Risk Factors for Preoperative and Postoperative Delirium in Elderly Patients with Hip Fracture
- 29 July 2009
- journal article
- Published by Wiley in Journal of the American Geriatrics Society
- Vol. 57 (8), 1354-1361
- https://doi.org/10.1111/j.1532-5415.2009.02377.x
Abstract
OBJECTIVES: To evaluate risk factors for preoperative and postoperative delirium. DESIGN: Prospective cohort study. SETTING: Departments of orthopedic surgery in two Norwegian hospitals. PARTICIPANTS: Three hundred sixty-four patients with and without cognitive impairment, aged 65 and older. MEASUREMENTS: Patients were screened daily for delirium using the Confusion Assessment Method. Established risk factors and risk factors regarded as clinically important according to expert opinion were explored in univariate analyses. Variables associated with the outcomes (P<.05) were entered into multivariate logistic regression models. RESULTS: Delirium was present in 50 of 237 (21.1%) assessable patients preoperatively, whereas 68 of 187 (36.4%) patients developed delirium postoperatively (incident delirium). Multivariate logistic regression identified four risk factors for preoperative delirium: cognitive impairment (adjusted odds ratio (AOR)=4.7, 95% confidence interval (CI)=1.9–11.3), indoor injury (AOR=3.6, 95% CI=1.1–12.2), fever (AOR=3.4, 95% CI=1.5–7.7), and preoperative waiting time (AOR=1.05, 95% CI=1.0–1.1 per hour). Cognitive impairment (AOR=2.9, 95% CI=1.4–6.2), indoor injury (AOR=2.9, 95% CI=1.1–6.3), and body mass index (BMI) less than 20.0 (AOR=2.9, 95% CI=1.3–6.7) were independent and statistically significant risk factors for postoperative delirium. CONCLUSION: Time from admission to operation is a risk factor for preoperative delirium, whereas low BMI is an important risk factor for postoperative delirium in hip fracture patients. Cognitive impairment and indoor injury are independent risk factors for preoperative and postoperative delirium.This publication has 17 references indexed in Scilit:
- Statins and postoperative deliriumCMAJ : Canadian Medical Association Journal, 2008
- Delirium after elective surgery among elderly patients taking statinsCMAJ : Canadian Medical Association Journal, 2008
- Independent Vascular and Cognitive Risk Factors for Postoperative DeliriumAmerican Journal Of Medicine, 2007
- Prognostic Significance of Delirium in Frail Older PeopleDementia and Geriatric Cognitive Disorders, 2005
- Risk Factors for Postoperative Delirium after Liver Resection for Hepatocellular CarcinomaWorld Journal of Surgery, 2004
- Early oral feeding after elective abdominal surgery—what are the issues?Nutrition, 2002
- Acute Confusional States in Patients Undergoing Hip SurgeryGerontology, 1999
- Reorganization of Nursing and Medical Care to Reduce the Incidence of Postoperative Delirium and Improve Rehabilitation Outcome in Elderly Patients Treated for Femoral Neck FracturesScandinavian Journal of Caring Sciences, 1999
- Clinical Profile of Delirium in Patients Treated for Femoral Neck FracturesDementia and Geriatric Cognitive Disorders, 1999
- Acute Confusional States in Elderly Patients Treated for Femoral Neck FractureJournal of the American Geriatrics Society, 1988