Arshi Armin, Lai Wilson C, Chen James B, Bukata Susan V, Stavrakis Alexandra I, Zeegen Erik N
Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Geriatr Orthop Surg Rehabil. 2018 Dec 5;9:2151459318814823. doi: 10.1177/2151459318814823. eCollection 2018.
Perioperative delirium in elderly hip fracture patients has been correlated with significant morbidity. The purpose of this study was to determine the preoperative risk factors for and short-term sequelae of postoperative delirium in geriatric hip fracture patients.
We queried the American College of Surgeons National Surgical Quality Improvement Program to identify geriatric (≥65 years) patients who sustained operative hip fractures in 2016. Cohorts of patients with and without documented postoperative delirium were identified. Primary data on patient demographics and comorbidities were collected and correlated with postoperative complications and hip fracture outcome measures. Multivariate regression was used to compute risk-adjusted odds ratios (OR) of risk factors and sequelae of delirium.
In total, 8,439 geriatric hip fracture patients were identified of whom 2,569 patients (30.4%) had postoperative delirium. Age (OR 1.03 [1.02-1.04, < 0.001), white race (OR 1.54 [1.19-2.00], = 0.001), American Society of Anesthesiologists classification (OR 1.20 [1.07-1.36], = 0.003), baseline dementia (OR 2.46 [2.11-2.86], < 0.001), and preoperative delirium (OR 10.06 [8.12-12.45], < 0.001) were independent risk factors for postoperative delirium in multivariate analysis. Patients with postoperative delirium had a significantly higher risk-adjusted 30-day mortality (12.0% vs. 4.8%, OR 2.22 [1.74-2.84], < 0.001) and morbidity profile. Postoperative delirium was also independently associated with higher rates of discharge to (OR 1.65 [1.32-2.06], < 0.001) and prolonged stay in (OR 1.79 [1.53-2.09], < 0.001) an inpatient facility, hospital readmission (OR 1.94 [1.58-2.38], < 0.001) and hospital length of stay (7.6 ± 5.0 vs. 6.1 ± 4.1 days, < 0.001), as well as lower rates of immediate postoperative weight bearing (OR 0.73 [0.63-0.86], < 0.001).
Postoperative delirium is a common occurrence in geriatric hip fractures with multiple risk factors. Delirium portends higher mortality and worse perioperative hospital-based outcomes.
Multidisciplinary foreknowledge and management efforts are warranted to mitigate the risk of developing delirium, which strongly predicts perioperative morbidity, mortality, and hip fracture outcomes.
老年髋部骨折患者围手术期谵妄与显著的发病率相关。本研究的目的是确定老年髋部骨折患者术后谵妄的术前危险因素及短期后遗症。
我们查询了美国外科医师学会国家外科质量改进计划，以识别2016年接受髋部骨折手术的老年（≥65岁）患者。确定了有和没有术后谵妄记录的患者队列。收集了患者人口统计学和合并症的原始数据，并将其与术后并发症和髋部骨折结局指标相关联。采用多因素回归计算谵妄危险因素和后遗症的风险调整比值比（OR）。
共识别出8439例老年髋部骨折患者，其中2569例（30.4%）发生术后谵妄。年龄（OR 1.03 [1.02 - 1.04]，< 0.001）、白种人（OR 1.54 [1.19 - 2.00]，= 0.001）、美国麻醉医师协会分级（OR 1.20 [1.07 - 1.36]，= 0.003）、基线痴呆（OR 2.46 [2.11 - 2.86]，< 0.001）和术前谵妄（OR 10.06 [8.12 - 12.45]，< 0.001）在多因素分析中是术后谵妄的独立危险因素。术后谵妄患者的风险调整30天死亡率显著更高（12.0%对4.8%，OR 2.22 [1.74 - 2.84]，< 0.001）且发病率更高。术后谵妄还与入住（OR 1.65 [1.32 - 2.06]，< 0.001）和在（OR 1.79 [1.53 - 2.09]，< 0.001）住院设施的停留时间延长、医院再入院（OR 1.94 [1.58 - 2.38]，< 0.001）以及住院时间（7.6 ± 5.0对6.1 ± 4.1天，< 0.001）显著相关，以及术后立即负重率较低（OR 0.73 [0.63 - 0.86]，< 0.001）。
术后谵妄在老年髋部骨折中很常见，有多种危险因素。谵妄预示着更高的死亡率和更差的围手术期基于医院的结局。
需要多学科的预先了解和管理努力来降低发生谵妄的风险，谵妄强烈预测围手术期发病率、死亡率和髋部骨折结局。
