Anaesthesiology Department, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal.
Internal Medicine Department, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal.
Eur Geriatr Med. 2021 Aug;12(4):777-785. doi: 10.1007/s41999-021-00456-w. Epub 2021 Feb 11.
Hip fractures are a worldwide health issue primarily for older patients, conditioning major morbidity and mortality. An experienced multidisciplinary team is essential to manage surgery and peri-operative implications, to enable rapid functional and cognitive recovery. Delirium is a recognizable problem associated with negative outcomes. Our study aims to determine the influence of pre-operative delirium in the incidence of post-operative delirium, and to evaluate the association between other known peri-operative risk factors with both conditions.
A single-center, retrospective cohort study, conducted at a Level II trauma center over a 14-month period, included 241 patients with 65 years of age or older submitted to hip fracture surgery. Peri-operative data were gathered regarding baseline characteristics (sociodemographic, functional and cognitive status), intra-operative events (anesthesia technique, surgery duration, blood loss) and post-operative outcomes (delirium occurrence).
Statistical analysis evidenced a female (75.5%) and elderly population (83.9 ± 7.8 years old) with significant comorbidities (cognitive impairment in 51.9%, ASA ≥ III in 79.7%, mean CIRS-G 8.83 ± 4.69) that underwent surgical fracture repair, mostly under 4 h (96.3%) and under regional anesthesia (63.1%). Pre- and post-operative delirium incidence was 18.3% and 12.9%, respectively, displaying increased presence according to cognitive impairment severity.
Post-operative delirium was almost inexistent when it was absent pre-operatively. Moreover, pre-operative cognitive status was associated with the development of pre- and post-operative delirium. Careful cognitive assessment, implementation of preventive strategies and avoidance of peri-operative pro-delirium factors are crucial for comprehensive geriatric care.
髋部骨折是一个全球性的健康问题，主要发生在老年患者，导致严重的发病率和死亡率。一个经验丰富的多学科团队对于管理手术和围手术期的并发症至关重要，以实现快速的功能和认知恢复。谵妄是与负面结果相关的可识别问题。我们的研究旨在确定术前谵妄对术后谵妄发生率的影响，并评估其他已知围手术期风险因素与这两种情况的关联。
这是一项单中心、回顾性队列研究，在一个二级创伤中心进行，研究对象为 241 名年龄在 65 岁或以上接受髋部骨折手术的患者。收集围手术期数据，包括基线特征（社会人口统计学、功能和认知状态）、术中事件（麻醉技术、手术持续时间、失血量）和术后结果（谵妄发生情况）。
统计分析显示，患者为女性（75.5%）和老年人（83.9±7.8 岁），存在显著的合并症（认知障碍 51.9%，ASA≥III 79.7%，CIRS-G 平均 8.83±4.69），接受手术骨折修复，大多在 4 小时内（96.3%）和局部麻醉下（63.1%）进行。术前和术后谵妄的发生率分别为 18.3%和 12.9%，随着认知障碍严重程度的增加，发生率增加。
术前无谵妄时，术后谵妄几乎不存在。此外，术前认知状态与术前和术后谵妄的发生有关。仔细的认知评估、实施预防策略和避免围手术期促谵妄因素对全面老年护理至关重要。
