Relationship Between Preoperative Malnutrition And Postoperative Delirium In Elderly Patients With Hip Fracture

Objective:Postoperative delirium(POD)is a serious dysfunction of attention and cognitive,even life-threatening in severe cases.The incidence rate of delirium after hip fracture surgery is high in the elderly.Malnutrition is closely related to hip fracture in the elderly,both of which often coexist.Therefore,this study mainly discusses the correlation between preoperative malnutrition and postoperative delirium of hip fracture in the elderly,in order to better prevent the occurrence of postoperative delirium.Methods:The design of this study was a cross-sectional study,involving 102 patients,who underwent hip fracture surgery in our hospital from September 2017 to June 2019,with 65years old or more.General clinical data,such as gender,age,body mass index(BMI),history(such as hypertension,diabetes,coronary heart disease)and some serological indicators were collected.At the same time,the nutritional status of all patients was assessed by mini nutritional assessment(MNA-SF)and serum related nutritional indicators(such as hemoglobin,albumin,prealbumin).The patients,divided into a delirious group and a non-delirious group,were assessed whether in a delirious state or not,using the delirium assessment method(CAM),after the surgery in 1-5days.This article studies the relationship between preoperative nutritional status and postoperative delirium,using binary logistic regression analysis.P<0.05 was statistically significant.Results:1.There were 102 patients included in the study,including 37 males(36.27%)and 65females(63.73%).The average age was(78.08±6.09).Among them,28 patients(27.3%)had postoperative delirium,including 10 males(35.7%)and 18 females(64.3%).Compared with the non delirium group,the delirium group was older(81.00 vs 78.50,P<0.05),with higher blood glucose and ASA(P<0.05).At the same time,the serum albumin level,prealbumin level,MNA-SF score and body mass index(BMI)of delirium group were lower than those of non delirium Group[(32.43 vs 38.55)g/L,(160 vs 219)g/L,(7.0 vs 11.5),(21.63±4.02 vs 23.17±3.24);P<0.05].The history of coronary heart disease and diabetes in delirium group was higher than that in non delirium Group[(32.1%vs 10.8%),(42.9%vs 12.6%)P<0.05].2.The results,comparing the distribution of different nutritional status between the two groups,showed that the subjects,in the delirium group,were 15 patients(53.6%)in malnutrition,10 patients(35.7%)at risk of malnutrition,and only 3 patients(10.7%)in normal nutrition,and the incidence of total nutritional abnormality was 89.3%.In the non delirium group,the subjects were only 11 patients(14.9%)in malnutrition,23 patients(31.1%)at risk of malnutrition,and 40 patients(54.1%)in normal nutrition,and the incidence of total nutritional abnormalities was 45.9%.The incidence of nutritional abnormalities in the two groups was statistically significant by X~2test(P<0.05),that is,the proportion of nutritional abnormalities in the delirium group was significantly higher than that in the non-delirium group.3.The results of correlation analysis between postoperative delirium and nutritional status showed that:the elderly(OR=1.141,95%CI=1.005-1.296,P<0.05),hyperglycemia(OR=1.304,95%CI=1.036,1.632,P<0.05),malnutrition(OR=19.768,95%CI=2.951-132.427,P<0.05)and malnutrition risk(OR=6.464,95%CI=1.113-33.368,P<0.05)were an independent risk factor for postoperative delirium in elderly patients,using multivariate logistic regression analysis.The higher level of albumin(OR=0.615,95%CI=0.482-0.837,P<0.05)was the protective factor of postoperative delirium in elderly patients.Conclusion:1.The incidence of postoperative delirium in elderly patients with hip fracture is high,and the risk factors for postoperative delirium are advanced age,high blood sugar,low serum albumin level,malnutrition status and malnutrition risk based on mna-sf score.2.The proportion of malnutrition in delirium patients after hip fracture surgery was significantly higher than that in non-delirium group.3.After adjusting for confounding factors,preoperative malnutrition and risk of malnutrition were independent risk factors for postoperative delirium in elderly patients with hip fracture.