Clinical Interventions in Aging (Feb 2023)

Delirium After Surgery for Proximal Femoral Fractures in the Frail Elderly Patient: Risk Factors and Clinical Outcomes

  • de Haan E,
  • van Rijckevorsel VA,
  • Bod P,
  • Roukema GR,
  • de Jong L

Journal volume & issue
Vol. Volume 18
pp. 193 – 203

Abstract

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Eveline de Haan,1,2 Veronique AJIM van Rijckevorsel,1 Pepijn Bod,1 Gert R Roukema,1 Louis de Jong1 On behalf of Dutch Hip Fracture Registry Collaboration (DHFR)1Surgery Department, Maasstad Hospital, Rotterdam, the Netherlands; 2Surgery Department, Franciscus Hospital, Rotterdam, the NetherlandsCorrespondence: Eveline de Haan, Tel +31654922535, Email [email protected]: The primary aim of this study was to identify risk factors for delirium after hip fracture surgery. The secondary purpose of this study was to verify peri-operative clinical outcomes, adverse events and mortality rates in delirium patients after hip fracture surgery.Patients and Methods: A prospective hip fracture database was used to obtain data. In total, 2051 patients older than 70 years undergoing a hip fracture surgery between 01– 01-2018 and 01– 01-2021 were included. A delirium was diagnosed by a geriatrician based on the DSM-V criteria.Results: The results showed that 16% developed a delirium during hospital admission. Multivariable analysis showed that male gender (OR: 1.99, p< 0.001), age (OR: 1.06, p< 0.001), dementia (OR: 1.66, p=0.001), Parkinson’s disease (OR: 2.32, p=0.001), Δhaemoglobin loss (OR: 1.19, p=0.022), pneumonia (OR: 3.86, p< 0.001), urinary tract infection (UTI) (OR: 1.97, p=0.001) and wound infection (OR: 3.02, p=0.007) were significant independent prognostic risk factors for the development of a delirium after hip surgery. The median length in-hospital stay was longer in patients with a delirium (9 days) vs patients without a delirium (6 days) (p< 0.001). The 30-day mortality was 7% (with delirium 16% vs with no delirium 6% (p< 0.001)).Conclusion: Significant independent prognostic factors associated with delirium after hip surgery were male gender, age, dementia, Parkinson’s disease, Δhaemoglobin loss, pneumonia, UTI and wound infection.Keywords: geriatric patients, hip fractures, delirium, risk factors, clinical outcomes

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