Predictors of Postoperative Delirium in Elderly Patients Undergoing Hemiarthroplasty for Intertrochanteric Femur Fractures: A Prospective Observational Study.
TL;DR
POD is common after hemiarthroplasty in elderly patients and is influenced by both vulnerability and perioperative factors, and CGA-based screening facilitates early risk stratification and targeted preventive strategies.
Abstract
Background
Postoperative delirium (POD) is a frequent complication following hip fracture surgery in older adults and is associated with adverse clinical outcomes. Early identification of high-risk patients using the Comprehensive Geriatric Assessment (CGA) may improve perioperative management and reduce morbidity.
Objectives
To determine POD incidence and identify clinical, geriatric, and perioperative predictors using CGA-based assessment.
Materials And Methods
This prospective observational study included 350 patients aged ≥65 years who underwent hemiarthroplasty at a tertiary care hospital. Preoperative CGA assessed cognition, frailty, nutrition, functional status, comorbidity burden, and delirium risk. POD was evaluated using the Confusion Assessment Method on postoperative days 1, 3, and 5. Logistic regression identified independent predictors, and model performance was assessed using the Receiver-Operating-Characteristic analysis.
Results
POD occurred in 74 (21.1%) patients. Patients with POD were older and had higher frailty, greater comorbidity burden, lower cognitive scores, higher functional dependence, poorer nutritional status, and higher 4-A's test (4AT) scores (all P < 0.01). Delayed surgery, greater intraoperative blood loss, and general anesthesia were also associated with POD. Independent predictors included advanced age (odds ratio [OR]: 1.11), frailty (OR: 2.39), delayed surgery (OR: 1.74), general anesthesia (OR: 1.88), lower Mini-Mental State Examination scores (OR: 2.21), higher 4AT scores (OR: 3.04), malnutrition (OR: 2.16), and multiple comorbidities (OR: 1.72). The predictive model demonstrated good discrimination (area under the curve: 0.75). POD was associated with longer hospital stay, higher intensive care unit admission, and increased 30-day mortality.
Conclusion
POD is common after hemiarthroplasty in elderly patients and is influenced by both vulnerability and perioperative factors. CGA-based screening facilitates early risk stratification and targeted preventive strategies.