Abstract
BackgroundPost-operative cognitive impairment is common in elderly patients following surgery for hip fracture, with undertreated pain being an important etiological factor. Non-opioid based analgesic techniques, such as nerve blocks, may help reduce the risk of cognitive complications. The aim of this study was to investigate whether receiving a fascia iliaca compartment block (FICB) as part of a pre-operative analgesic regime increased the odds of high post-operative abbreviated mental test scores (AMTS) when compared with conventional analgesia without a nerve block.MethodsA retrospective data analysis of a cohort of 959 patients, aged ≥ 65 years with a diagnosis of hip fracture and admitted to a single hospital over a two-year period was performed. A standardized analgesic regime was used on all patients, and 541/959 (56.4%) of included patients received a FICB. Provision of the FICB was primarily determined by availability of an anesthetist, rather than by patient status and condition. Post-operative cognitive ordinal outcomes were defined by AMTS severity as high (score of ≥9/10), moderate, (score of 7–8) and low (score of ≤6). A multivariable ordinal logistic regression analysis was performed on patient status and clinical care factors, including admission AMTS, age, gender, source of admission, time to surgery, type of anesthesia and ASA score.ResultsAdmission FICB was associated with higher adjusted odds for a high AMTS (score of ≥9) relative to lower AMTS (score of ≤8) than conventional analgesia only (OR = 1.80, 95% CI 1.27–2.54; p = 0.001). Increasing age, lower AMTS on admission to hospital, and being admitted from a residential or nursing home were associated with worse cognitive outcomes. Mode of anesthesia or surgery did not significantly influence post-operative AMTS.ConclusionPost-operative AMTS is influenced by pre-operative analgesic regimes in elderly patients with hip fracture. Provision of a FICB to patients on arrival to hospital may improve early post-operative cognitive performance in this population.
Highlights
Post-operative cognitive impairment is common in elderly patients following surgery for hip fracture, with undertreated pain being an important etiological factor
The aim of this study was to investigate whether patients receiving fascia iliaca compartment block (FICB) were more likely to exhibit high post-operative abbreviated mental test scores (AMTS) than those patients who received conventional analgesia without a nerve block
From a total data set of 959 patients, 934 (97.4%) had a pre-operative AMTS recorded and 909 patients (94.8%) had a post-operative AMTS recorded
Summary
Post-operative cognitive impairment is common in elderly patients following surgery for hip fracture, with undertreated pain being an important etiological factor. Undertreated pain and inadequate analgesia are important risk factors for development of post-operative cognitive impairment and delirium in patients following hip fracture [1]. Irrespective of etiology, cognitive impairment in patients following a hip fracture can adversely affect the patients’ ability to self-care, independently mobilize, request nursing assistance and engage with other post-operative recovery processes. Post-operative delirium in elderly patients is associated with increased one year mortality and worse functional outcomes [2]. Early intervention to reduce the risk of cognitive decline in patients with hip fracture represents a clear opportunity to improve postoperative outcomes and recovery
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