Abstract
BackgroundDelirium is common in hip fracture patients and many risk factors have been identified. Controversy exists regarding the possible impact of intraoperative control of blood pressure upon acute (delirium) and long term (dementia) cognitive decline. We explored possible associations between perioperative hemodynamic changes, use of vasopressor drugs, risk of delirium and risk of new-onset dementia.MethodsProspective follow-up study of 696 hip fracture patients, assessed for delirium pre- and postoperatively, using the Confusion Assessment Method. Pre-fracture cognitive function was assessed using the Informant Questionnaire of Cognitive Decline in the Elderly and by consensus diagnosis. The presence of new-onset dementia was determined at follow-up evaluation at six or twelve months after surgery. Blood pressure was recorded at admission, perioperatively and postoperatively.ResultsPreoperative delirium was present in 149 of 536 (28%) assessable patients, and 124 of 387 (32%) developed delirium postoperatively (incident delirium). The following risk factors for incident delirium in patients without pre-fracture cognitive impairment were identified: low body mass index, low level of functioning, severity of physical illness, and receipt of ≥ 2 blood transfusions. New-onset dementia was diagnosed at follow-up in 26 of 213 (12%) patients, associated with severity of physical illness, delirium, receipt of vasopressor drugs perioperatively and high mean arterial pressure postoperatively.ConclusionRisk factors for incident delirium seem to differ according to pre-fracture cognitive status. The use of vasopressors during surgery and/or postoperative hypertension is associated with new-onset dementia after hip fracture.
Highlights
A hip fracture is a potentially devastating event, and serious surgical and medical complications occur frequently [1]
New-onset dementia was diagnosed at follow-up in 26 of 213 (12%) patients, associated with severity of physical illness, delirium, receipt of vasopressor drugs perioperatively and high mean arterial pressure postoperatively
The use of vasopressors during surgery and/or postoperative hypertension is associated with new-onset dementia after hip fracture
Summary
A hip fracture is a potentially devastating event, and serious surgical and medical complications occur frequently [1]. The median age of hip fracture patients is above 80 years [3]. Age > 82 years, n/N (%) NEADL < 45 points, n/N (%) BMI < 20.0 kg/m2, n/N (%) Time admission to surgery > 24 hours, n/N (%) Admission and preoperative data ASA group III, IV or V, n/N (%) CRP > 10 mg/L, n/N (%) MAP at admission, mmHg, median (IQR) HR at admission, bpm, median (IQR) Per- and postoperative data Type of anaesthesia. General anaesthesia Spinal or epidural anaesthesia Duration of anaesthesia, in quartiles Q1 Q2 Q3 Q4 Being in Q4 vs Q1-Q3 Received benzodiazepine iv perioperatively, n/N (%) Lowest MAP during anaesthesia, mmHg, median (IQR) Difference in MAP from admission to lowest value during anaesthesia. Prefracture NEADL < 45 points, n/N (%) Prefracture Barthel Index 19 or 20, n/N (%) Prefracture hypertension, n/N (%) Charlson comorbidity index >1, n/N (%) Polypharmacy (= 5 or more medic), n/N (%) Injury occurred indoors, n/N (%) Admission data ASA group III, IV or V, n/N (%)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
