Wuhan Mental Health Center, Wuhan, China.
Department of Orthopedics, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, Hubei, China.
Orthop Surg. 2023 Feb;15(2):534-539. doi: 10.1111/os.13501. Epub 2023 Jan 3.
The low recognition rate of postoperative delirium has gradually aroused clinical attention in China. The present study was to investigate the impact of consultation-liaison psychiatry on postoperative delirium in elderly hip fracture patients.
From March 2012 to September 2013, 89 patients with hip fractures hospitalized in Wuhan Mental Health Center were included in this prospective study as the consultation-liaison group. A total of 81 patients selected from August 2010 to February 2012 were defined as the conventional group. The delirium was evaluated using the confusion assessment method (CAM) recommended by the American Psychiatric Association guidelines.
There was no difference of sex, age, trauma, surgical methods, and anesthesia between two groups (p > 0.05). The consultation rate of consultation-liaison group was significantly higher than that of conventional group (37.07% vs 17.28%, p < 0.05). After the consultation, there were 26 cases (78%) and nine cases (64%) of delirium in the consultation-liaison and conventional group, respectively (p > 0.05). In the consultation-liaison group, three patients (9.09%) were diagnosed with anxiety and three patients (9.09%) were diagnosed with depression, while in the conventional group, three patients (21.42%) were diagnosed with communication and one patient (7.14%) was diagnosed with depression. In addition, this study showed the incidence of delirium in consultation-liaison group was significantly higher than that of conventional group (29.21% vs 11.11%, p < 0.05). The average hospital stay in consultation-liaison group was significantly lower than that of conventional group (11.42 ± 2.63 vs. 15.17 ± 2.38 days, p < 0.01).
Consultation-liaison psychiatry could improve the recognition rate of postoperative delirium in elderly hip fracture patients, shorten hospitalization time. The training of mental health knowledge for non-psychiatrists could improve the ability of early identification and treatment of delirium.
术后谵妄的低识别率在中国逐渐引起临床关注。本研究旨在探讨联络精神病学对老年髋部骨折患者术后谵妄的影响。
2012 年 3 月至 2013 年 9 月，89 例髋部骨折住院患者纳入本前瞻性研究作为联络精神病学组。2010 年 8 月至 2012 年 2 月期间共选择 81 例患者作为常规组。采用美国精神病学协会指南推荐的谵妄评估方法（CAM）评估谵妄。
两组患者的性别、年龄、创伤、手术方法和麻醉均无差异（p>0.05）。联络精神病学组的联络率明显高于常规组（37.07%比 17.28%，p<0.05）。联络后，联络精神病学组和常规组分别有 26 例（78%）和 9 例（64%）发生谵妄（p>0.05）。在联络精神病学组中，有 3 例（9.09%）被诊断为焦虑，3 例（9.09%）被诊断为抑郁，而在常规组中，有 3 例（21.42%）被诊断为沟通问题，1 例（7.14%）被诊断为抑郁。此外，本研究显示联络精神病学组谵妄发生率明显高于常规组（29.21%比 11.11%，p<0.05）。联络精神病学组的平均住院时间明显短于常规组（11.42±2.63 天比 15.17±2.38 天，p<0.01）。
联络精神病学可提高老年髋部骨折患者术后谵妄的识别率，缩短住院时间。对非精神科医生进行心理健康知识培训可提高早期识别和治疗谵妄的能力。
