Zywiel Michael G, Hurley Richard T, Perruccio Anthony V, Hancock-Howard Rebecca L, Coyte Peter C, Rampersaud Y Raja
Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, 1E441, Toronto, ON M5T 2S8, Canada. E-mail address for M.G. Zywiel:
Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th floor, Toronto, ON M5T 3M6, Canada.
J Bone Joint Surg Am. 2015 May 20;97(10):829-36. doi: 10.2106/JBJS.N.00724.
Patients who experience a fragility hip fracture are at high risk for perioperative delirium. The purpose of the present study was to evaluate the impact, from a hospital perspective, of perioperative delirium on the length of the hospital stay and episode-of-care costs for elderly patients who underwent surgical treatment of a fragility hip fracture.
A total of 242 patients sixty-five years of age or older (mean age, eighty-two years; range, sixty-five to 103 years) who underwent surgical treatment of a fragility hip fracture at a single center between January 2011 and December 2012 were evaluated. Demographic, clinical, surgical, and adverse-events data were extracted and analyzed. The confusion assessment method (CAM) was used prospectively to detect perioperative delirium.
One hundred and sixteen (48%) of the 242 patients developed perioperative delirium during their stay in the hospital. Compared with patients with no delirium, delirium was associated with a mean incremental total length of hospital stay of 7.4 days (95% confidence interval [CI] = 3.7 to 11.2 days; p < 0.001), a mean incremental length of stay following surgery of 7.4 days (95% CI = 3.8 to 11.1 days; p < 0.001), and a mean incremental episode-of-care cost (in 2012 Canadian dollars) of $8286 (95% CI = $3690 to $12,881; p < 0.001). The total incremental episode-of-care cost attributable to delirium over the study period was $961,131 in 2012 Canadian dollars.
Nearly 50% of elderly patients who underwent surgery for a fragility hip fracture developed perioperative delirium, which was associated with a significant incremental in-hospital length of stay and significant incremental episode-of-care costs. These findings highlight the importance of implementing cost-effective interventions to reduce the prevalence of perioperative delirium in elderly patients with a low-energy hip fracture.
发生脆性髋部骨折的患者围手术期谵妄风险很高。本研究的目的是从医院角度评估围手术期谵妄对接受脆性髋部骨折手术治疗的老年患者住院时间和护理期间费用的影响。
对2011年1月至2012年12月期间在单一中心接受脆性髋部骨折手术治疗的242例65岁及以上患者（平均年龄82岁；范围65至103岁）进行评估。提取并分析人口统计学、临床、手术和不良事件数据。前瞻性地使用意识模糊评估法（CAM）来检测围手术期谵妄。
242例患者中有116例（48%）在住院期间发生围手术期谵妄。与未发生谵妄的患者相比，谵妄与平均住院总时长增加7.4天相关（95%置信区间[CI]=3.7至11.2天；p<0.001），术后平均住院时长增加7.4天（95%CI=3.8至11.1天；p<0.001），护理期间平均费用增加（以2012年加拿大元计）8286加元（95%CI=3690至12881加元；p<0.001）。在研究期间，因谵妄导致的护理期间总费用增量为961,131加元（2012年加拿大元）。
近50%接受脆性髋部骨折手术的老年患者发生围手术期谵妄，这与住院时长显著增加和护理期间费用显著增加相关。这些发现凸显了实施具有成本效益的干预措施以降低低能量髋部骨折老年患者围手术期谵妄发生率的重要性。
