Factors associated with post-operative delirium in hip fracture patients: what should we care

Kong, Dequn; Luo, Wei; Zhu, Zhijun; Sun, Shiyuan; Zhu, Jun

doi:10.1186/s40001-022-00660-9

Cited by 17 publications

(13 citation statements)

References 49 publications

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“…Hypoalbuminemia was another risk factor for POD in patients with hip fracture in our study, which was consistent with Chu’s study (Chu et al, 2021 ) and Kong’s study (Kong et al, 2022 ). Chu et al found that albumin ≤32.26 g/L was an independent risk factor in elderly patients with hip fracture, which was slightly different from Kong’s study (albumin ≤32.26 g/L vs. albumin ≤40 g/L).…”

Section: Discussionsupporting

confidence: 93%

Development and Validation of a Nomogram for Predicting Postoperative Delirium in Patients With Elderly Hip Fracture Based on Data Collected on Admission

Yang

Wang

Guo

et al. 2022

Front. Aging Neurosci.

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Delirium is a common postoperative complication in elderly hip fracture patients that seriously affects patients’ lives and health, and early delirium risk prediction, and targeted measures can significantly reduce the incidence of delirium. The purpose of this study was to develop and validate a nomogram for the prediction of postoperative delirium (POD) in elderly hip fracture patients. A total of 328 elderly patients with hip fractures enrolled retrospectively in department 1 of our hospital were randomly divided into the training set (n = 230) and the internal validation set (n = 98). The least absolute shrinkage and selection operator (LASSO) regression analysis was used for feature variable selection, and multivariate logistic regression with a backward stepwise method was used to construct a nomogram in the training set. The discrimination efficacy and calibration efficacy of the nomogram were evaluated through the receiver operating characteristic (ROC) curve and calibration curve, respectively. The clinical usefulness was estimated through decision curve analysis (DCA) and clinical impact curve (CIC) analysis. Another validation set from department 2 of our hospital, containing 76 elderly patients with hip fractures, was used for external validation of the nomogram. A total of 43 (13.1%) and 12 (15.8%) patients had POD in department 1 and department 2, respectively. The nomogram was constructed by three predictors, including dementia, chronic obstructive pulmonary disease (COPD), and albumin level. The nomogram showed good discrimination efficacy and calibration efficacy, with the AUC of 0.791 (95% CI, 0.708–0.873), 0.820 (95% CI, 0.676–0.964), and 0.841 (95% CI, 0.717–0.966) in the training set, the internal validation set, and the external validation set, respectively. Both DCA and CIC demonstrated that this nomogram has good clinical usefulness. The nomogram constructed by dementia, COPD, and albumin level can be conveniently used to predict POD in patients with elderly hip fractures.

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Section: Discussionsupporting

confidence: 93%

Development and Validation of a Nomogram for Predicting Postoperative Delirium in Patients With Elderly Hip Fracture Based on Data Collected on Admission

Yang

Wang

Guo

et al. 2022

Front. Aging Neurosci.

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“…Kong et al have reported that elderly patients (≥75 years of age) with a hip fracture are 3.112 times more likely to develop delirium after a hip surgery. [13] In general, elderly patients have poor functional ability and degeneration of internal organs accompanied by many chronic medical diseases. Moreover, they are prone to merge due to poor oral intake and metabolic disorder, leading to malnutrition.…”

Section: Discussionmentioning

confidence: 99%

Is there a difference between preoperative and postoperative delirium in elderly hip fracture patients?: A retrospective case control study

Lim,

Roh,

Park

et al. 2024

Medicine

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Delirium is associated with greater morbidity, higher mortality, and longer periods of hospital day after hip fracture. There are number of studies on postoperative delirium after a hip fracture. However, few studies have made a distinction between preoperative and postoperative delirium. The purpose of this study is to compare risk factors and clinical outcome between preoperative and postoperative delirium in elderly patients with a hip fracture surgery. A total of 382 consecutive patients aged > 65 years who underwent operation for hip fracture were enrolled. Among them, the patients diagnosed with delirium were divided into 2 groups (a preoperative delirium group and a postoperative delirium group) according to the onset time of delirium. To evaluate risk factors for preoperative and postoperative delirium, we analyzed demographic data, preoperative laboratory data, and perioperative data. To compare clinical outcomes between preoperative and postoperative delirium, we analyzed postoperative complications, KOVAL score, regression, readmission, and 2-year survival rate. Delirium was diagnosed in 150 (39.3%) patients during hospitalization. Preoperative and postoperative delirium occurred in 67 (44.6%) and 83 (55.4%) patients, respectively. Independent risk factors of preoperative delirium included age (odds ratio: 1.47, 95% confidential interval [CI]: 1.13–2.23, P = .004), stroke (odds ratio [OR]: 2.70, 95% CI: 1.11–6.01, P = .015), American Society of Anesthesiologist (OR: 1.68, 95% CI: 1.137–2.24, P = .033), and time from admission to operation (OR: 1.08, 95% CI: 1.01–1.16, P = .031). There was no significant difference in preoperative KOVAL score between the 2 groups. However, postoperative KOVAL score (5.1 ± 2.0 vs 4.4 ± 2.1, P = .027) and regression rate (68.7% vs 44.6%, P = .029) were significantly higher in the preoperative delirium group than in the postoperative delirium group. Moreover, the 2-year survival rate was significantly lower in the preoperative delirium group than in the postoperative delirium group (62.7% vs 78.3%, P = .046). Characteristics, risk factors, and prognosis are different for patients with preoperative delirium and postoperative delirium. Preoperative delirium patients showed different risk factors with poorer prognosis and higher mortality. Therefore, hip fracture patients with risk factors for preoperative delirium should be monitored more carefully due to their greater risk of mortality.

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“…Postoperative delirium (POD) is a frequent and severe complication in geriatric patients who have undergone hip fracture surgery, with an incidence rate ranging from 4 to 53% ( 2 – 10 ). POD is an acute cognitive dysfunction characterized by changes in consciousness or attention that cannot be attributed to pre-existing cognitive impairment ( 2 , 8 , 9 ). Hallucinations and delusions, restlessness, disturbed speech, decreased attention, disordered thinking, agitated behavior, and disturbances in sleep–wake cycles are the most prevalent symptoms ( 5 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

Association between preoperative albumin levels and postoperative delirium in geriatric hip fracture patients

Wang,

Yao,

Tang

et al. 2024

Front. Med.

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ObjectiveThis study aims to examine the association between preoperative serum albumin levels and postoperative delirium (POD) in geriatric patients who have undergone hip fracture surgery, with the goal of offering novel insights for clinical interventions targeting POD.MethodsA retrospective analysis was conducted on the medical records of patients who underwent hip fracture surgery in a tertiary medical institution from January 2013 to November 2023. The patients were classified based on hypoalbuminemia (defined as a serum albumin level < 35 g/L) and clinical threshold. Multivariable logistic regression and propensity score matching analysis (PSM) were employed to calculate the adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for POD to eliminate potential confounding factors. Additionally, subgroup analysis was performed to explore the interaction effect.ResultsThe retrospective cohort study included 1,440 patients, with an incidence of POD found to be 19.1%. In a multivariable logistic regression analysis, patients with hypoalbuminemia had an adjusted OR of 2.99 (95%CI: 2.14–4.18) compared to those with normal albumin levels (≥ 35 g/L). Furthermore, a significant trend was observed across different severity categories, including mild hypoalbuminemia (34.9–30.0 g/L; adjusted OR = 2.71, 95%CI: 1.84–3.99), moderate hypoalbuminemia (29.9–25.0 g/L, adjusted OR = 3.44, 95%CI: 1.88–6.28), and severe hypoalbuminemia (<25.0 g/L; adjusted OR = 3.97, 95%CI: 1.78–8.86), with a trend value of p <0.001. Similar results were observed in the PSM analysis. Additionally, treating preoperative serum albumin level as a continuous variable, the risk of POD increased by 11% (95% CI, 1.08–1.15) with each 1 g/L decrease in preoperative serum albumin level.ConclusionLow preoperative levels of albumin are strongly associated with POD in geriatric patients with hip fractures, and a significant dose–response relationship exists between them.

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Factors associated with post-operative delirium in hip fracture patients: what should we care

Cited by 17 publications

References 49 publications

Development and Validation of a Nomogram for Predicting Postoperative Delirium in Patients With Elderly Hip Fracture Based on Data Collected on Admission

Development and Validation of a Nomogram for Predicting Postoperative Delirium in Patients With Elderly Hip Fracture Based on Data Collected on Admission

Is there a difference between preoperative and postoperative delirium in elderly hip fracture patients?: A retrospective case control study

Association between preoperative albumin levels and postoperative delirium in geriatric hip fracture patients

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