Hemoglobin Concentration and Post-Operative Delirium in Elderly Patients Undergoing Femoral Neck Fracture Surgery

Abstract

This study aimed to determine the relationship between hemoglobin (Hb) concentration and post-operative delirium (POD) in elderly patients undergoing femoral neck fracture (FNF) surgery and to investigate whether the change in Hb concentration is associated with POD and the risk factors for POD. A total of 889 patients admitted with FNF between January 2016 and December 2020 were enrolled in this single-center, retrospective, case–control study. Hb concentrations were determined at admission and post-operative day 1 and the change in Hb concentration was defined as the absolute value of difference in pre-operative and post-operative Hb concentration. POD was assessed using the Confusion Assessment Method for the Intensive Care Unit (ICU) or the Confusion Assessment Method once a daily after surgery. The logistic regression analysis was performed for statistical analysis. In total, 172 (19.3%) patients developed POD and 151 (87.8%) patients developed POD within post-operative 3 days. Low pre-operative Hb concentration [p = 0.026, odds ratio (OR) = 0.978] and significant change in Hb concentration (p = 0.006, OR = 1.033) were significantly associated with POD. After excluding change in Hb concentration or pre-operative Hb concentration, neither of them was significantly associated with POD (p > 0.05). The interaction analysis of change in Hb concentration and pre-operative Hb concentration in the logistic regression model was negative. There was no significant relationship between post-operative Hb concentration and POD. Age (p < 0.001, OR = 1.072), stroke history (p = 0.003, OR = 2.489), post-operative ICU transfer (p = 0.007, OR = 1.981), and visual analog scale score within post-operative 2 days (p1 = 0.016 and p2 = 0.006) were independently associated with POD in the logistic regression analysis. Patients with low pre-operative Hb concentrations and high changes in Hb concentration seem to have an increased risk of POD and should receive more attention. Old age, stroke history, post-operative ICU transfer, and pain within post-operative 2 days were significantly associated with POD.

Evaluating Nutritional Risk Factors for Delirium in Intensive-Care-Unit Patients: Present Insights and Prospects for Future Research

“…In a recent retrospective analysis, the authors underscored a notable link between diminished pre-operative Hb concentrations and significant fluctuations in Hb levels, indicating an elevated risk of postoperative delirium. Furthermore, factors such as advanced age, a history of stroke, transfer to the ICU postoperatively, and experiencing pain within the initial 2 days following surgery exhibited noteworthy associations in this study [92].…”

The effect of parecoxib sodium on postoperative delirium in elderly patients with hip arthroplasty

“…Severe pain, both preoperative and postoperative, may increase stress and the occurrence of POD in patients ( Ding et al, 2021 ; Liu et al, 2022 ). The higher the degree of pain, the higher the incidence of POD, which might be related to the fact that pain can significantly affect sleep and disrupt the sleep-wake cycle in the patient, thus impairing cognitive function ( Jaiswal et al, 2020 ).…”

Machine learning for prediction of delirium in patients with extensive burns after surgery

“…In the study, the results of the multifactorial logistic regression analysis showed that both pre‐op Hb and pre‐op RBC were associated with the development of delirium in the patients, and we found that this result could be due to the multicollinearity of these two factors through the analysis of multicollinearity. At the same time, previous studies have shown that Hb 50,51 and delirium are more strongly correlated than RBC 52 . Therefore, to avoid affecting the performance of the model and to improve the accuracy of the prediction model, we finally chose to include pre‐op Hb in the prediction model and exclude pre‐op RBC.…”