Identification of factors contributing to the development of postoperative delirium in geriatric patients with hip fractures- A prospective study

INTRODUCTION: Geriatric hip fractures are a major cause of concern globally and often a frequent reason for morbidity and mortality. Postoperative delirium (POD) is a frequent but often under-diagnosed complication, especially after a major hip surgery. Some of the factors that have been associated with POD are diabetes, high American Society of Anesthesiologists (ASA) grading, electrolyte imbalance, and blood pressure fluctuations. Malnutrition as a risk factor is only recently being recognized. Although there are many possible risk factors reported, they are quite conflicting and not very clear. Therefore, we have attempted to conduct this study to identify the potential risk factors for the development of POD in patients with hip fractures. MATERIALS AND METHODS: A prospective observational study was performed on 110 geriatric hip fracture patients admitted to tertiary health care in South India. Data regarding preoperative blood investigations, ASA grading, hypertension and diabetes status, MNA (mini nutritional assessments) status, serum albumin, and serum electrolytes values were recorded. The Confusion Assessment Method tool (CAM) was used to diagnose delirium in the postoperative period. Statistical analysis was done for various factors influencing the occurrence of POD. RESULTS: Among the total of 110 cases of geriatric hip fractures patients, 44.5% of the patients developed postoperative delirium. Advancing age, hypoalbuminemia, malnourishment, and uncontrolled diabetes played an important role to the development of post operative delirium in patients with hip fractures. CONCLUSION: Advancing age, hypoalbuminemia, malnourishment, and uncontrolled diabetes are strong predictors for the development of postoperative delirium in geriatric hip fracture patients. Since age is a non-modifiable risk factor, interventional strategies aimed at correcting modifiable risk factors like nutrition, serum albumin levels, and diabetes control play an important part in preventing delirium in the postoperative period in elderly hip fracture patients. MeSH terms: Hip Fractures, Postoperative Complication, Delirium, Nutrition Assessment, Serum Albumin