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Ann Fr Anesth Reanim. 2013 Sep;32(9):e91-6. doi: 10.1016/j.annfar.2013.06.006. Epub 2013 Aug 14.

Delirium in older people after proximal femoral fracture repair: role of a preoperative screening cognitive test.

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  • 1Département de gériatrie, université Paris-Est Créteil, hôpital Henri-Mondor - Albert-Chenevier, Assistance Publique-Hôpitaux de Paris, 94010 Créteil, France; Service de gériatrie et consultation mémoire, Assistance Publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie, hôpital Charles-Foix, 7, avenue de la République, 94200 Ivry-sur-Seine, France. Electronic address: anthony.meziere@cfx.aphp.fr.



Preoperative cognitive impairment has been identified as a major risk factor for postoperative delirium in older people. The aim of this study was to evaluate whether a validated and rapid screening cognitive test - COgnitive Disorder EXamination (CODEX) - performed preoperatively before proximal femoral fracture repair, was associated with a risk of postoperative delirium.


We performed an observational prospective cohort study in orthopedic surgery department of a French hospital.


We included patients aged 70years or older undergoing proximal femoral fracture repair and who were free of known dementia and delirium at the preoperative phase.


Before surgery, the anesthesiologist realized the CODEX based on three-word recall test, simplified clock drawing and if one of these tasks was abnormal, spatial orientation was assessed. Delirium was routinely sought on postoperative day 3 (D3) using the Confusion Assessment Method by the geriatrician.


Among the 52 included patients, seven (13.5%) had delirium on D3. All seven patients were among the 25 patients with abnormal CODEX results. None of the 27 patients with normal CODEX results had postoperative delirium. Abnormal CODEX was significantly associated with the risk of postoperative delirium in univariate analysis and after adjustment for age (odds ratio [OR]: 13.33; 95% confidence interval, [95%CI]: 1.85±∞; P<0.003).


Abnormal preoperative rapid screening test CODEX is independently associated with postoperative delirium in older people undergoing hip fracture surgery and free of known dementia.

Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.


Cognitive test; Complications postopératoires; Confusion; Delirium; Fracture de l’extrémité supérieure du fémur; Hip fractures; Old people; Postoperative complications; Sujet âgé; Test cognitif

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