Surgical delay is a risk factor of delirium in hip fracture patients with mild–moderate cognitive impairment
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To investigate the relationship between onset of delirium and time to surgery in hip fracture (HF) patients with a different degree of cognitive impairment.
Retrospective analysis of a prospective database of 939 older adults, aged ≥ 75 years admitted with a fragility HF. Subjects underwent a Comprehensive Geriatric Assessment on admission, evaluating health status, prefracture functional status in basic and instrumental activities of daily living, and walking ability. According to the Short Portable Mental Status Questionnaire score, patients were stratified into three categories: cognitively healthy (0–2 errors), mildly to moderately impaired (3–7 errors) and severely impaired (8–10 errors). Time to surgery (from admission) was expressed as days. The occurrence of delirium was ascertained daily by Confusion Assessment Method.
Two hundred ninety-two (31.1%) patients experienced delirium during in-hospital stay. They were older, with a higher degree of comorbidity and functional impairment compared to patients without delirium. In multivariate analysis, surgical delay resulted a significant independent risk factor for delirium (HR 1.11, 95% CI 1.01–1.24), along with age, prefracture functional disability and cognitive impairment. When the analysis was performed accounting for the cognitive categories, surgical delay demonstrated to increase the risk of delirium only in the subcategory of mildly to moderately impaired patients, while no significant effect was demonstrated in patients cognitively healthy or severely impaired.
The study supports the concept that older adults with HF should undergo surgery quickly. Patients with mild-to-moderate cognitive impairment should be primarily considered as the best target for interventions aiming to reduce time to surgery.
KeywordsDelirium Hip fracture Orthogeriatric Osteoporosis Dementia
Giulio Pioli: study concept and design, acquisition of subjects and data, analysis and interpretation of data, preparation and critical review of the manuscript. Andrea Giusti: interpretation of data, preparation and critical review of the manuscript. Chiara Bendini, Paolo Pignedoli, Michele Cappa, Enrico Iotti, Maria Alice Ferri, and Eleonora Bergonzini: acquisition of subjects and data, interpretation of data, preparation of the manuscript. Ettore Sabetta: study concept, acquisition of subjects and data, interpretation of data, preparation and critical review of the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study was undertaken in accordance with the Declaration of Helsinki and approved by the Provincial Ethic Committee (2017/DIRSC/0012).
All patients gave written informed consent for the use personal data for research aims.
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