The clinical profile and association of delirium in geriatric patients with hip fractures in a tertiary care hospital in India

Abstract

Introduction: Delirium is common in hospitalized geriatric patients with hip fractures. A number of peri-operative predisposing and postoperative precipitating factors have been identified in Western literature but data regarding this problem within the Indian context is scarce.

Method: The objectives of the study were to ascertain the incidence of delirium in geriatric patients admitted for the treatment of hip fractures in the Department of Orthopaedics of a tertiary care referral centre in South India, to delineate their clinical profile and identify probable contributing factors for development of delirium in this group of patients. The study was a prospective, cohort study design that was conducted on patients above the age of 60 years, admitted to the orthopaedic ward with hip fracture and who underwent hip surgery. A total of 81 patients were recruited from May 1st 2004 to April 30th 2005 (total duration of one year).

Results: Of the 81 patients 17 (21%) of the patients developed post-operative delirium. On multivariate analysis the presence of underlying dementia (OR 16.97), duration of surgery > 2.5 hrs (OR 8.23) and preoperative packed cell volume < 25 (OR 8.07) were found to be independent predisposing risk factors that were associated with the development of postoperative delirium. Postoperative infections, metabolic abnormalities and vascular events were found to be important detected medical causes for precipitating post-operative delirium. Patients who had delirium had longer hospital stays and poor ambulation at discharge.

Conclusions: Delirium in geriatric patients undergoing hip fracture surgery results in poor postoperative outcomes and increased cost. The etiology of delirium is multi-factorial. A number of potentially modifiable factors have been identified as risk factors for delirium. Appropriate intervention strategies involving physicians and geriatricians need to be implemented within the Indian context to reduce the incidence of delirium.