To Analyze The Risk Factors For Delirium Of Elderly Patients Undergoing Hip Fracture Operation

Objective:Postoperative delirium is one of the common compliations after hip fracture,affecting the patient’s quality of life and physical and mental health.Through this study to analyze the risk factors for delirium of elderly patients undergoing hip fracture operation,identify specific subpopulations of patients who are at greater risk for postoperative delirium,and pertinently bring forward precautionary measures.The aim is to reduce the incidence of delirium,improve the prognosis of patients.Methods:From February 2015 to August 2016,240 cases of postoperative elder with hip fracture from the intensive care unit of China-Japan unionhospital of Jilin university.To closely observate preoperative and postoperative day 1 to day 3,and collect the general information of patients,including age、sex、height、weight、anesthetic、operationtime、cardiovascular event history and so on.The patients were divided into traditional group and fast-track surgery group.Under the instruction of professional doctors and anesthesiologist,patients can eat something that no alcohol,transparent liquid with a little suger,such as water,tea,coffee when 2-h preoperative.And can eat easy to digest food when 6-h preoperative,can something properly.The patients of traditional group,12-h solid food fasting before operation and 4-h liquid fasting before operation.Other perioperative measures are the same.All patients were assessed with mini-mental state examination by the same researchers when 1-d preoperative.And all patients were evaluated whether with dementia and cognitive dysfunction.To diagnose the delirium,need to be divided into two steps: The depth of sedation scale(RASS)assess the depth of sedation of patients and then to use intensive care delirium assessment method to evaluate delirium(CAM)in theICU.Calculating the patient’s body mass index sex、height、weight、anesthetic、hospitalization time、operationtime、cerebrovascular accident history and so on.BMI was divided into 5 grades according to WHO standards and assigned repectively.The data was dealt with t text,with p<0.05 for the difference was statistically significant.Single factor logistic regression and multi-factor logistic regression analysis were applied to discuss related risk fractors of postoperative delirium.Results:1、The incidence of postoperative delirium in FTS group was 6.67%,and the incidence of traditional group was 20.83%,the incidence of delirium in the FTS group was lower than the traditional group.There was significant difference on solid food and liquid fasting.2 、 There was significant difference on age(x2=12.019,P<0.05),alcohol use(x2=19.407,P<0.05),time from injury to operation(x2=20.454,P<0.05),diabetes(x2=24.569,P<0.05),BMI index(t=2.107,P<0.05),operative time(t=-6.516,P<0.05)by single factor analysis.Multi-factor logistic regression analysis showed that POD occurrence rate in patient with age 70 ~80 and the age>80 were higher than that in patients with the age<70.OR values were 7.720(95%CI1.174~50.762)and 8.339(95%CI 1.036~67.140).POD occurrence rate in patients with lower BMI was higher than that in patients with normal BMI.OR values was13.791(95%CI 1.359~139.979).POD occurrence rate in patients with alcohol use is equal or more than 3 time per week was higher than that in patients with less 3 time per week.OR values was 7.120(95%CI 1.299 ~39.015).POD occurrence rate in patients with diabetes was higher than that in patients with no diabetes.OR values was 9.180(95%CI 1.810 ~46.545).POD occurrence rate in patients with operation time is equal or more than 180 min was higher than that in patients with less 180 min.OR values was 11.559(95%CI 1.741~76.728).POD occurrence rate in patients with equal or more than 7 d from injury to operation was higher than that in patients with 1 ~7 d from injury to operation.OR values was 14.943(95%CI 2.646~84.384).Conclusion:1、This study confirmed that reduce the preoperative fasting and the drink time can reduce the incidence of derilium,is beneficial to patients with postoperative recovery,shorter hospital stay.2、Age、low BMI、diabetes、alcohol use、operative time、time from injury to operation are the risk factors for POD in elderly patients with hip fracture.These factors have great values in POD,and the results showed that the successive order of factors affecting the POD was operative time、diabetes、alcohol use、age、BMI、the time from injury to operation.3、There was no significant correlation between anesthetic techniques、smoking and postoperative delirium.