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Perioperative hemodynamics and risk for delirium and new onset dementia in hip fracture patients; A prospective follow-up study
BACKGROUND: Delirium is common in hip fracture patients and many risk factors have been identified. Controversy exists regarding the possible impact of intraoperative control of blood pressure upon acute (delirium) and long term (dementia) cognitive decline. We explored possible associations between...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5503267/ https://www.ncbi.nlm.nih.gov/pubmed/28700610 http://dx.doi.org/10.1371/journal.pone.0180641 |
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author | Neerland, Bjørn Erik Krogseth, Maria Juliebø, Vibeke Hylen Ranhoff, Anette Engedal, Knut Frihagen, Frede Ræder, Johan Bruun Wyller, Torgeir Watne, Leiv Otto |
author_facet | Neerland, Bjørn Erik Krogseth, Maria Juliebø, Vibeke Hylen Ranhoff, Anette Engedal, Knut Frihagen, Frede Ræder, Johan Bruun Wyller, Torgeir Watne, Leiv Otto |
author_sort | Neerland, Bjørn Erik |
collection | PubMed |
description | BACKGROUND: Delirium is common in hip fracture patients and many risk factors have been identified. Controversy exists regarding the possible impact of intraoperative control of blood pressure upon acute (delirium) and long term (dementia) cognitive decline. We explored possible associations between perioperative hemodynamic changes, use of vasopressor drugs, risk of delirium and risk of new-onset dementia. METHODS: Prospective follow-up study of 696 hip fracture patients, assessed for delirium pre- and postoperatively, using the Confusion Assessment Method. Pre-fracture cognitive function was assessed using the Informant Questionnaire of Cognitive Decline in the Elderly and by consensus diagnosis. The presence of new-onset dementia was determined at follow-up evaluation at six or twelve months after surgery. Blood pressure was recorded at admission, perioperatively and postoperatively. RESULTS: Preoperative delirium was present in 149 of 536 (28%) assessable patients, and 124 of 387 (32%) developed delirium postoperatively (incident delirium). The following risk factors for incident delirium in patients without pre-fracture cognitive impairment were identified: low body mass index, low level of functioning, severity of physical illness, and receipt of ≥ 2 blood transfusions. New-onset dementia was diagnosed at follow-up in 26 of 213 (12%) patients, associated with severity of physical illness, delirium, receipt of vasopressor drugs perioperatively and high mean arterial pressure postoperatively. CONCLUSION: Risk factors for incident delirium seem to differ according to pre-fracture cognitive status. The use of vasopressors during surgery and/or postoperative hypertension is associated with new-onset dementia after hip fracture. |
format | Online Article Text |
id | pubmed-5503267 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-55032672017-07-25 Perioperative hemodynamics and risk for delirium and new onset dementia in hip fracture patients; A prospective follow-up study Neerland, Bjørn Erik Krogseth, Maria Juliebø, Vibeke Hylen Ranhoff, Anette Engedal, Knut Frihagen, Frede Ræder, Johan Bruun Wyller, Torgeir Watne, Leiv Otto PLoS One Research Article BACKGROUND: Delirium is common in hip fracture patients and many risk factors have been identified. Controversy exists regarding the possible impact of intraoperative control of blood pressure upon acute (delirium) and long term (dementia) cognitive decline. We explored possible associations between perioperative hemodynamic changes, use of vasopressor drugs, risk of delirium and risk of new-onset dementia. METHODS: Prospective follow-up study of 696 hip fracture patients, assessed for delirium pre- and postoperatively, using the Confusion Assessment Method. Pre-fracture cognitive function was assessed using the Informant Questionnaire of Cognitive Decline in the Elderly and by consensus diagnosis. The presence of new-onset dementia was determined at follow-up evaluation at six or twelve months after surgery. Blood pressure was recorded at admission, perioperatively and postoperatively. RESULTS: Preoperative delirium was present in 149 of 536 (28%) assessable patients, and 124 of 387 (32%) developed delirium postoperatively (incident delirium). The following risk factors for incident delirium in patients without pre-fracture cognitive impairment were identified: low body mass index, low level of functioning, severity of physical illness, and receipt of ≥ 2 blood transfusions. New-onset dementia was diagnosed at follow-up in 26 of 213 (12%) patients, associated with severity of physical illness, delirium, receipt of vasopressor drugs perioperatively and high mean arterial pressure postoperatively. CONCLUSION: Risk factors for incident delirium seem to differ according to pre-fracture cognitive status. The use of vasopressors during surgery and/or postoperative hypertension is associated with new-onset dementia after hip fracture. Public Library of Science 2017-07-10 /pmc/articles/PMC5503267/ /pubmed/28700610 http://dx.doi.org/10.1371/journal.pone.0180641 Text en © 2017 Neerland et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Neerland, Bjørn Erik Krogseth, Maria Juliebø, Vibeke Hylen Ranhoff, Anette Engedal, Knut Frihagen, Frede Ræder, Johan Bruun Wyller, Torgeir Watne, Leiv Otto Perioperative hemodynamics and risk for delirium and new onset dementia in hip fracture patients; A prospective follow-up study |
title | Perioperative hemodynamics and risk for delirium and new onset dementia in hip fracture patients; A prospective follow-up study |
title_full | Perioperative hemodynamics and risk for delirium and new onset dementia in hip fracture patients; A prospective follow-up study |
title_fullStr | Perioperative hemodynamics and risk for delirium and new onset dementia in hip fracture patients; A prospective follow-up study |
title_full_unstemmed | Perioperative hemodynamics and risk for delirium and new onset dementia in hip fracture patients; A prospective follow-up study |
title_short | Perioperative hemodynamics and risk for delirium and new onset dementia in hip fracture patients; A prospective follow-up study |
title_sort | perioperative hemodynamics and risk for delirium and new onset dementia in hip fracture patients; a prospective follow-up study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5503267/ https://www.ncbi.nlm.nih.gov/pubmed/28700610 http://dx.doi.org/10.1371/journal.pone.0180641 |
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