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J Clin Anesth. 2020 Mar;60:28-33. doi: 10.1016/j.jclinane.2019.08.015. Epub 2019 Aug 19.

The association of preoperative delirium with postoperative outcomes following hip surgery in the elderly.

Author information

1
School of Medicine, University of California San Diego, San Diego, CA, USA.
2
Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, San Diego, CA, USA.
3
Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, San Diego, CA, USA; Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, San Diego, CA, USA. Electronic address: ragabriel@ucsd.edu.

Abstract

STUDY OBJECTIVE:

To determine the association of preoperative delirium with postoperative outcomes following hip surgery in the elderly.

DESIGN:

Retrospective cohort study.

SETTING:

Postoperative recovery.

PATIENTS:

8466 patients all of whom were 65 years of age or older undergoing surgical repair of a femoral fracture. Of the total population studied, 1075 had preoperative delirium. Of those with preoperative delirium, 746 were ASA class 3 or below and 327 were ASA class 4 or above. Of the 7391 patients without preoperative delirium, 5773 were ASA class 3 or below and 1605 were ASA class 4 or above. The remainder in each group was of unknown ASA class.

INTERVENTIONS:

We used multivariable logistic regression to explore the association of preoperative delirium with 30-day postoperative outcomes. The odds ratio (OR) with associated 95% confidence interval (CI) was reported for each covariate.

MEASUREMENTS:

Data was collected regarding the incidence of postoperative outcomes including: delirium, pulmonary complications, extended hospital stay, infection, renal complications, vascular complications, cardiac complications, transfusion necessity, readmission, and mortality.

MAIN RESULTS:

After adjusting for potential confounders, the odds of postoperative delirium (OR 9.38, 95% CI 7.94-11.14), pulmonary complications (OR 1.83, 95% CI 1.4-2.36), extended hospital stay (OR 1.47, 95% CI 1.26-1.72), readmission (OR 1.27, 95% CI 1.01-1.59) and mortality (OR 1.92, 95% CI 1.54-2.39) were all significantly higher in patients with preoperative delirium compared to those without.

CONCLUSIONS:

After controlling for potential confounding variables, we showed that preoperative delirium was associated with postoperative delirium, pulmonary complications, extended hospital stay, hospital readmission, and mortality. Given the lack of studies on preoperative delirium and its postoperative outcomes, our data provides a strong starting point for further investigations as well as the development and implementation of targeted risk-reduction programs.

KEYWORDS:

ACS NSQIP; Hip surgery; Postoperative complications; Preoperative delirium

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