Abstract
Postoperative delirium is common in elderly patients with hip fracture. Pain is a major risk factor for delirium, and regional nerve blocks (RNBs) effectively control pain in hip fractures. This study aimed to evaluate the effect of RNB on delirium after hip surgery in elderly patients. This retrospective comparative study was performed in a single institution, and the data were collected from medical records between March 2018 and April 2021. Patients aged ≥60 years who underwent proximal femoral fracture surgery were included, while those with previous psychiatric illness and cognitive impairment were excluded. Two hundred and fifty-two patients were enrolled and divided into an RNB or a control group according to RNB use. Delirium was assessed as the primary outcome and postoperative pain score, pain medication consumption, and rehabilitation assessment as the secondary outcomes. Between the RNB (n = 129) and control groups (n = 123), there was no significant difference in the baseline characteristics. The overall incidence of delirium was 21%; the rate was lower in the RNB group than in the control group (15 vs. 27%, respectively, p = 0.027). The average pain score at 6 h postoperatively was lower in the RNB group than in the control group (2.8 ± 1.5 vs. 3.3 ± 1.6, respectively, p = 0.030). There was no significant difference in the pain score at 12, 24, and 48 h postoperatively, amount of opioids consumed for 2 postoperative days, and time from injury to wheelchair ambulation. We recommend RNB as a standard procedure for elderly patients with hip fracture due to lower delirium incidence and more effective analgesia in the early postoperative period.
Highlights
Osteoporotic hip fracture is a major health problem because it is associated with high mortality, morbidity, and costs [1]
The regional nerve blocks (RNBs) group consisted of 129 patients, while the control group consisted of 123 patients
There was no significant difference found in the average age, body mass index (BMI), adjusted Charlson comorbidity index (ACCI), Koval score before injury, injury mechanism, method of anesthesia, fracture type, time from injury to surgery, time from admission to surgery, and type of surgery
Summary
Osteoporotic hip fracture is a major health problem because it is associated with high mortality, morbidity, and costs [1]. There are downward trends of mortality related to hip fracture, greater efforts are needed to achieve better outcomes [2]. The health status and health-related quality of life of elderly patients are seriously affected by the presence of hip fracture, and most patients cannot return to their performance status before injury [3]. Postoperative delirium is one of the most common complications in elderly patients with hip fracture and could result in cognitive impairment, short-term functional impairment, and increased mortality [4]. Pain is a major risk factor for delirium; most elderly patients with hip fracture have a limited
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