Risk factors for onset of delirium after neck of femur fracture surgery: a prospective observational study.

Muaaz Tahir,Shahbaz S Malik,Atul Malik,Jakub Kozdryk,Usman Ahmed,Syeda Huma Naqvi

doi:10.1051/sicotj/2018018

Abstract

Background: Delirium is a common complication after surgery in the elderly that leads to increased length of stay and other adverse outcomes. The aim of this study was to better understand the exact causes of post-operative delirium in patients undergoing surgery for neck of femur (NOF) fractures.Methods: We performed a prospective cohort study of 381 consecutive patients undergoing surgery for NOF fractures at a single institution. Baseline cognitive status and risk factors were recorded on admission. Post-operative cognitive status was assessed at regular intervals until discharge. Binary logistic regression was performed to identify independent predictors of delirium.Results: Patients who developed post-operative delirium (n = 70) were significantly older (average age 83 vs. 78, p = 0.019) and more likely to be female (79% vs. 67%, p = 0.062) than non-affected patients. The presence of delirium was associated with increased length of stay (13 vs. 10 days, p = 0.001) and 1-year mortality (25.7% vs. 15% p = 0.03). Independent predictors of delirium included age ≥65 years (Odds Ratio = 5.8), presence of anaemia (OR = 2.9), hypoxia (OR = 2.86), cardiac disease (OR = 2.8), Chronic Obstructive Pulmonary Disease (OR = 2.5), new onset electrolyte imbalance (OR = 2.2) and renal failure (OR = 1.9).Conclusion: Overall analysis demonstrated an increased incidence of delirium in older females with greater comorbid conditions. It was also found to be associated with increased morbidity and mortality. We recommend clinicians put greater effort into recognising risk factors of delirium and diagnosing it in a timely manner to mitigate its effects.

Highlights

Postoperative delirium is a common complication of surgical interventions in the elderly
Its incidence is substantially influenced by patient-related risk factors, previous reviews have indicated that it affects a large proportion of orthopaedic patients
Patients experiencing delirium were significantly older and more likely to be female (79% vs. 67%, p = 0.062) than non-affected patients (Table 2)

Summary

Introduction

Postoperative delirium is a common complication of surgical interventions in the elderly. Characterised by acute and fluctuating impairment of cognition, attention, and consciousness, it is a multifactorial condition that is associated with poor outcomes. Its incidence is substantially influenced by patient-related risk factors, previous reviews have indicated that it affects a large proportion of orthopaedic patients. In 2007, a metaanalysis of 26 studies reported higher rates of delirium in patients undergoing hip fracture surgery (ranging from 4 to 53 percent) compared with elective surgery (3.6–28.3 percent) [1]. Delirium has immediate adverse implications for the orthopaedic patient such as an increased risk of major complications, slow recovery and a longer inpatient stay. Patients are typically less compliant with rehabilitation protocols and are more likely to require nursing home placement after discharge.

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