Perioperative risk factors of postoperative delirium in elderly patients with hip fractures

Background Postoperative delirium (POD) is a common complication in elderly patients with hip fractures, it is characterized by disorders of consciousness, attention, perception, thinking, memory, mental activity and emotions. Objective Our aim was to identify the perioperative risk factors of postoperative delirium in elderly patients with hip fracture. Methods We carried out a prospective cohort study on 80 elderly patients 60 years and older with recent fragile hip fractures, who attended the orthopedic department of Ain shams university hospitals, Cairo, Egypt. Patients who were delirious on admission and those with major traumatic fractures were excluded from the study. Each patient gave an oral consent and then subjected to history taking with assessment of perioperative risk factors of delirium. Delirium was assessed in preoperative period, day 1 and 2 postoperative by CAM (confusion assessment method). Cognitive impairment was assessed by MiniMental-state-examination (MMSE), severity of pain by pain scale, depression by patient health Questionnaire 2 (PHQ2), functional assessment by activity of daily living (ADL) and instrumental activity of daily living (IADL), assessment of risk of delirium by DEAR score. Radiological assessment of the fracture femur by X-ray. Preoperative lab investigations including: CBC, serum electrolyte panel, kidney & liver function test & fasting blood glucose were done Results 38% of our study population developed delirium preoperatively after admission, 68% developed delirium at day 1 postoperative versus only 37% at day 2 postoperatively. There was a significant difference between delirious & non delirious patients preoperatively in presence of hypertension, IHD & COPD, presence of cognitive impairment by MMSE, severity of pain and presence of risk of delirium by DEAR score and there was a significant difference between delirious & non delirious patients in day one postoperative in presence of co-morbidities as diabetes, ischemic heart diseases (IHD), chronic obstructive pulmonary disease (COPD), visual & hearing impairment, while there was a statistically significant difference between delirious & non delirious patients in day two postoperative in presence of visual & hearing impairment and in presence of cognitive impairment by MMSE, depression by PHQ2, severity of pain & risk of delirium by DEAR score Logistic regression model revealed that cognitive impairment and severity of pain were independent predictors of POD preoperatively, while functional dependency by IADL, visual & hearing impairment & diabetes were independent predictors of POD in day 1 postoperative while depression by PHQ2 was independent factor of POD in day 2 postoperative. Conclusion Postoperative delirium is common in patients with hip fractures as 68% of patients developed delirium at day one postoperative and 37% at day two postoperatively. Logistic regression revealed that cognitive impairment and severity of pain were independent predictors of POD preoperatively.

Predictors of poor outcomes in children with tracheoesophageal fistula/oesophageal atresia: an Australian experience

ObjectiveThe aim of this study is to characterize long-term morbidities of oesophageal atresia (OA) with or without tracheoesophageal fistula (TOF).MethodsInfants born with OA/TOF from 2000 to 2016 in Western Australia were included for analysis. Infants were categorized into high-risk and low-risk groups based on the presence of one or more perioperative risk factors [low birth weight, vertebraldefects, anal atresia, cardiac defects, TOF, renalanomalies, limb abnormalities (VACTERL), anastomotic leak, long gap OA, and failure to establish oral feeds within the first month] identified by a previous Canadian study. Frequency of morbidities in infants with perioperative risk factors was compared.ResultsOf 102 patients, 88 (86%) had OA with distal TOF (type C). The most common morbidities in our cohort were anastomotic oesophageal strictures (AS) (n=53, 52%), tracheomalacia (n=48, 47%), gastroesophageal reflux disease (GORD) (n=42, 41%) and recurrent respiratory tract infections (n=40, 39%). Presence of GORD (30/59 vs 12/43, p=0.04) and median frequency of AS dilatations (8 vs 3, n=59, p=0.03) were greater in the high-risk group. This study further confirmed that inability to be fed orally within the first month was associated with high morbidities.ConclusionsGastrointestinal and respiratory morbidities remain high in OA/TOF regardless of perioperative risk factors. Inability to be fed orally within the first month is a predictor of poor outcomes with high frequency of gastrointestinal and respiratory comorbidities.

Perioperative Risk Factors Predisposing to Atrial Fibrillation After CABG Surgery

Objectives: To detect perioperative risk factors for atrial fibrillation (AF) after coronary artery bypass graft (CABG) and to assess the impact of AF on outcome and postoperative complications. Methods: We undertook a prospective observational study of 1000 consecutive patients who underwent isolated CABG in Cairo University hospitals and other centers from March 2019 to November 2020. Patients were subsequently divided into 2 groups depending on the occurrence of postoperative AF. Preoperative, intraoperative, and postoperative risk factors were recorded for all patients, as well as postoperative mortality, complications, and hospital and intensive care unit (ICU) lengths of stay. Results: Postoperative atrial fibrillation (POAF) occurred in 78 patients (7.8%), with significant risk factors of age (P = .001), low ejection fraction (P = .001), absence of preoperative beta-blocker use (P = .001), and presence of right coronary artery lesion (P = .003). The intraoperative significant risk factor was the absence of total coronary revascularization (P = .001). Postoperative significant risk factors were electrolyte imbalance (P = .001) and postoperative inotropes (P = .02). Patients with postoperative AF had increased risk of mortality (P = .001) and longer ICU (P = .001) and hospital (P = .001) stays. Conclusion: The risk of POAF can be decreased by modifying perioperative adjustable risk factors, namely routinely using preoperative beta-blockers (unless contraindicated), achieving total coronary revascularization, avoiding postoperative electrolyte imbalance, and avoiding unnecessary use of inotropic support.