Surgery Department, Maasstad Hospital, 3079 DZ Rotterdam, the Netherlands,
Surgery Department, Franciscus Hospital, 3045 PM Rotterdam, the Netherlands.
Clin Interv Aging. 2019 Feb 26;14:427-435. doi: 10.2147/CIA.S189760. eCollection 2019.
The primary aim of the present study was to verify the potential risk factors for developing a delirium after hip fracture surgery. The secondary aim of this study was to examine the related clinical outcomes after a delirium developed post-hip fracture surgery.
Data were extracted from a prospective hip fracture database and completed by retrospective review of the hospital records. A total of 463 patients undergoing hip fracture (hip hemiarthroplasty) surgery in a level II trauma teaching hospital between January 2011 and May 2016 were included. Delirium was measured using the Delirium Observation Screening Scale, the confusion assessment method, and an observatory judgment by geriatric medicine specialists.
The results showed that 26% of the patients (n=121) developed a delirium during hospital stay with a median duration during admission of 5 days (IQR 3-7). The multivariable model showed that the development of delirium was significantly explained by dementia (OR 2.75, =0.001), age (OR 1.06, =0.005), and an infection during admission (pneumonia, deep surgical site infection, or urinary tract infection) (OR 1.23, =0.046). After 1 year of follow-up, patients who developed delirium after hip fracture surgery were significantly more discharged to (semi-independent) nursing homes (<0.001) and had a significantly higher mortality rate (<0.001) compared to patients without delirium after hip fracture surgery.
The results showed that 26% of the patients undergoing hip fracture surgery developed a delirium. The risk factors including age, dementia, and infection during admission significantly predicted the development of the delirium. No association was confirmed between delirium and time of admission or time to surgery. The development of delirium after hip fracture surgery was subsequently found to be a significant predictor of admission to a nursing home and mortality after 1 year.
本研究的主要目的是验证髋部骨折手术后发生谵妄的潜在危险因素。本研究的次要目的是检查髋部骨折手术后发生谵妄后的相关临床结果。
从一个前瞻性髋部骨折数据库中提取数据，并通过回顾性查阅医院记录来完成。共纳入 2011 年 1 月至 2016 年 5 月在一家二级创伤教学医院接受髋部骨折（半髋关节置换术）手术的 463 名患者。使用谵妄观察筛查量表、意识模糊评估方法和老年医学专家的观察判断来测量谵妄。
结果显示，26%的患者（n=121）在住院期间发生谵妄，中位住院时间为 5 天（IQR 3-7）。多变量模型显示，谵妄的发生与痴呆（OR 2.75，p=0.001）、年龄（OR 1.06，p=0.005）和入院期间的感染（肺炎、深部手术部位感染或尿路感染）（OR 1.23，p=0.046）显著相关。在 1 年的随访中，与髋部骨折手术后未发生谵妄的患者相比，发生谵妄的患者明显更多地被转至（半独立）养老院（<0.001），死亡率明显更高（<0.001）。
结果显示，26%的髋部骨折手术患者发生了谵妄。包括年龄、痴呆和入院期间感染在内的危险因素显著预测了谵妄的发生。谵妄与入院时间或手术时间之间没有关联。髋部骨折手术后发生谵妄随后被发现是 1 年后入住养老院和死亡的显著预测因素。
