Post-operative delirium in older hip fracture patients: a new onset or was it already there?

Abstract

To investigate if and how the incidence of post-operative delirium is related to the existence of pre-operative delirium and other peri-operative risk factors in older patients undergoing hip fracture surgery. Delirium was present more often pre- than post-operatively. The presence of pre- and post-operative delirium increased according to cognitive impairment severity. Identifying delirium onset is crucial to provide appropriate prevention and management by a multidisciplinary team. Hip fractures are a worldwide health issue primarily for older patients, conditioning major morbidity and mortality. An experienced multidisciplinary team is essential to manage surgery and peri-operative implications, to enable rapid functional and cognitive recovery. Delirium is a recognizable problem associated with negative outcomes. Our study aims to determine the influence of pre-operative delirium in the incidence of post-operative delirium, and to evaluate the association between other known peri-operative risk factors with both conditions. A single-center, retrospective cohort study, conducted at a Level II trauma center over a 14-month period, included 241 patients with 65 years of age or older submitted to hip fracture surgery. Peri-operative data were gathered regarding baseline characteristics (sociodemographic, functional and cognitive status), intra-operative events (anesthesia technique, surgery duration, blood loss) and post-operative outcomes (delirium occurrence). Statistical analysis evidenced a female (75.5%) and elderly population (83.9\u2009±\u20097.8 years old) with significant comorbidities (cognitive impairment in 51.9%, ASA\u2009≥\u2009III in 79.7%, mean CIRS-G 8.83\u2009±\u20094.69) that underwent surgical fracture repair, mostly under 4 h (96.3%) and under regional anesthesia (63.1%). Pre- and post-operative delirium incidence was 18.3% and 12.9%, respectively, displaying increased presence according to cognitive impairment severity. Post-operative delirium was almost inexistent when it was absent pre-operatively. Moreover, pre-operative cognitive status was associated with the development of pre- and post-operative delirium. Careful cognitive assessment, implementation of preventive strategies and avoidance of peri-operative pro-delirium factors are crucial for comprehensive geriatric care.