Geriatric Unit, Department of Neuromotor Physiology and Rehabilitation, ASMN-IRCCS Hospital, Viale Risorgimento 80, 42123, Reggio Emilia, Italy.
Rheumatology Unit, Department of Locomotor System, ASL003, Via del Giappone 5, 16011, Arenzano, Italy.
Aging Clin Exp Res. 2019 Jan;31(1):41-47. doi: 10.1007/s40520-018-0985-y. Epub 2018 Jun 8.
To investigate the relationship between onset of delirium and time to surgery in hip fracture (HF) patients with a different degree of cognitive impairment.
Retrospective analysis of a prospective database of 939 older adults, aged ≥ 75 years admitted with a fragility HF. Subjects underwent a Comprehensive Geriatric Assessment on admission, evaluating health status, prefracture functional status in basic and instrumental activities of daily living, and walking ability. According to the Short Portable Mental Status Questionnaire score, patients were stratified into three categories: cognitively healthy (0-2 errors), mildly to moderately impaired (3-7 errors) and severely impaired (8-10 errors). Time to surgery (from admission) was expressed as days. The occurrence of delirium was ascertained daily by Confusion Assessment Method.
Two hundred ninety-two (31.1%) patients experienced delirium during in-hospital stay. They were older, with a higher degree of comorbidity and functional impairment compared to patients without delirium. In multivariate analysis, surgical delay resulted a significant independent risk factor for delirium (HR 1.11, 95% CI 1.01-1.24), along with age, prefracture functional disability and cognitive impairment. When the analysis was performed accounting for the cognitive categories, surgical delay demonstrated to increase the risk of delirium only in the subcategory of mildly to moderately impaired patients, while no significant effect was demonstrated in patients cognitively healthy or severely impaired.
The study supports the concept that older adults with HF should undergo surgery quickly. Patients with mild-to-moderate cognitive impairment should be primarily considered as the best target for interventions aiming to reduce time to surgery.
研究不同认知障碍程度的髋部骨折（HF）患者谵妄发作与手术时间的关系。
回顾性分析了 939 名年龄≥75 岁、因脆性 HF 入院的老年人的前瞻性数据库。患者入院时接受全面老年评估，评估健康状况、骨折前基本和工具性日常生活活动中的功能状态以及行走能力。根据简短便携式精神状态问卷评分，患者分为 3 类：认知正常（0-2 个错误）、轻度至中度受损（3-7 个错误）和严重受损（8-10 个错误）。手术时间（从入院开始）表示为天数。每天通过意识混乱评估方法确定谵妄的发生情况。
292 名（31.1%）患者在住院期间发生谵妄。与无谵妄的患者相比，他们年龄更大，合并症和功能障碍程度更高。多变量分析显示，手术延迟是谵妄发生的显著独立危险因素（HR 1.11，95%CI 1.01-1.24），此外还有年龄、骨折前功能障碍和认知障碍。在考虑认知分类的分析中，手术延迟仅在轻度至中度受损患者亚组中增加了谵妄的风险，而在认知正常或严重受损的患者中则没有显著影响。
该研究支持了 HF 老年患者应尽快手术的观点。轻度至中度认知障碍患者应主要被视为旨在减少手术时间的干预措施的最佳目标人群。
