Risk factors and prognosis of postoperative delirium in nonagenarians with hip fracture

Zhao, Shengjie; Sun, Tiansheng; Zhang, Jianzheng; Chen, Xiaobin; Wang, Xiaowei

doi:10.1038/s41598-023-27829-4

Cited by 16 publications

(3 citation statements)

References 21 publications

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“…In addition, Lu et al reported that SIRI was positively correlated with the occurrence of postoperative delirium in older patients with hip arthroplasty surgery ( 44 ). Numerous studies have confirmed that postoperative delirium in hip fracture patients was obviously associated with poor outcomes, including higher mortality ( 45 , 46 ). Thus, the positive association between SIRI and mortality may be partially explained by its association with complications after hip fracture.…”

Section: Discussionmentioning

confidence: 99%

Association of systemic inflammation response index with mortality risk in older patients with hip fracture: a 10-year retrospective cohort study

Fang,

Gao,

Wang

et al. 2024

Front. Med.

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ObjectiveWith a rapidly aging global population, the assessment of mortality risk following hip fracture in older adults has received increasing attention. Recently, the system inflammation response index (SIRI) has been identified as a novel prognostic marker to reflect both systemic inflammation and immune status. However, it is not yet known whether SIRI is a potential predictor of subsequent death in hip fracture patients. Therefore, this study aimed to investigate the association between SIRI and mortality in older patients with hip fracture.MethodsA total of 1,206 older hip fracture patients undergoing surgery between January 2013 and December 2022 were consecutively derived from our longitudinal database. Patients were divided into three groups according to SIRI tertiles, calculated as neutrophil × monocyte / lymphocyte. Survival status was obtained from medical records or telephone interviews, and the study outcome was all-cause mortality after hip fracture at the longest follow-up. Multivariate Cox proportional hazard model and restricted cubic spline (RCS) regression model were used to evaluate the association between SIRI and mortality. Moreover, a series of sensitivity analyses were conducted to further validate the robustness of the association.ResultsDuring a median follow-up of 43.85 months, 337 patients (27.94%) died. After full adjustment, each unit increase in SIRI was significantly associated with a 2.2% increase in overall mortality (95% confidence interval [CI]: 1.001–1.042, p = 0.029). Similarly, compared with the first tertile of SIRI, the second and third tertile showed a 1.335-fold (95% CI: 1.011–1.762, p = 0.042) and 1.447-fold (95% CI, 1.093–1.917, p = 0.010) higher risk of death. Sensitivity analyses confirmed the stability of the association. Moreover, RCS analysis revealed a positive non-linear relationship between SIRI and mortality (P for nonlinearity = 0.021).ConclusionHigh SIRI level at admission was significantly and positively associated with an increased risk of death, suggesting that SIRI may be an independent predictor of mortality in older patients with hip fracture.

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Section: Discussionmentioning

confidence: 99%

Association of systemic inflammation response index with mortality risk in older patients with hip fracture: a 10-year retrospective cohort study

Fang,

Gao,

Wang

et al. 2024

Front. Med.

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“…In this particular investigation, the mECM was employed to detect comorbidities in patients upon admission utilizing 30 unique medical conditions and screened and further stratified into groups 1–5 representing <0, 0, 1–5, 6–13, ≥14, respectively. Prior research has illustrated that this technique is significantly more effective at accounting for comorbidities than other approaches, resulting in a more accurate forecast of complications and mortality 15 , 16 . Functional independence measures (FIM) was utilized to assess and determine the patients’ capability to carry out their everyday tasks and perform their activities of daily living.…”

Section: Methodsmentioning

confidence: 99%

Efficacy of surgical intervention over conservative management in intertrochanteric fractures among nonagenarians and centenarians: a prospective cohort study

Guo,

Xu,

Geng

et al. 2024

International Journal of Surgery

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Background: Optimal treatment strategy for nonagenarians and centenarians with hip fractures (NCHF) remained unknown. We aimed to compare the outcomes of surgical and conservative management in NCHF. Methods: A prospective cohort study was conducted based on CPMHF database with NCHF patients hospitalized during 2014–2020. Comorbidities were evaluated by mECM score and restricted cubic spline was utilized to visually assess the dose-effect relationship between the mECM and outcomes. Propensity score matching was performed to balance baseline characteristics between non-surgical and surgical groups. Multivariate logistic regression, Cox proportional hazard analysis, and survival analysis were employed for unfavorable outcomes (UFO) evaluation. Competing risk of death were analyzed based on Fine and Gray’s hazard model and then constructed nomogram models for predicting survival rates. Subgroup analyses were used to determine potential population heterogeneity and sensitivity analyses were performed to test robustness of the results. Results: We found increasing trends for UFO with the increase in the mECM score, and that high mECM score (HMS, ≥3) was independently associated with a 2.42-fold (95%CI, 2.07-3.54; P=0.024) increased risk of UFO, which remained significant after considering the competing role of death and were more pronounced in non-surgical treatment, women, no insurance, and patients with spouse (all P for interaction<0.05). Surgical intervention was identified to be significant protective factors for UFO (RR, 0.59; 95%CI, 0.46-0.75; P<0.001) and severe complications (RR, 0.63; 95%CI, 0.41-0.96; P=0.033) after PSM, as well as survival (HR, 0.40, 95%CI, 0.28-0.58; P<0.001), which remained significant after considering the competing role of death and in all sensitivity analyses and were more pronounced in HMS participants (P for interaction=0.006). Subgroup analyses revealed surgical patients with HMS had a significantly higher UFO rate (excluding death, P<0.001) while non-surgical patients with HMS had higher mortality rate as compared to the others (P=0.005). Conclusion: Surgical treatment for NCHF yields better outcomes compared to conservative treatment.

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“…1 Previous study reported that the incidence of delirium after surgery ranges from 20% to 45% among older patients. 2 POD is linked to with neuropsychiatric symptoms, longer hospital stay, higher medical expenditures and lower in activities of daily living, [3][4][5] especially in older patients. More importantly, POD can also potentially be associated with the long-term cognitive dysfunction, dementia and even an increase in mortality.…”

Section: Introductionmentioning

confidence: 99%

The Potential Value of Systemic Inflammation Response Index on Delirium After Hip Arthroplasty Surgery in Older Patients: A Retrospective Study

Lu,

Lin,

Wang

et al. 2023

IJGM

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To explore the relationship between the systemic inflammation response index (SIRI) and postoperative delirium (POD) in older patients with hip arthroplasty surgery. Patients and Methods: Older patients who underwent elective hip arthroplasty surgery were included in this retrospective study. SIRI, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were collected from blood routine examination at admission. Binary logistic regression analysis was performed to evaluate the association between SIRI levels and POD was analyzed. Results: Ultimately, 116 older patients who met the inclusion criteria were assessed. Thirty-four (29%) of 116 patients diagnosed with POD were defined as the POD group, and the rest consisted of the Non-POD group. Compared with non-POD patients, POD patients showed significantly higher levels of SIRI (P < 0.001) and NLR (P = 0.002) at admission. There was no significance in the levels of PLR between two groups. SIRI was independently associated with the occurrence of POD in multivariate logistic regression analysis [odds ratio (OR) = 3.34, 95% confidence interval (95% CI) = 1.26-8.85, P = 0.016]. Receiver operating characteristic curve analysis indicated that SIRI with an optimal cutoff value of 0.987 predicted the POD with a sensitivity of 88.2% and specificity of 74.4%, and the area under the curve was 0.82 (95% CI, 0.74-0.90, P < 0.01). Conclusion:Preoperative SIRI and NLR levels in the blood are associated with the occurrence of POD. Moreover, preoperative SIRI level is a useful candidate biomarker to identify delirium after elective hip arthroplasty surgery in older patients.

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Risk factors and prognosis of postoperative delirium in nonagenarians with hip fracture

Cited by 16 publications

References 21 publications

Association of systemic inflammation response index with mortality risk in older patients with hip fracture: a 10-year retrospective cohort study

Association of systemic inflammation response index with mortality risk in older patients with hip fracture: a 10-year retrospective cohort study

Efficacy of surgical intervention over conservative management in intertrochanteric fractures among nonagenarians and centenarians: a prospective cohort study

The Potential Value of Systemic Inflammation Response Index on Delirium After Hip Arthroplasty Surgery in Older Patients: A Retrospective Study

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