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Predictors and Sequelae of Postoperative Delirium in a Geriatric Patient Population With Hip Fracture

INTRODUCTION: Postoperative delirium is common for patients with hip fracture. Predictors of postoperative delirium and its association with preexisting dementia and adverse postoperative outcomes in a geriatric hip fracture population were assessed. METHODS: Patients with hip fracture aged 60 years...

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Autores principales: Haynes, Monique S., Alder, Kareme D., Toombs, Courtney, Amakiri, Ikechukwu C., Rubin, Lee E., Grauer, Jonathan N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8133215/
https://www.ncbi.nlm.nih.gov/pubmed/33989253
http://dx.doi.org/10.5435/JAAOSGlobal-D-20-00221
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author Haynes, Monique S.
Alder, Kareme D.
Toombs, Courtney
Amakiri, Ikechukwu C.
Rubin, Lee E.
Grauer, Jonathan N.
author_facet Haynes, Monique S.
Alder, Kareme D.
Toombs, Courtney
Amakiri, Ikechukwu C.
Rubin, Lee E.
Grauer, Jonathan N.
author_sort Haynes, Monique S.
collection PubMed
description INTRODUCTION: Postoperative delirium is common for patients with hip fracture. Predictors of postoperative delirium and its association with preexisting dementia and adverse postoperative outcomes in a geriatric hip fracture population were assessed. METHODS: Patients with hip fracture aged 60 years and older were identified in the 2016 and 2017 National Surgical Quality Improvement Program Procedure Targeted Databases. Independent risk factors of postoperative delirium were identified. Associations with mortality, readmission, and revision surgery were evaluated using moderation and mediation analysis. RESULTS: Of 18,754 patients with hip fracture, 30.2% had preoperative dementia, 18.8% had postoperative delirium, and 8.3% had both preoperative dementia and postoperative delirium. Independent predictors of postoperative delirium were as follows: older age, male sex, higher American Society of Anesthesiologists score, dependent functional status, nongeneral anesthesia, preoperative diabetes, bleeding disorder, and preoperative dementia. Preoperative dementia and postoperative delirium each had an independent correlation with 30-day mortality (odds ratios = 2.06 and 1.92, respectively, with P < 0.001 for both). However, when both were present, those with preoperative dementia and postoperative delirium had an even higher odds of mortality based on moderation analysis (odds ratio = 2.25, P < 0.001). Readmissions and reoperations were significantly correlated with postoperative delirium, but not with preoperative dementia. The combination of preoperative dementia and postoperative delirium, however, did have compounding effects. Furthermore, a significant proportion of the total effect of preoperative dementia on mortality and readmission was accounted for by the development of postoperative delirium based on mediation analysis (medeff: 7%, P < 0.001 and medeff: 35%, P < 0.001). DISCUSSION: Postoperative delirium is a potentially preventable postoperative adverse outcome that was seen in 18.8% of 18,754 patients with hip fracture. Those with preoperative dementia seem to be a particularly at-risk subpopulation. Quality improvement initiatives to minimize postoperative delirium in this hip fracture population should be considered and optimized.
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spelling pubmed-81332152021-05-24 Predictors and Sequelae of Postoperative Delirium in a Geriatric Patient Population With Hip Fracture Haynes, Monique S. Alder, Kareme D. Toombs, Courtney Amakiri, Ikechukwu C. Rubin, Lee E. Grauer, Jonathan N. J Am Acad Orthop Surg Glob Res Rev Research Article INTRODUCTION: Postoperative delirium is common for patients with hip fracture. Predictors of postoperative delirium and its association with preexisting dementia and adverse postoperative outcomes in a geriatric hip fracture population were assessed. METHODS: Patients with hip fracture aged 60 years and older were identified in the 2016 and 2017 National Surgical Quality Improvement Program Procedure Targeted Databases. Independent risk factors of postoperative delirium were identified. Associations with mortality, readmission, and revision surgery were evaluated using moderation and mediation analysis. RESULTS: Of 18,754 patients with hip fracture, 30.2% had preoperative dementia, 18.8% had postoperative delirium, and 8.3% had both preoperative dementia and postoperative delirium. Independent predictors of postoperative delirium were as follows: older age, male sex, higher American Society of Anesthesiologists score, dependent functional status, nongeneral anesthesia, preoperative diabetes, bleeding disorder, and preoperative dementia. Preoperative dementia and postoperative delirium each had an independent correlation with 30-day mortality (odds ratios = 2.06 and 1.92, respectively, with P < 0.001 for both). However, when both were present, those with preoperative dementia and postoperative delirium had an even higher odds of mortality based on moderation analysis (odds ratio = 2.25, P < 0.001). Readmissions and reoperations were significantly correlated with postoperative delirium, but not with preoperative dementia. The combination of preoperative dementia and postoperative delirium, however, did have compounding effects. Furthermore, a significant proportion of the total effect of preoperative dementia on mortality and readmission was accounted for by the development of postoperative delirium based on mediation analysis (medeff: 7%, P < 0.001 and medeff: 35%, P < 0.001). DISCUSSION: Postoperative delirium is a potentially preventable postoperative adverse outcome that was seen in 18.8% of 18,754 patients with hip fracture. Those with preoperative dementia seem to be a particularly at-risk subpopulation. Quality improvement initiatives to minimize postoperative delirium in this hip fracture population should be considered and optimized. Wolters Kluwer 2021-05-14 /pmc/articles/PMC8133215/ /pubmed/33989253 http://dx.doi.org/10.5435/JAAOSGlobal-D-20-00221 Text en Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Haynes, Monique S.
Alder, Kareme D.
Toombs, Courtney
Amakiri, Ikechukwu C.
Rubin, Lee E.
Grauer, Jonathan N.
Predictors and Sequelae of Postoperative Delirium in a Geriatric Patient Population With Hip Fracture
title Predictors and Sequelae of Postoperative Delirium in a Geriatric Patient Population With Hip Fracture
title_full Predictors and Sequelae of Postoperative Delirium in a Geriatric Patient Population With Hip Fracture
title_fullStr Predictors and Sequelae of Postoperative Delirium in a Geriatric Patient Population With Hip Fracture
title_full_unstemmed Predictors and Sequelae of Postoperative Delirium in a Geriatric Patient Population With Hip Fracture
title_short Predictors and Sequelae of Postoperative Delirium in a Geriatric Patient Population With Hip Fracture
title_sort predictors and sequelae of postoperative delirium in a geriatric patient population with hip fracture
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8133215/
https://www.ncbi.nlm.nih.gov/pubmed/33989253
http://dx.doi.org/10.5435/JAAOSGlobal-D-20-00221
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