Albanese Anita M, Ramazani Noyan, Greene Natasha, Bruse Laura
University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA.
Adjunct Clinical Assistant Professor Community Faculty, University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA.
Geriatr Orthop Surg Rehabil. 2022 Mar 4;13:21514593211058947. doi: 10.1177/21514593211058947. eCollection 2022.
Postoperative delirium (POD) is a serious complication occurring in 4-53.3% of geriatric patients undergoing surgeries for hip fracture. Incidence of hip fractures is projected to grow 11.9% from 258,000 in 2010 to 289,000 in 2030 based on 1990 to 2010 data. As prevalence of hip fractures is projected to increase, POD is also anticipated to increase.
Postoperative delirium remains the most common complication of emergency hip fracture surgery leading to high morbidity and mortality rates despite significant research conducted regarding this topic. This study reviews literature from 1990 to 2021 regarding POD in geriatric hip fracture management.
Potentially modifiable and non-modifiable risk factors for developing POD include, but are not limited to, male gender, older age, multiple comorbidities, specific comorbidities (dementia, cognitive impairment, diabetes, vision impairment, and abnormal blood pressure), low BMI, preoperative malnutrition, low albumin, low hematocrit, blunted preoperative cytokines, emergency surgery, time to admission and surgery, preoperative medical treatment, polypharmacy, delirium-inducing medications, fever, anesthesia time, and sedation depth and type. Although the pathophysiology remains unclear, the leading theories suggest neurotransmitter imbalance, inflammation, and electrolyte or metabolic derangements as the underlying cause of POD. POD is associated with increased length of hospital stay, cost, morbidity, and mortality. Prevention and early recognition are key factors in managing POD. Methods to reduce POD include utilizing interdisciplinary teams, educational programs for healthcare professionals, reducing narcotic use, avoiding delirium-inducing medications, and multimodal pain control.
While POD is a known complication after hip fracture surgery, further exploration in prevention is needed. Early identification of risk factors is imperative to prevent POD in geriatric patients. Early prevention will enhance delivery of health care both pre- and post-operatively leading to the best possible surgical outcome and better quality of life after hip fracture treatment.
术后谵妄（POD）是一种严重并发症，在接受髋部骨折手术的老年患者中发生率为4%至53.3%。根据1990年至2010年的数据，髋部骨折的发生率预计将增长11.9%，从2010年的25.8万例增至2030年的28.9万例。由于髋部骨折的患病率预计会上升，术后谵妄也可能增加。
尽管针对这一主题已开展大量研究，但术后谵妄仍是急诊髋部骨折手术最常见的并发症，导致高发病率和死亡率。本研究回顾了1990年至2021年有关老年髋部骨折治疗中术后谵妄的文献。
发生术后谵妄的潜在可改变和不可改变风险因素包括但不限于男性、高龄、多种合并症、特定合并症（痴呆、认知障碍、糖尿病、视力障碍和血压异常）、低体重指数、术前营养不良、低白蛋白、低血细胞比容、术前细胞因子水平降低、急诊手术、入院和手术时间、术前药物治疗、多种药物治疗、诱发谵妄的药物、发热、麻醉时间以及镇静深度和类型。尽管其病理生理学尚不清楚，但主要理论认为神经递质失衡、炎症以及电解质或代谢紊乱是术后谵妄的潜在病因。术后谵妄与住院时间延长、费用增加、发病率和死亡率升高相关。预防和早期识别是管理术后谵妄的关键因素。减少术后谵妄的方法包括利用跨学科团队、为医护人员开展教育项目、减少麻醉药物使用、避免使用诱发谵妄的药物以及多模式疼痛控制。
虽然术后谵妄是髋部骨折手术后已知的并发症，但仍需进一步探索预防方法。早期识别风险因素对于预防老年患者术后谵妄至关重要。早期预防将改善术前和术后的医疗服务，从而实现最佳手术效果，并提高髋部骨折治疗后的生活质量。
