Radinovic Kristina, Markovic-Denic Ljiljana, Dubljanin-Raspopovic Emilija, Marinkovic Jelena, Milan Zoka, Bumbasirevic Vesna
Clinic of Anesthesiology, Clinical Center of Serbia, Belgrade, Serbia.
Institute of Epidemiology, University of Belgrade, Belgrade, Serbia.
Geriatr Gerontol Int. 2015 Jul;15(7):848-55. doi: 10.1111/ggi.12358. Epub 2014 Sep 26.
We aimed to evaluate the factors contributing to delirium after hip fracture and assess the effect of incident delirium on short-term clinical outcomes.
A total of 270 non-delirious, consecutive hip fracture patients 60 years and older were included in a prospective cohort study. The patients were assessed with respect to physical status according to the American Society of Anesthesiologists classification, medical comorbidities with the Charlson Comorbidity Index, cognitive function with the Portable Mental Status Questionnaire and depression with the Geriatric Depressive Scale. Incident delirium was evaluated daily. Clinical outcomes and 1-month mortality were recorded.
Incident delirium was present in 53.0% of patients. Patients with delirium were older (P = 0.046), had higher American Society of Anesthesiologists and Charlson Comorbidity Index scores (P < 0.001), lower Portable Mental Status Questionnaire scores and higher Geriatric Depressive Scale scores (P < 0.001, P = 0.003, respectively). After adjusting for age, multivariate regression analysis in the first model showed that patients with delirium were at higher risk of reintervention plus death (P < 0.05), complications P < 0.001), a higher severity complication score (P < 0.05) and longer length of hospital stay (P < 0.001). In the second model, after adjusting for propensity score, patients with delirium were at higher risk of reintervention plus death (P < 0.05) and longer length of hospital stay (P < 0.01).
Patients who are older, with worse physical status, worse cognitive function and depression are more likely to develop delirium after hip fracture. Incident delirium has negative independent effects on short-term outcomes in elderly patients after hip fracture.
我们旨在评估髋部骨折后谵妄的相关因素，并评估新发谵妄对短期临床结局的影响。
一项前瞻性队列研究纳入了270例60岁及以上无谵妄的连续性髋部骨折患者。根据美国麻醉医师协会分类对患者的身体状况进行评估，采用Charlson合并症指数评估合并症，采用简易精神状态问卷评估认知功能，采用老年抑郁量表评估抑郁情况。每天评估新发谵妄。记录临床结局和1个月死亡率。
53.0%的患者出现新发谵妄。谵妄患者年龄更大（P = 0.046），美国麻醉医师协会和Charlson合并症指数评分更高（P < 0.001），简易精神状态问卷评分更低，老年抑郁量表评分更高（分别为P < 0.001，P = 0.003）。在对年龄进行校正后，第一个模型的多变量回归分析显示，谵妄患者再次干预加死亡的风险更高（P < 0.05）、并发症风险更高（P < 0.001）、并发症严重程度评分更高（P < 0.05）以及住院时间更长（P < 0.001）。在第二个模型中，在对倾向评分进行校正后，谵妄患者再次干预加死亡的风险更高（P < 0.05）且住院时间更长（P < 0.01）。
年龄较大、身体状况较差、认知功能较差和有抑郁症状的患者髋部骨折后更易发生谵妄。新发谵妄对老年髋部骨折患者的短期结局有负面独立影响。
