Prevalence and risk factors of postoperative delirium in elderly hip fracture patients

Abstract

ObjectiveTo explore the risk factors associated with postoperative delirium (PD) in elderly patients following total hip arthroplasty (THA) for hip fracture.MethodsThis prospective study enrolled elderly patients (≥ 65 years) with hip fractures who underwent THA under general anaesthesia, and who had a complete set of postoperative observations. Detailed medical history and perioperative characteristics were recorded. During the postoperative period, patients were assessed twice daily for PD using the Confusion Assessment Method.ResultsA total of 572 patients were eligible for inclusion in the study. Of these, 120 patients (21.0%) were diagnosed with PD and 452 patients (79.0%) did not experience PD. Multivariate stepwise logistic regression analyses showed that older age, a history of stroke, lower albumin, higher blood glucose, higher total bilirubin, higher C-reactive protein, longer surgery duration and higher volume of red blood cell transfusions were independent risk factors for PD.ConclusionsCorrecting the modifiable risk factors might help prevent PD. Strategies might include nutritional support, tight blood glucose control, improvement of liver function, preoperative infection control and minimizing surgical injury or blood loss.

The trajectory of C‐reactive protein serum levels in older hip fracture patients with postoperative delirium

“…A short delirium episode was defined as a postoperative delirium for 1 or 2 days. 12,[19][20][21][22][23][24] In agreement with most of these studies, we did not find an association between preoperative serum CRP levels and postoperative delirium in patients undergoing surgery for hip fracture. Duration of delirium was defined as the number of days with delirium according to CAM criteria.…”

“…7,9,10 Delirium has been associated with higher serum levels of the acute-phase protein C-reactive protein (CRP) in medical and surgical patients, [11][12][13][14][15] but neutral findings have been reported as well. 12,[19][20][21][22][23][24] Possible explanations for these discrepancies are small sample sizes, comorbidity, elective hip arthroplasty versus acute surgery for hip fracture, and differences in time points of blood sampling. However, studies in more homogenous patient groups, such as patients undergoing hip surgery, also have produced inconsistent findings.…”

Incidence and risk factors of postoperative delirium in elderly patients undergoing urological surgery: A multi‐institutional prospective study

“…In contrast, procedures associated with longer operation times and more invasiveness, such as Cx and open radical nephrectomy, had high incidences of postoperative delirium. These operations are associated with multiple factors that could induce delirium, such as general anesthesia, mechanical ventilation, severe pain and intense inflammatory responses . The results suggest that the risk of postoperative delirium in urological surgery is clearly correlated to the invasiveness of the operation.…”

“…Many other studies have suggested preoperative cognitive impairment as a risk factor . A history of CVD is a well‐known risk factor for delirium . In addition, hypoalbuminemia is also a well‐known risk factor for dementia in hospitalized patients, including those undergoing surgery, in many studies .…”

“…1,2 The incidence of postoperative delirium tends to depend on the type of surgery. Cardiovascular surgery and surgery for hip fractures are most commonly associated with postoperative delirium in elderly patients, with incidences of 23.5-52% 3,4 and 21-65%, 5,6 respectively. The incidence of delirium is affected by multiple factors.…”