Prevention of Postoperative Delirium Hip Fracture in Elderly

Increased risk for postoperative delirium has been documented in elderly patients undergoing hip fracture repair.([FOOTNOTE=Zywiel MG, Hurley RT, Perruccio AV, Hancock-Howard RL, Coyte PC, Rampersaud YR. Health economic implications of perioperative delirium in older patients after surgery for a fragility hip fracture. J Bone Joint Surg Am. 2015;97(10):829-836.],[ANCHOR=],[LINK=])

High, low, and mean incidence of postoperative delirium in hip fracture repair.

Study	Procedure	Incidence of Delirium	Elderly?	N
Gottschalk 2015([FOOTNOTE=Gottschalk A, Hubbs J, Vikani AR, Gottschalk LB, Sieber FE. The Impact of Incident Postoperative Delirium on Survival of Elderly Patients After Surgery for Hip Fracture Repair. Anesth Analg. 2015;121(5):1336-1343.],[ANCHOR=],[LINK=])	Hip fracture repair	32.90%	Yes	459
Guo 2016([FOOTNOTE=Guo Y, Jia P, Zhang J, Wang X, Jiang H, Jiang W. Prevalence and risk factors of postoperative delirium in elderly hip fracture patients. J Int Med Res. 2016;44(2):317-327.],[ANCHOR=],[LINK=])	Hip fracture repair	21%	Yes	572
Lee 2011([FOOTNOTE=Lee KH, Ha YC, Lee YK, Kang H, Koo KH. Frequency, risk factors, and prognosis of prolonged delirium in elderly patients after hip fracture surgery. Clin Orthop Relat Res. 2011;469(9):2612-2620.],[ANCHOR=],[LINK=])	Hip fracture repair	30.20%	Yes	232
Mosk 2017([FOOTNOTE=Mosk CA, Mus M, Vroemen JP, et al. Dementia and delirium, the outcomes in elderly hip fracture patients. Clin Interv Aging. 2017;12:421-430.],[ANCHOR=],[LINK=])	Hip fracture repair	35%	Yes	566
Yang 2017([FOOTNOTE=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(2):115-126.],[ANCHOR=],[LINK=])	Hip fracture repair	24%	Yes	5364
Zywiel 2015¹	Hip fracture repair	48%	Yes	242

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KAT 2008

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Kat 2008

Kat et al.([FOOTNOTE=Kat MG, Vreeswijk R, de Jonghe JF, et al. Long-term cognitive outcome of delirium in elderly hip surgery patients. A prospective matched controlled study over two and a half years. Dement Geriatr Cogn Disord. 2008;26(1):1-8.],[ANCHOR=],[LINK=]) prospectively matched 71 patients diagnosed with postoperative delirium with 41 controls without postoperative delirium who had a similar risk factor profile. Outcome was assessed in all patients 30 months after discharge. A significantly greater proportion of patients with postoperative delirium died, were diagnosed with dementia or mild cognitive impairment (MCI), or were institutionalized at 30 months.

	Relative risk
Mortality	1.4
Diagnosis of dementia or MCI	1.8
Institutionalization	1.8

BICKEL 2008

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Bickel 2008

Bickel et al.([FOOTNOTE=Bickel H, Gradinger R, Kochs E, Forstl H. High risk of cognitive and functional decline after postoperative delirium. A three-year prospective study. Dement Geriatr Cogn Disord. 2008;26(1):26-31.],[ANCHOR=],[LINK=]) conducted preoperatively and postoperatively daily assessments of cognitive function in hip surgery patients aged 60 years or greater (n=200). Patient outcome was assessed among patients with and without postoperative delirium 8 and 38 months after discharge. Adjusted* logistic regression analysis established associations between delirium and cognitive impairment, subjective memory decline, and incident need for long-term care at 38 months.

	Adjusted* odds ratio 8 months after discharge	Adjusted* odds ratio 38 months after discharge
Cognitive impairment/dementia	NS	41.2
Complaints about memory decline after surgery	4.7	6.2
Incident need for long-term care	NS	5.7
*Adjusted for age, sex, medical comorbidity, and preoperative cognitive performance

Elderly patients undergoing hip fracture repair (n=114) under propofol sedation with spinal anesthesia were randomized to receive either deep (BIS™ index values≈50) or light (BIS™ index values ≥80) sedition.([FOOTNOTE=Sieber FE, Zakriya KJ, Gottschalk A, et al. Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Mayo Clin Proc. 2010;85(1):18-26.],[ANCHOR=],[LINK=]) Postoperative delirium was assessed after the second day postoperatively. The light sedation group had a 50% reduction in delirium compared to the deep sedation group.

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Hip Fracture Repair Complications

Reduce the postoperative delirium risk

Hip Fracture Repair Incidence

High, low, and mean incidence of postoperative delirium in hip fracture repair.

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CLINICAL EVIDENCE

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CLINICAL AND ECONOMIC BURDEN

KAT 2008

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Kat 2008

Relative risk for mortality, diagnosis of dementia or MCI, or institutionalization among patients with postoperative delirium 30 months after discharge

BICKEL 2008

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Bickel 2008

Significant associations between postoperative delirium and long-term (8 and 38 months after discharge) patient outcome

REDUCING THE RISK OF POSTOPERATIVE DELIRIUM VIA BIS™-GUIDED ANESTHESIA

Sieber 2010

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Hip Fracture Repair Complications

Reduce the postoperative delirium risk

Hip Fracture Repair Incidence

High, low, and mean incidence of postoperative delirium in hip fracture repair.

CLINICAL EVIDENCE

CLINICAL EVIDENCE

E-Learning

Discover our broad online education offering.

CLINICAL AND ECONOMIC BURDEN

KAT 2008

Back

Kat 2008

Relative risk for mortality, diagnosis of dementia or MCI, or institutionalization among patients with postoperative delirium 30 months after discharge

BICKEL 2008

Back

Bickel 2008

Significant associations between postoperative delirium and long-term (8 and 38 months after discharge) patient outcome

REDUCING THE RISK OF POSTOPERATIVE DELIRIUM VIA BIS™-GUIDED ANESTHESIA

Sieber 2010

Recommended Product

Gain Insight into Brain Response

Learn More

Acute Care & Monitoring

PATIENT SAFETY IN OUR HANDS

Follow us on Facebook

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Corporate Resources

Medical Surgical Portfolio

Additional Resources

Medtronic Limited

©2024 Medtronic