Treatment and prevention of postoperative complications in hip fracture patients: infections and delirium

Abstract

The course of older patients with hip fractures is often complicated by infections and delirium. Accurate care and high suspicion for these complications are essential, since these conditions are associated with an increase in mortality, length of hospital stay and nursing home placement, poorer mobility, and functional decline. Because of immunosenescence and higher infection rates, older patients need specific care, immediate diagnosis, and treatment of infections. Numerous guidelines of various medical societies outline the management of nosocomial infections, but there is a need of an individualized treatment plan because of comorbidities and polypharmacy. Hygiene measures have first priority to reduce the rate of infections. Treatment of geriatric syndromes like malnutrition, exsiccosis, gait disorders, falls, delirium, urine incontinence, and organ insufficiency are as important as immunization against pneumococci and influenza. Advanced age, cognitive impairment, hearing loss, peripheral vascular disease, prior delirium episodes, sight disorders, and polypharmacy are established risk factors for delirium; thus, older people with several chronic diseases are prone to delirium. A multifactorial approach, comprising standardized screening, oxygen support, intravenous fluid administration and augmented nutrition, monitoring of vital signs, pain treatment, optimized medication, and modification in perioperative management, significantly reduces delirium incidence during hospitalization for hip fracture. An interdisciplinary approach between surgeons and geriatricians may warrant optimized satisfaction of patients' needs.

The Neutrophil to Lymphocyte Ratio on Admission and Short-Term Outcomes in Orthogeriatric Patients

“…Previous research has shown that infective complications occur primarily in patients with persistent elevation and/or second rise in CRP concentrations (CRP>96 mg/L) after the first 3 postoperative days 62 . Postoperative infections complicating HF surgery have been reported in 8.9% - 61% 10 , 93 - 97 and were associated (particularly deep wound and chest infections) with delirium, increased length of hospital stay, 30-day and 1-year mortality 2 , 10 , 98 . The increased susceptibility of orthogeriatric patients to postoperative infective complications, one of the main factors affecting outcomes, is, at least partially, a result of age-related decline and dysregulation in immune functions 99 - 103 .…”

“…Preoperative multimorbidity of older adults (>50% have three or more chronic diseases 1 ) causes a significant increase in the burden of morbidity and mortality and requires specific management. Postoperative adverse outcomes dominated by cardiovascular events 2 - 6 and inflammatory complications 7 - 10 are associated with increased hospital stay, institutionalization, poorer quality of life, higher inpatient and long-term mortality, greater use of healthcare resources and substantially increased costs 11 - 13 . Although post-admission and postoperative conditions and complications contribute significantly to outcomes, it is important to identify preoperative outcome-affecting risk factors related to both medical comorbidities and orthopaedic conditions and treatment.…”

The prevalence and risk factors for urinary tract infection in elderly patients presenting with proximal femoral fractures: a prospective observational study

“…Early treatment of UTI decreased the risk of delirium, thus further decreasing hospital stay and improving patient morbidity. [12][13][14] In the South African health care system there is great emphasis on saving money and decreasing the cost of health care. Research has substantiated this clear financial implication and shows that almost 20% more money is being spent per patient with complications, when compared to uncomplicated cases.…”

Increased risk of mortality after postoperative infection in hip fracture patients

“…Early remobilization, respiratory exercises, and nutritional support could potentially avert some types of postoperative infections. [30,31] Systemic prophylactic antibiotics in hip fracture surgery is well-recommended, [32,33] but doses, durations, and combinations might be optimized. Furthermore, the rehabilitation of the patients immediately after discharge, including resources in municipalities, as well as collaboration with GPs, is presumably highly important for the prognosis following postoperative infections.…”