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. 2023 Aug 15:10:1165734.
doi: 10.3389/fmed.2023.1165734. eCollection 2023.

Postoperative delirium is a risk factor of institutionalization after hip fracture: an observational cohort study

François Labaste  1   2 , François Delort  1 , Fabrice Ferré  1 , Fanny Bounes  1 , Nicolas Reina  3 , Philippe Valet  2 , Cédric Dray  2 , Vincent Minville  1   2
Affiliations

Postoperative delirium is a risk factor of institutionalization after hip fracture: an observational cohort study

François Labaste et al. Front Med (Lausanne). .

Abstract

Introduction: Hip fracture is a common clinical problem in geriatric patients often associated with poor postoperative outcomes. Postoperative delirium (POD) and postoperative neurocognitive disorders (NCDs) are particularly frequent. The consequences of these disorders on postoperative recovery and autonomy are not fully described. The aim of this study was to determine the role of POD and NCDs on the need for institutionalization at 3 months after hip fracture surgery.

Method: A population-based prospective cohort study was conducted on hip fracture patients between March 2016 and March 2018. The baseline interview, which included a Mini-Mental State Examination (MMSE), was conducted in the hospital after admission for hip fracture. NCDs were appreciated by MMSE scoring evolution (difference between preoperative MMSE and MMSE at day 5 >2 points). POD was evaluated using the Confusion Assessment Method. The primary endpoint was the rate of new institutionalization at 3 months. We used a multivariate analysis to assess the risk of new institutionalization.

Results: A total of 63 patients were included. Thirteen patients (20.6%) were newly institutionalized at 3 months. Two factors were significantly associated with the risk of postoperative institutionalization at 3 months: POD (OR = 5.23; 95% CI 1.1-27.04; p = 0.04) and IADL evolution (OR = 1.8; 95% CI 1.23-2.74; p = 0.003).

Conclusion: Only POD but not NCDs was associated with the risk of dependency and institutionalization after hip fracture surgery. The prevention of POD appears to be essential for improving patient outcomes and optimizing the potential for returning home.

Keywords: delirium; dependence; hip fracture; institutionalization; orthopedic surgery.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart diagram of the study.
See this image and copyright information in PMC

References

    1. Dyer SM, Crotty M, Fairhall N, Magaziner J, Beaupre LA, Cameron ID, et al. A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr. (2016) 16:158. 10.1186/s12877-016-0332-0 - DOI - PMC - PubMed
    1. Katsoulis M, Benetou V, Karapetyan T, Feskanich D, Grodstein F, Pettersson-Kymmer U, et al. Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project. J Intern Med. (2017) 281:300–10. 10.1111/joim.12586 - DOI - PubMed
    1. Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Anesthesiology. (2018) 129:872–9. 10.1097/ALN.0000000000002334 - DOI - PubMed
    1. Patel V, Champaneria R, Dretzke J, Yeung J. Effect of regional versus general anaesthesia on postoperative delirium in elderly patients undergoing surgery for hip fracture: a systematic review. Br Med J Open. (2018) 8:e020757. 10.1136/bmjopen-2017-020757 - DOI - PMC - PubMed
    1. Yang Y, Zhao X, Dong T, Yang Z, Zhang Q, Zhang Y. Risk factors for postoperative delirium following hip fracture repair in elderly patients: a systematic review and meta-analysis. Aging Clin Exp Res. (2017) 29:115–26. 10.1007/s40520-016-0541-6 - DOI - PubMed