Abstract
Background
Proximal femoral fractures are frequent injuries of elderly people and are often associated with declines in physical function and high rates of morbidity and mortality. A severe and frequent complication after hip surgery is postoperative delirium (POD), potentially associated with poorer clinical outcomes. We hypothesized that elderly patients with POD after hip fracture showed significantly worse clinical outcomes within one year after the fracture, compared to patients not suffering from POD. Additionally, relevant predictors of POD were evaluated.
Methods
Patients with proximal femoral fractures aged ≥ 60 years were included in a prospective, single-center observational study in Germany and followed up for 12 months. POD was evaluated by daily application of the Confusion Assessment Method (CAM) during the acute hospital stay. A variety of standardized instruments were used to evaluate patients’ functional and cognitive capacity, mobility, quality of life (HrQoL), depression, pain, etc., at baseline, discharge, and follow-up. A multiple logistic regression analysis was conducted to determine socio-demographic and clinical predictors of POD.
Results
Among 402 included patients (mean age: 81.3 ± 8.2 years), 184 (45.8%) developed POD (mean duration: 6.5 ± 4.4 days). At baseline, POD patients were significantly older, more often institutionalized, cognitively and physically more impaired, reported lower HrQoL, and had significantly more complications during the hospital stay. Multiple logistic regression analyses explained 22% of the variance, while prolonged intensive care unit stays, level of pain after surgery, and diminished pre-operative physical and cognitive state were significant predictors of POD. In-hospital mortality and overall mortality after 12 months were significantly higher in POD patients. Twelve months after the fracture, POD was significantly associated with diminished mobility, HrQoL, cognitive and functional capacity, and higher risk of falls.
Conclusions
Pain management is an important and controllable variable during hospital stay and should be a specific focus of the postoperative period, especially in functionally and cognitively impaired patients. Since patients with POD showed significantly worse clinical outcomes at discharge and 12 months post-fracture, prevention and effective treatment of POD should be of high priority in elderly patients with hip fractures.