A retrospective study on risk factors associated with postoperative delirium in elderly patients with hip fracture / 中华骨科杂志

ABSTRACT

Objective To investigate the incidence and related risk factors of delirium in elderly patients with hip frac-ture. Methods From October 2014 to February 2017, 306 patients with femoral neck fracture or intertrochanteric fracture more than 65 years old underwent elective hip arthroplasty (hip arthroplasty, proximal femoral nail fixation) were retrospective-ly analyzed. Patients' general information was recorded: age, sex, body mass index (BMI), history of diabetes mellitus, history of coronary heart disease, cerebral infarction, preoperative biochemical tests, left ventricular ejection fraction, thrombosis of both lower extremities, intraoperative status (ASA score, NYHA heart function score, anesthesia, anesthesia time, etc.), periop-erative blood transfusion, biochemical examination on the first day after surgery, perioperative albumin consumption, etc.; ac-cording to whether delirium happened after surgery, those patients were divided into delirium group and non-delirium Group and analyzed the incidence of postoperative delirium. Using univariate logistic regression analysis screened factors associated with postoperative delirium. The results were entered into the multivariate logistic regression analysis, screening the high risk factors for postoperative delirium.Results The incidence of delirium was 59(19.29%) after perioperative hip fracture, includ-ing 23 males and 36 females, ranging in age from 70 to 93 years with an average of (81.9±5.4) years. 247 cases had no deliri-um,including 81 males and 166 females,aged 65-96 years,with an average(76.4±8.1)years.The factors of age,length of hos-pital stay, days before surgery, preoperative hematocrit, perioperative albumin consumption, perioperative blood transfusion, preoperative leukocyte levels, preoperative albumin levels, preoperative creatinine, urea level, Mallampati classification (Mar-kov grade), cardiac function score (NYHA score), ASA score, intraoperative blood loss, postoperative leukocyte level, left ven-tricular ejection fraction, previous cerebral infarction, history of coronary heart disease, and diabetes were statistically signifi-cant different; univariate logistic regression analysis showed that the factors of age, ASA score, history of diabetes mellitus, length of hospitalization, and perioperative albumin consumption were demonstrated to have relationship with the occurrence of postoperative delirium. Multivariate regression analysis showed that age, history of diabetes and ASA score are the high risk factors of postoperative delirium.Conclusion Age,history of diabetes mellitus and ASA score are risk factors of delirium in el-derly patients with hip fracture.Those patients older than 75 years,with the history of diabetes mellitus or ASA score> 2 points were at higher risk of postoperative delirium,which prolongs hospitalization and increases protein consumption.