Incidence Of Delirium And Risk Factors In Elderly Patients With Osteoporotic Hip Fracture

Research background and purpose:With the acceleration of the aging society,the incidence of hip fracture in the elderly is gradually increasing.The hip fractures include femoral neck fractures and femoral intertrochanteric fractures,which are mainly treated by operation.Delirium is an important postoperative complication,manifested as a reversible mental disorder,which is characterized by inattention,abnormal level of consciousness,confusion and fluctuations.And delirium can significantly prolong the hospital stay of patients,increase medical expenses,increase complications and mortality,and seriously reduce the quality of life of patients.Identifying high-risk groups and improving the risk factors of postoperative delirium can prevent the occurrence of postoperative delirium.This study investigated the incidence of delirium and related factors in elderly patients with osteoporotic hip fractures,and aimed to explore the possible independent risk factors for delirium after surgery,provide clear causal clues for further research on the cause of postoperative delirium,and promote prevention and treatment of postoperative delirium.Materials and Methods:A total of 313 patients with hip fractures admitted to our hospital from August2017 to August 2019 were collected according to the inclusion criteria.49 patients with preoperative delirium and Alzheimer's disease,postoperative hospital stay of less than 7days and incomplete medical records were excluded and 264 patients were enrolled in the study at last.According to the occurrence of delirium during hospitalization,the patients were divided into delirium group(n=57)and control group(n=207).Age,sex,BMI,preoperative complications,cardiac function NYHA grade,fracture type,preoperative preparation time,ASA grade,mode of anesthesia,operation method,operation time,intraoperative blood loss,preoperative white blood cell count,preoperative hemoglobin,preoperative albumin,postoperative delirium and other related factors were collected.SPSS 24.0 statistical software was used for statistical description and statistical analysis.First of all,the univariate analysis was carried out.The measurement data was expressed by(?x±s),and the comparison between groups was expressed by t-test.The counting data was expressed by constituent ratio,and the comparison between groups was expressed by?2 test.The statistically significant factors between delirium group and control group by univariate analysis were used as covariates of binary logistic regression analysis.The independent risk factors and odds ratios of postoperative delirium were obtained by multivariate analysis with the occurrence of postoperative delirium.Result:Postoperative delirium occurred in 57 of the 264 elderly patients with hip fractures,with an incidence of 21.59%.The average age of patients in this study was 79.69±7.15years,of which 95 were males(35.98%),80.84±7.36 years old,169 females(64.02%),and 79.05±6.96 years old;147 cases were femoral neck fractures(55.7%)and 117cases were femoral intertrochanteric fractures(44.3%);231 cases(87.5%)were treated with general anesthesia,and 33 cases(12.5%)were treated with spinal anesthesia.Univariate analysis showed that age(t=-2.246,P=0.026),preoperative complications(?~2=5.144,P=0.023),preoperative albumin<35g/L(?~2=4.312,P=0.038),preoperative hemoglobin<100g/L(?~2=3.869,P=0.049),NYHA grade?3(?~2=8.398,P=0.004),ASA grade?3(?~2=10.449,P=0.001),timing of surgery(t=-2.052,p=0.044),surgical duration(t=-2.786,p=0.006)and preoperative white blood cell count(t=-2.672,p=0.009)were the risk factors of postoperative delirium in elderly patients with osteoporotic hip fractures.The results of multivariate analysis showed that age(OR=1.090,95%CI:1.026-1.158,P=0.005),preoperative preparation time(OR=1.113,95%CI:1.017-1.218,P=0.019),length of operation(OR=1.021,95%CI:1.01-1.031,P<0.001),preoperative white blood cell count(OR=1.222,95%CI:1.091-1.368,P=0.001),ASA score?3(OR=0.347,95%CI:0.131~0.919,P=0.033)and preoperative hemoglobin?100g/L(OR=0.249,95%CI:0.106~0.588,P=0.001)were independent risk factors for postoperative delirium in elderly patients with osteoporotic hip fractures.Conclusions:The incidence of postoperative delirium is high in elderly patients with osteoporotic hip fractures.Age,length of operation,ASA grade?3,preoperative preparation time,preoperative hemoglobin level and preoperative hemoglobin<100g/L are independent risk factors for postoperative delirium in elderly patients with osteoporotic hip fractures.