Type 2 Diabetes Mellitus with Tight Glucose Control and Poor Pre-Injury Stair Climbing Capacity May Predict Postoperative Delirium: A Secondary Analysis

Abstract

(1) Background: Previous evidence demonstrates that tight glycemic control and good physical function could reduce the risk of delirium. This study aimed to investigate whether the occurrence of postoperative delirium (POD) in older hip fracture surgery patients is associated with preoperative glycemic control factors or pre-injury physical performance. (2) Methods: Three-hundred and nine individuals aged over 65 years and scheduled for hip fracture surgery were included at a single center. Glycemic control factors and pre-injury physical performance were assessed preoperatively. The presence of delirium was assessed using the Confusion Assessment Method on postoperative hospitalization days. Univariate and multivariable logistic regression models and a risk prediction model of POD were established. (3) Results: Among the 309 patients, 52 (16.83%) experienced POD during the hospital stay. The numbers of pre-injury physical performance and type 2 diabetes mellitus (T2DM) patients were significantly different in the POD and non-POD groups. The multivariable model showed that development of delirium was significantly explained by preoperative fasting blood glucose (FBG) (OR 0.804, p = 0.004), stair climbing (OR 0.709, p = 0.003), T2DM (odds ratio (OR) 3.654, p = 0.001), and age-adjusted Charlson comorbidity index (ACCI) (OR 1.270, p = 0.038). The area under the receiver operating characteristic curve (AUROC) of the risk prediction model including those covariates was 0.770. (4) Conclusions: More older T2DM patients develop POD after hip fracture surgery than patients without T2DM. A simple assessment of preoperative FBG and pre-injury stair climbing capacity may identify those at high risk for the development of POD. Higher preoperative FBG and good pre-injury stair climbing capacity are protective factors for POD.

The Association of Preoperative Diabetes With Postoperative Delirium in Older Patients Undergoing Major Orthopedic Surgery: A Prospective Matched Cohort Study

“…In line with previous studies, 11,12 our findings support the notion that preoperative diabetes is a significant predictor of POD in elderly patients undergoing major orthopedic surgery. In contrast to recently published work which were retrospective studies without match, 29,30 the strength of the current study is its prospective matched cohort design with preoperative diabetes as the primary exposure, which minimizes confounding from age, sex, and surgery type. Another strength is the well identification of diabetes, with all diabetics confirmed with a known history or a new preoperative diagnosis, which decreased the likelihood of missed diabetes.…”

Association between increased systemic immune-inflammation index and postoperative delirium in older intertrochanteric fracture patients

“…Recent research has revealed a close association between diabetes and cognitive dysfunction, including dementia and Alzheimer’s disease. This association may be driven by factors such as insulin resistance, altered glucose metabolism, vascular changes, and the metabolism of β-amyloid and tau [ 32 – 34 ].In our study, the relevant p value ( P = 0.047 ) was unfortunately close to 0.05, which may be attributed to the small sample size.…”

Clinical Values of Serum Uric Acid Levels in the Occurrence of Cognitive Impairment in AlcoholDependent Patients

“… 14 Long-term excessive drinking or alcoholism will lead to alcohol dependence, acute and chronic alcoholism, and extensive and severe damage to the central nervous system, including brain atrophy, toxic myopathy, multiple mental derangement, central nervous system degeneration, metabolic disease, and mental disorders. 15 , 16 The neuropsychological cognitive impairment caused by alcoholism, called alcohol-induced cognitive impairment, occurs in as many as 50%-80% of patients with alcohol dependence. 17 It is well known that cognitive function is a unique higher neural function of human beings, which involves multiple dimensions, including memory, understanding, attention, language, and executive function.…”