium prediction was 8.05 (mmol/L), 32.26 (g/L), and 19.35 (kg/m 2 ), respectively, and the area under curve of postoperative blood sugar, albumin, and BMI was 0.792, 0.714, and 0.703, respectively. Those patients with a history of delirium, postoperative hypoxemia, blood glucose ≥8.05 mmol/L, albumin ≤32.26 g/L, and BMI ≤19.35 kg/m 2 particularly need the attention of healthcare providers for the prevention of delirium.

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Section: Introductionmentioning

confidence: 99%

The risk factors of postoperative delirium in general anesthesia patients with hip fracture

Chu

Yi-xuan²,

Dai³

et al. 2021

Medicine

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“…They observed 571 patients in which the morbidity of delirium was 38.5%, whereas the mortality rates of non-delirium and delirium groups separately were 8.3% and 24.1%, respectively. Bai et al 4 enrolled a total of 6288 patients and reported the prevalence of POD was 28% (23%-34%). They found that approximately one-fourth of patients undergoing hip fracture surgery went on to develop POD, and delirium increased both short-term and long-term mortality in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative delirium (POD) is a common clinical manifestation that occurs in 13-51% of elderly patients with hip fractures 4,5 . Several studies have demonstrated a correlation between POD and length of stay (LOS), as well as hospital costs [6][7][8] .…”

Section: Introductionmentioning

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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“…Thus, exercise prehabilitation has been suggested as a strategy to improve the functional reserve of frail patients, and presumably, to mitigate frailty-associated mortality. 5,6 Postoperative delirium is an acute disorder of attention and cognition that is associated with frailty 7e10 and increased mortality in the perioperative setting, 11 including after orthopaedic trauma. 12e14 Whether the relationship between frailty and mortality is mediated in part by postoperative delirium is unclear.…”

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confidence: 99%

Postoperative delirium mediates 180-day mortality in orthopaedic trauma patients

Pedemonte

Sun

Franco-Garcia³

et al. 2021

British Journal of Anaesthesia

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Background: Frailty has been associated with increased incidence of postoperative delirium and mortality. We hypothesised that postoperative delirium mediates a clinically significant (!1%) percentage of the effect of frailty on mortality in older orthopaedic trauma patients. Methods: This was a single-centre, retrospective observational study including 558 adults 65 yr and older, who presented with an extremity fracture requiring hospitalisation without initial ICU admission. We used causal statistical inference methods to estimate the relationships between frailty, postoperative delirium, and mortality. Results: In the cohort, 180-day mortality rate was 6.5% (36/558). Frail and prefrail patients comprised 23% and 39%, respectively, of the study cohort. Frailty was associated with increased 180 day mortality from 1.4% to 12.2% (11% difference; 95% confidence interval [CI], 8.4e13.6), which translated statistically into an 88.7% (79.9e94.3%) direct effect and an 11.3% (5.7e20.1%) postoperative delirium mediated effect. Prefrailty was also associated with increased 180 day mortality from 1.4% to 4.4% (2.9% difference; 2.4e3.4), which was translated into a 92.5% (83.8e99.9%) direct effect and a 7.5% (0.1e16.2%) postoperative delirium mediated effect. Conclusions: Frailty is associated with increased postoperative mortality, and delirium might mediate a clinically significant, but small percentage of this effect. Studies should assess whether, in patients with frailty, attempts to mitigate delirium might decrease postoperative mortality.

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Association between postoperative delirium and mortality in elderly patients undergoing hip fractures surgery: a meta-analysis

Cited by 63 publications

References 42 publications

The risk factors of postoperative delirium in general anesthesia patients with hip fracture

The risk factors of postoperative delirium in general anesthesia patients with hip fracture

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

Postoperative delirium mediates 180-day mortality in orthopaedic trauma patients

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