Shooka Esmaeeli1, Esteban Franco-Garcia2,3, Oluwaseun Akeju3,4, Marilyn Heng4,5, Carmen Zhou6, Ruben J Azocar1,7, Sadeq A Quraishi8,9. 1. Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, 800 Washington St, Ziskind 6038, Boston, MA, 02111, USA. 2. Department of Geriatrics, Massachusetts General Hospital, Boston, MA, 02114, USA. 3. Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA. 4. Harvard Medical School, Harvard University, Boston, MA, 02114, USA. 5. Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA. 6. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA. 7. Tufts University School of Medicine, Tufts University, Boston, MA, 02111, USA. 8. Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, 800 Washington St, Ziskind 6038, Boston, MA, 02111, USA. squraishi@tuftsmedicalcenter.org. 9. Tufts University School of Medicine, Tufts University, Boston, MA, 02111, USA. squraishi@tuftsmedicalcenter.org.
Abstract
BACKGROUND: Among elderly orthopedic trauma patients, the prevalence of delirium during hospitalization has been reported to be as high as 60%. Frail elderly patients have an increased risk of delirium after elective surgery; however, such an association remains underexplored among trauma patients. AIM: Our goal was to investigate whether preoperative frailty is associated with postoperative delirium (POD) in elderly orthopedic trauma patients. METHODS: We conducted a single-center, retrospective, cross-sectional study. All patients were ≥ 65 years of age and were admitted to the hospital between 01/01/2017 and 08/31/2018 for surgical intervention of a significant extremity fracture. Frailty was assessed using the fatigue, resistance, ambulation, illness, and loss of weight questionnaire. Delirium was assessed using the Confusion Assessment Method. POD was defined as new-onset delirium that occurred within 24 h after surgery. To investigate whether frailty is associated with POD, we performed a multiple variable logistic regression, controlling for biologically relevant confounders. RESULTS: Five hundred fifty-six patients comprised the analytic cohort. Incidence of POD was 14% (n = 80). Multiple variable regression analysis demonstrated that each unit increment in FRAIL score was associated with a 33% higher likelihood of POD (OR 1.33; 95% CI 1.02-1.72, p = 0.03). CONCLUSIONS: Our results suggest that preoperative frailty increases the risk of POD in hospitalized, elderly, orthopedic trauma patients. Future studies are needed to determine whether perioperative interventions focused on improving frailty can reduce the risk of POD and improve outcomes in this rapidly growing cohort of patients.
BACKGROUND: Among elderly orthopedic trauma patients, the prevalence of delirium during hospitalization has been reported to be as high as 60%. Frail elderly patients have an increased risk of delirium after elective surgery; however, such an association remains underexplored among trauma patients. AIM: Our goal was to investigate whether preoperative frailty is associated with postoperative delirium (POD) in elderly orthopedic trauma patients. METHODS: We conducted a single-center, retrospective, cross-sectional study. All patients were ≥ 65 years of age and were admitted to the hospital between 01/01/2017 and 08/31/2018 for surgical intervention of a significant extremity fracture. Frailty was assessed using the fatigue, resistance, ambulation, illness, and loss of weight questionnaire. Delirium was assessed using the Confusion Assessment Method. POD was defined as new-onset delirium that occurred within 24 h after surgery. To investigate whether frailty is associated with POD, we performed a multiple variable logistic regression, controlling for biologically relevant confounders. RESULTS: Five hundred fifty-six patients comprised the analytic cohort. Incidence of POD was 14% (n = 80). Multiple variable regression analysis demonstrated that each unit increment in FRAIL score was associated with a 33% higher likelihood of POD (OR 1.33; 95% CI 1.02-1.72, p = 0.03). CONCLUSIONS: Our results suggest that preoperative frailty increases the risk of POD in hospitalized, elderly, orthopedic trauma patients. Future studies are needed to determine whether perioperative interventions focused on improving frailty can reduce the risk of POD and improve outcomes in this rapidly growing cohort of patients.
Authors: Pratik Pandharipande; Bryan A Cotton; Ayumi Shintani; Jennifer Thompson; Brenda Truman Pun; John A Morris; Robert Dittus; E Wesley Ely Journal: J Trauma Date: 2008-07