BACKGROUND: Delirium in elderly patients after hip fracture surgery is believed to be a transient event, although it frequently lasts for more than 4 weeks. QUESTIONS/PURPOSES: We determined the incidence, risk factors, morbidity, and mortality of prolonged delirium in elderly patients after hip fracture surgery. PATIENTS AND METHODS: We evaluated 232 elderly patients (older than 65 years) (232 hips) who underwent hip fracture surgery for the development and duration of delirium and categorized them into three groups; nondelirium group, transient (≤ 4 weeks) delirium group, and prolonged (> 4 weeks) delirium group. Patients underwent a global geriatric evaluation, which included postoperative complications, mortality, and functional and mental status evaluations. The three groups were compared with respect to these variables. RESULTS: Seventy patients (30.2%) had delirium develop, and among these, 14 (20%) had prolonged delirium with a total incidence of 6%. Multivariate analysis showed preinjury dementia was a risk factor of prolonged delirium. At the final followup, five (62.5%) of the eight patients who were ambulatory outdoors in the prolonged delirium group became housebound, whereas only 18 (16.4%) of the 110 patients who were ambulatory outdoors in the nondelirium group became housebound. Survival at 40 months was 81.0% (95% confidence interval, 72.6%-89.3%) in the nondelirium group and 63.6% (95% confidence interval, 35.2%-92.1%) in the prolonged delirium group. CONCLUSIONS: Prolonged delirium was found to be associated with a poor functional outcome and increased mortality. LEVEL OF EVIDENCE: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
BACKGROUND:Delirium in elderly patients after hip fracture surgery is believed to be a transient event, although it frequently lasts for more than 4 weeks. QUESTIONS/PURPOSES: We determined the incidence, risk factors, morbidity, and mortality of prolonged delirium in elderly patients after hip fracture surgery. PATIENTS AND METHODS: We evaluated 232 elderly patients (older than 65 years) (232 hips) who underwent hip fracture surgery for the development and duration of delirium and categorized them into three groups; nondelirium group, transient (≤ 4 weeks) delirium group, and prolonged (> 4 weeks) delirium group. Patients underwent a global geriatric evaluation, which included postoperative complications, mortality, and functional and mental status evaluations. The three groups were compared with respect to these variables. RESULTS: Seventy patients (30.2%) had delirium develop, and among these, 14 (20%) had prolonged delirium with a total incidence of 6%. Multivariate analysis showed preinjury dementia was a risk factor of prolonged delirium. At the final followup, five (62.5%) of the eight patients who were ambulatory outdoors in the prolonged delirium group became housebound, whereas only 18 (16.4%) of the 110 patients who were ambulatory outdoors in the nondelirium group became housebound. Survival at 40 months was 81.0% (95% confidence interval, 72.6%-89.3%) in the nondelirium group and 63.6% (95% confidence interval, 35.2%-92.1%) in the prolonged delirium group. CONCLUSIONS:Prolonged delirium was found to be associated with a poor functional outcome and increased mortality. LEVEL OF EVIDENCE: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
Authors: Dan K Kiely; Edward R Marcantonio; Sharon K Inouye; Michele L Shaffer; Margaret A Bergmann; Frances M Yang; Michael A Fearing; Richard N Jones Journal: J Am Geriatr Soc Date: 2009-01 Impact factor: 5.562
Authors: Allan Gottschalk; Jessica Hubbs; Ami R Vikani; Lindsey B Gottschalk; Frederick E Sieber Journal: Anesth Analg Date: 2015-11 Impact factor: 5.108
Authors: Christine C Johnson; Sonal Sodha; Juan Garzon-Muvdi; Steve A Petersen; Edward G McFarland Journal: Clin Orthop Relat Res Date: 2013-12-10 Impact factor: 4.176