Department of Anesthesiology and Pain Medicine, Hallym Sacred Heart Hospital, Hallym University College of Medicine.
Department of Orthopaedic Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
Clin Interv Aging. 2017 Nov 6;12:1835-1842. doi: 10.2147/CIA.S147585. eCollection 2017.
Postoperative delirium is a risk factor for worse outcome after hip fracture surgery in elderly patients. Postoperative delirium is associated with anesthesia, postoperative pain, and patient factors. We investigated the incidence, predictors, and prognostic implications of post-operative delirium after hemiarthroplasty (HA) in elderly patients with femoral neck fracture.
A total of 356 consecutive patients aged >70 years who underwent HA for femoral neck fracture were enrolled. Diagnosis of delirium was made by a psychiatrist based on patient status and an objective scoring system. The patients were divided into 2 categories according to the HA onset time (immediate [≤24 h after surgery] vs delayed delirium [>24 h after surgery]) and its incidence, predictors and mortality were evaluated.
Postoperative delirium was diagnosed in 110 patients (30.9%) during hospitalization. Immediate and delayed delirium occurred in 59 (53.6%), and 51 (46.4%) patients, respectively. The independent predictors of immediate delirium included age (odds ratio [OR] 1.47, 95% CI 0.98-2.23, =0.066), and general anesthesia (OR 2.25, 95% CI 1.17-4.43, =0.015). The independent predictors of delayed delirium were parkinsonism (OR 5.75, 95% CI 1.66-19.96, =0.006), intensive care unit stay (OR 1.85, 95% CI 0.97-3.56, =0.064), and higher American Society of Anesthesiologists grade (OR 2.33, 95% CI 0.90-6.07, =0.083). On Kaplan-Meier survival analysis, the 2-year survival rate was significantly lower in the immediate delirium group than those in the delayed and control groups (71.0% vs 83.6% vs 87.8%, respectively; =0.031).
Immediate and delayed delirium after HA for femoral neck fracture had different predictors and immediate delirium was associated with worse prognosis.
术后谵妄是老年髋部骨折患者术后预后不良的危险因素。术后谵妄与麻醉、术后疼痛和患者因素有关。我们研究了老年股骨颈骨折行人工股骨头置换术后（HA）术后谵妄的发生率、预测因素及其对预后的影响。
共纳入 356 例年龄>70 岁的连续患者，因股骨颈骨折行 HA。根据患者的状态和客观评分系统，由精神科医生诊断谵妄。根据 HA 发病时间（≤术后 24 小时[即发谵妄]与>24 小时[迟发谵妄]）将患者分为 2 组，并评估其发病率、预测因素和死亡率。
住院期间有 110 例（30.9%）患者诊断为术后谵妄。即刻和迟发性谵妄分别发生在 59 例（53.6%）和 51 例（46.4%）患者中。即刻谵妄的独立预测因素包括年龄（优势比[OR] 1.47，95%可信区间[CI] 0.98-2.23，=0.066）和全身麻醉（OR 2.25，95%CI 1.17-4.43，=0.015）。迟发性谵妄的独立预测因素为帕金森病（OR 5.75，95%CI 1.66-19.96，=0.006）、重症监护病房（OR 1.85，95%CI 0.97-3.56，=0.064）和美国麻醉医师协会（ASA）分级较高（OR 2.33，95%CI 0.90-6.07，=0.083）。Kaplan-Meier 生存分析显示，即刻谵妄组的 2 年生存率明显低于迟发性谵妄组和对照组（分别为 71.0%、83.6%和 87.8%，=0.031）。
股骨颈骨折行 HA 术后即刻和迟发性谵妄的预测因素不同，即刻谵妄与预后不良有关。
