Division of Trauma and Surgical Critical Care, Jersey Shore University Medical Center, Neptune, NJ, United States; Hackensack Meridian School of Medicine, Nutley, NJ, United States.
Office of Research Administration, Jersey Shore University Medical Center, Neptune, NJ, United States.
Injury. 2022 Apr;53(4):1469-1476. doi: 10.1016/j.injury.2022.01.041. Epub 2022 Jan 31.
In-hospital delirium after hip hemi-arthroplasty results in a prolonged hospital course and an increase in morbidity and mortality. Early identification of high-risk patients and preventive strategies can reduce the occurrence of delirium. The purpose of the study is to identify the risk factors of delirium and create a scoring system for point of care physicians. The risk factors were created and validated in the study.
Certain factors are associated with in-hospital delirium after hip hemi-arthroplasty in geriatric patients.
The National Surgical Quality Improvement Program (NSQIP) database from 2016 to 2019 was accessed for the study. The study included all geriatric patients, ages 65 years and older, who underwent hip hemi-arthroplasty following a hip fracture. A multivariable analysis was performed to identify the risk of delirium using all the available information including patient demography, timing of surgery, comorbidities, and infective complications. Eighty percent of the data were used to develop a risk model, and 20% of the data were used to validate the model. A Receiving Operating Characteristics (ROC) curve was created. The Area Under the Curve (AUC) was calculated with a 95% confidence interval (CI). A Delirium Risk in Geriatric Hip Hemi-Arthroplasty (DRIGHA) score was created.
Out of 13,174 patients who qualified for the study, 3924 (29.8%) patients developed in-hospital delirium. The risk model showed advanced age, male gender, prior history of delirium and dementia, certain comorbidities, and complications were associated with a higher incidence of in-hospital delirium. The AUC was 0.79 (95% CI, 0.78-0.80). The DRIGHA score predicted the risk of delirium from 8 to 99.4%.
Certain demography characteristics, comorbidities and infective complications were associated with a higher risk of developing in-hospital delirium. A DRIGHA score can be calculated at the bedside through a web-based calculator. Preventive strategies in high-risk patients will reduce the incidence of delirium.
髋关节半髋关节置换术后院内谵妄导致住院时间延长，发病率和死亡率增加。早期识别高危患者和预防策略可以降低谵妄的发生。本研究的目的是确定谵妄的危险因素，并为床边医生创建评分系统。危险因素是在研究中创建和验证的。
某些因素与老年患者髋关节半髋关节置换术后院内谵妄有关。
本研究检索了 2016 年至 2019 年国家外科质量改进计划（NSQIP）数据库。研究包括所有 65 岁及以上因髋部骨折接受髋关节半髋关节置换术的老年患者。使用所有可用信息（包括患者人口统计学、手术时间、合并症和感染性并发症）进行多变量分析，以确定谵妄的风险。80%的数据用于开发风险模型，20%的数据用于验证模型。创建了接受者操作特征（ROC）曲线。计算曲线下面积（AUC）和 95%置信区间（CI）。创建了老年髋关节半髋关节置换术谵妄风险（DRIGHA）评分。
在符合研究条件的 13174 名患者中，有 3924 名（29.8%）患者发生了院内谵妄。风险模型显示，年龄较大、男性、既往有谵妄和痴呆史、某些合并症和并发症与更高的院内谵妄发生率相关。AUC 为 0.79（95%CI，0.78-0.80）。DRIGHA 评分可预测谵妄风险，范围为 8 至 99.4%。
某些人口统计学特征、合并症和感染性并发症与发生院内谵妄的风险增加有关。DRIGHA 评分可通过基于网络的计算器在床边计算。高危患者的预防策略将降低谵妄的发生率。
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