Review of Postoperative Delirium in Geriatric Patients After Hip Fracture Treatment

Abstract

Introduction Postoperative delirium (POD) is a serious complication occurring in 4–53.3% of geriatric patients undergoing surgeries for hip fracture. Incidence of hip fractures is projected to grow 11.9% from 258,000 in 2010 to 289,000 in 2030 based on 1990 to 2010 data. As prevalence of hip fractures is projected to increase, POD is also anticipated to increase. Signficance Postoperative delirium remains the most common complication of emergency hip fracture surgery leading to high morbidity and mortality rates despite significant research conducted regarding this topic. This study reviews literature from 1990 to 2021 regarding POD in geriatric hip fracture management. Results Potentially modifiable and non-modifiable risk factors for developing POD include, but are not limited to, male gender, older age, multiple comorbidities, specific comorbidities (dementia, cognitive impairment, diabetes, vision impairment, and abnormal blood pressure), low BMI, preoperative malnutrition, low albumin, low hematocrit, blunted preoperative cytokines, emergency surgery, time to admission and surgery, preoperative medical treatment, polypharmacy, delirium-inducing medications, fever, anesthesia time, and sedation depth and type. Although the pathophysiology remains unclear, the leading theories suggest neurotransmitter imbalance, inflammation, and electrolyte or metabolic derangements as the underlying cause of POD. POD is associated with increased length of hospital stay, cost, morbidity, and mortality. Prevention and early recognition are key factors in managing POD. Methods to reduce POD include utilizing interdisciplinary teams, educational programs for healthcare professionals, reducing narcotic use, avoiding delirium-inducing medications, and multimodal pain control. Conclusion While POD is a known complication after hip fracture surgery, further exploration in prevention is needed. Early identification of risk factors is imperative to prevent POD in geriatric patients. Early prevention will enhance delivery of health care both pre- and post-operatively leading to the best possible surgical outcome and better quality of life after hip fracture treatment.

Impact of nursing interventions on discharge disposition in patients with postoperative delirium

“…Regarding hypoalbuminemia, the relationship between malnutrition and delirium incidence and related outcomes is well documented 22-27. However, while preoperative hypoalbuminemia as a measure of malnutrition is associated with postoperative delirium incidence,20,28-31 we could not locate evidence indicating that preoperative hypoalbuminemia predicts the disposition of postoperative patients who experience delirium.…”

Updates in Neuroanesthesia

“…Recent literature suggests categorizing risk factors as those preceding or directly causing the onset Updates in Anesthesia -The Operating Room and Beyond of delirium. Older age, male sex, low pre-operative hematocrit, diabetes, preexisting cognitive impairment, and previous history of delirium are all factors that increase the risk of developing delirium [59]. Substances such as alcohol, recreational drugs, and steroids can lead to altered mental status and eventually delirium.…”

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

“…Due to the progressive aging of the global population, it is anticipated that the number of hip fractures worldwide will increase to an estimated 6.1 million cases by 2050, with an annual escalation of 1 to 3% ( 1 ). 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 ).…”