Delirium after hip hemiarthroplasty for proximal femoral fractures in elderly patients: risk factors and clinical outcomes

• Published in: Clinical interventions in aging Vol. 14; pp. 427 - 435
• Main Authors: de Jong, Louis, van Rijckevorsel, Veronique A J I M, Raats, Jelle W, Klem, Taco M A L, Kuijper, Tjallingius M, Roukema, Gert R
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2019; Taylor & Francis Ltd; Dove Medical Press
• Subjects: Age; Age Factors; Aged; Aged patients; Aged, 80 and over; Anesthesia; Arthroplasty; Clinical outcomes; Complications; Complications and side effects; Delirium; Delirium - etiology; Delirium - mortality; Dementia; Dementia - complications; Disease prevention; Female; femoral neck fracture; Fracture fixation; Fractures; Frailty; Health risk assessment; Hemiarthroplasty - adverse effects; hip fracture; Hip Fractures - mortality; Hip Fractures - surgery; Hip joint; Homes for the Aged; Hospitalization; Hospitals; Humans; Infections - complications; Male; Medical prognosis; Mortality; Nursing Homes; Older people; Original Research; Patient Discharge; Patient outcomes; Patients; Pneumonia - complications; Psychological aspects; Retrospective Studies; risk and prognostic factors; Risk Factors; Surgery; Surgical Wound Infection - complications; Trauma; Urinary Tract Infections - complications; Netherlands; femoral neck fracture; hemi athroplasty; hip fracture; risk and prognostic factors; mortality; fragile; delirium
• ISSN: 1178-1998; 1176-9092; 1178-1998
• DOI: 10.2147/cia.s189760

The primary aim of the present study was to verify the potential risk factors for developing a delirium after hip fracture surgery. The secondary aim of this study was to examine the related clinical outcomes after a delirium developed post-hip fracture surgery. Data were extracted from a prospective hip fracture database and completed by retrospective review of the hospital records. A total of 463 patients undergoing hip fracture (hip hemiarthroplasty) surgery in a level II trauma teaching hospital between January 2011 and May 2016 were included. Delirium was measured using the Delirium Observation Screening Scale, the confusion assessment method, and an observatory judgment by geriatric medicine specialists. The results showed that 26% of the patients (n=121) developed a delirium during hospital stay with a median duration during admission of 5 days (IQR 3-7). The multivariable model showed that the development of delirium was significantly explained by dementia (OR 2.75, =0.001), age (OR 1.06, =0.005), and an infection during admission (pneumonia, deep surgical site infection, or urinary tract infection) (OR 1.23, =0.046). After 1 year of follow-up, patients who developed delirium after hip fracture surgery were significantly more discharged to (semi-independent) nursing homes ( <0.001) and had a significantly higher mortality rate ( <0.001) compared to patients without delirium after hip fracture surgery. The results showed that 26% of the patients undergoing hip fracture surgery developed a delirium. The risk factors including age, dementia, and infection during admission significantly predicted the development of the delirium. No association was confirmed between delirium and time of admission or time to surgery. The development of delirium after hip fracture surgery was subsequently found to be a significant predictor of admission to a nursing home and mortality after 1 year.