Orthogeriatric co-management reduces incidence of delirium in hip fracture patients

Abstract

Hip fracture patients often display an acute confusional state (delirium) which is associated with worse outcomes. In this observational study, we found that co-management of hip fracture patients by a multidisciplinary team including a geriatrician and an orthopaedic surgeon could reduce the incidence of delirium.

Introduction: Delirium after hip fracture is common and is associated with negative outcomes. We investigated if orthogeriatric co-management reduced the incidence of delirium in hip fracture patients.

Methods: In this single-centre, prospective observational study, we compared the incidence of delirium and subsyndromal delirium (SSD) before (usual care group, n = 94) and after (orthogeriatric group, n = 103) the introduction of orthogeriatric co-management as an integrated care model. The outcome measure 'no delirium/SSD/delirium' was treated as an ordinal variable and analysed using the chi-squared test and multivariable ordinal logistic regression.

Results: The groups had similar baseline characteristics except for a higher proportion of patients with pre-existing cognitive impairment in the usual care group (51% vs. 37%, p = 0.045). Fewer patients in the orthogeriatric group developed SSD or delirium (no delirium: 59% vs. 40%/SSD: 6% vs. 13%/delirium: 35% vs. 47%; p = 0.021). The number needed to treat (NNT) to avoid one case of SSD or delirium was 5.3 (95% CI: 3.1 to 19.7). In a multivariable analysis adjusted for age, sex, ASA class, pre-existing cognitive impairment, time to surgery, type of surgery, and medical or surgical complications, the odds ratio for the development of SSD/delirium was lower in the orthogeriatric group (OR = 0.46, 95% CI: 0.23-0.89, p = 0.023).

Conclusion: Orthogeriatric co-management as an integrated care model reduced the incidence of SSD/delirium in hip fracture patients.

Keywords: Delirium; Hip fracture; Orthogeriatric co-management; Subsyndromal delirium.

Fig. 1

Flow chart of patient inclusion. CSF, cerebrospinal fluid

Fig. 2

Directed acyclic graph (DAG) depicting the causal model used as a basis for analysing the association between orthogeriatric co-management and the incidence of subsyndromal delirium/delirium. exposure outcome ancestor of exposure adjusted variable causal path biasing path (none present). Complication(s): any medical and/or surgical complication during hospital admission; time to surgery: time from hospital admission to skin incision; cognitive impairment: pre-existing cognitive impairment.