Abstract
Abstract Introduction Neck of femur fractures (NOF) remain a significant cause of mortality in the elderly, especially in those who develop delirium post operatively. The aim of our study is to identify risk factors that may contribute to developing a delirium. Method A prospective cohort study of 717 patients presenting to Morriston Hospital who underwent operative management for a NOF fracture. Results A total of 103 patients developed a post-operative delirium, an incidence of 14.4%. Clinical Frailty Score (CFS) and Abbreviated Mental Test Score (AMTS) proved to be significantly associated with developing delirium (p < 0.0001). Delirium was highly prevalent in patients with moderate frailty (CFS6≥) and an abnormal AMT score (<8), present in 70% and 73% respectively with individual odds ratios of 4.1 and 5.2. Delirious patients suffered higher inpatient mortality (16% v 5%, p 0.0004), an increased length of stay (32 vs 23 days, p < 0.0001) and were more likely to be directly institutionalised (10% vs 3% p 0.002) without rehabilitation. Admission inflammatory markers and prolonged waiting times for theatre were highly prevalent in both groups and not pursued. Conclusions Patients presenting with moderate frailty and abnormal AMTS were at greatest risk of developing a delirium which was associated with poorer outcomes. We propose identifying high-risk patients from the point of admission to ensure early targeting of potential reversible factors. A delirium toolkit could aid in identifying these patients and there may also be an argument for the prioritisation of high-risk individuals in theatre list given their increased mortality.
Published Version
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