Predictive nomogram for postoperative delirium in elderly patients with a hip fracture

Zhang, Xin; Tong, Da ke; Ji, Fang; Duan, Xu zhou; Liu, Pei zhao; Qin, Sheng; Xu, Kai; Di-li, Xia ti

doi:10.1016/j.injury.2018.10.034

Cited by 47 publications

(68 citation statements)

References 17 publications

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“…In fact, although the meta‐analysis about risk factors for POD in patients with hip fracture surgery had been reported previously, 6,7 the strength of our report is that we add the latest clinical trials data 3,4,13,17,20,22,23,27‐29,34,37,38,41,43,50,51,53 based on previous studies, and provide updated evidences for clinician. But our meta‐analysis has following limitations.…”

Section: Discussionmentioning

confidence: 97%

“…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%

“…The pooled results of nine papers 3,23,31,37,42,47,50,51,53 which described the association between BMI and the incidence of POD suggests that lower BMI is a risk factor for the development of POD after hip fracture surgery(WMD:-0.62, 95% CI:-0.81, -0.44, P<0.001, Figure 2D), with mild heterogeneity(P=0.05, I 2 = 49.3%, Table 2).…”

Section: Asa Score and Bmimentioning

confidence: 99%

“…A total of five studies 5,33,36,42,53 reported the association between regional anesthesia and POD after hip surgery. The results of metaanalysis indicate that patients conducted regional anesthesia are likely to sustain POD after hip surgery (RR 1.20; 95% CI: 1.01, 1.43; P=0.04, Figure 3A), with mild heterogeneity (P=0.33, I 2 = 13.6%, Table 2).…”

Section: Regional Anesthesia Transfusion and Elective Surgerymentioning

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

114

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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: 97%

Section: Discussionmentioning

confidence: 99%

Section: Asa Score and Bmimentioning

confidence: 99%

Section: Regional Anesthesia Transfusion and Elective Surgerymentioning

confidence: 99%

See 2 more Smart Citations

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

114

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“…As a graphical presentation of predictive model, nomogram has been widely used in the area of oncology [25][26][27][28], with great advantages such as easy operation, convenience and effectiveness. Previously, we have reported the predictive nomogram for the development of postoperative delirium in elderly patients with a hip fracture [29]. The nomogram created in this study is supposed to be used clinically as a prediction method in the preoperative assessment, thus further studies with prospective designs can be conducted based on the existing preliminary results.…”

Section: Discussionmentioning

confidence: 99%

Postoperative pneumonia in geriatric patients with a hip fracture: incidence, risk factors and a predictive nomogram

Zhang

Duan

Tong

et al. 2020

Preprint

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Background : To evaluate the incidence and risk factors of postoperative pneumonia (POP) in geriatric patients with a hip fracture after surgery, to design a predictive nomogram and to validate the accuracy of the nomogram. Methods : We retrospectively studied 1285 surgical-treated geriatric patients with a hip fracture from April 2010 to April 2018. Surgical treatment was performed on the patients of this study. The procedure methods were classified as: total hip arthroplasty, hemiarthroplasty, percutaneous fixation, intramedullary nail fixation and plate/screw fixation. The primary interest of end point of this study is the development of POP during the postoperative period. The postoperative period in this study was defined as the time from 24 hours after surgery to discharge. The diagnostic criteria for pneumonia were set according to the guidelines built by the Infectious Diseases Society of America and the American Thoracic Society (Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia, 2005). Potential variables for developing POP were identified using logistic regression analyses initially and were further selected via the method of LASSO. Then the independent risk factors were identified by multivariable regression analyses. A predictive nomogram was built based on the multiple regression model, and the calibration abilities of the nomogram was measured by Harrel C-index, calibration plot and Hosmer-Lemeshow test respectively. Decision curve analysis was carried out to assess the net benefit due to threshold probability and an on-line questionnaire survey was conducted among the clinicians to assess the applicability of the nomogram coherently. Results: Of the 1285 patients, 70 (5.4%) developed POP. COPD, number of comorbidities, ASA classification > 2, preoperative dependent functional status and cognitive impairment were identified as independent risk factors of POP. The nomogram built based on the results showed good accordance between the predicted probabilities and the observed frequency. The decision curve analysis confirmed the clinical utility of the nomogram when the threshold probabilities were between 5% and 65% due to the net benefit, while the results of on-line questionnaire among 200 clinicians showed that 91.5% of the participants had a mental shreshold of intervention between 5-50%. Conclusion: 1. COPD, number of comorbidities, ASA classification > 2, preoperative dependent functional status and cognitive impairment were independent risk factors for POP. 2. The nomogram built in this study has a good accordance between the predictive risk and the observational incidence. The results of decision curve and questionnaire among clinicians show well applicability of the nomogram.

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Hemoglobin level, degree of mobilization, and pneumonia are associated with the development of postoperative delirium in cemented hemiarthroplasty after femoral neck fracture

Riemenschneider,

Dobrawa,

Sturm

et al. 2024

Eur J Trauma Emerg Surg

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Purpose The aim of this retrospective study was to identify independent prognostic factors for developing a postoperative delirium (POD) in patients suffering from a proximal femoral neck fracture and treated by implantation of a hemiprosthesis. Methods A retrospective study, including patients with hip hemiarthroplasty due to a femoral neck fracture between 2011 and 2020 was performed. Demographic data, preexisting conditions, intra-/postoperative complications, mobilization and laboratory results were extracted from the patients’ charts. The different parameters were analyzed comparing patients with and without POD. Results 412 patients, mean age of 81 ± 9.58 years were included, 66.5% (n = 274) were female, 18.2% (n = 75) of them developed a POD. Significantly higher incidence of POD was associated with older age (p < 0.001), lower level of haemoglobin (p < 0.001), higher post-surgery interleukin 6 (IL 6) level (p = 0.008), higher postoperative level of leukocytes (p = 0.01). Patients with POD received more units of packed red blood cells (PRBC) (p = 0.007). Patients with no mobility limitations pre-operatively developed POD less frequently (p = 0.01), whereas suffering from pneumonia (p = 0.03) or limited mobility postoperatively increased the risk of POD (p < 0.001). Conclusion This study could help to identify patients with a risk for developing POD after a hemiarthroplasty in femoral neck fractures. As a consequence, frequent controls of Hb, IL 6 and leucocytes levels to avoid anemia and infections, as well as the well surgical treatment to guarantee a good postoperative outcome.

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Predictive nomogram for postoperative delirium in elderly patients with a hip fracture

Cited by 47 publications

References 17 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

Postoperative pneumonia in geriatric patients with a hip fracture: incidence, risk factors and a predictive nomogram

Hemoglobin level, degree of mobilization, and pneumonia are associated with the development of postoperative delirium in cemented hemiarthroplasty after femoral neck fracture

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