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Association of preoperative frailty with postoperative delirium in elderly orthopedic trauma patients

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Among elderly orthopedic trauma patients, the prevalence of delirium during hospitalization has been reported to be as high as 60%. Frail elderly patients have an increased risk of delirium after elective surgery; however, such an association remains underexplored among trauma patients.


Our goal was to investigate whether preoperative frailty is associated with postoperative delirium (POD) in elderly orthopedic trauma patients.


We conducted a single-center, retrospective, cross-sectional study. All patients were ≥ 65 years of age and were admitted to the hospital between 01/01/2017 and 08/31/2018 for surgical intervention of a significant extremity fracture. Frailty was assessed using the fatigue, resistance, ambulation, illness, and loss of weight questionnaire. Delirium was assessed using the Confusion Assessment Method. POD was defined as new-onset delirium that occurred within 24 h after surgery. To investigate whether frailty is associated with POD, we performed a multiple variable logistic regression, controlling for biologically relevant confounders.


Five hundred fifty-six patients comprised the analytic cohort. Incidence of POD was 14% (n = 80). Multiple variable regression analysis demonstrated that each unit increment in FRAIL score was associated with a 33% higher likelihood of POD (OR 1.33; 95% CI 1.02–1.72, p = 0.03).


Our results suggest that preoperative frailty increases the risk of POD in hospitalized, elderly, orthopedic trauma patients. Future studies are needed to determine whether perioperative interventions focused on improving frailty can reduce the risk of POD and improve outcomes in this rapidly growing cohort of patients.

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Data availability

In compliance with Institutional Review Board requirements at the Massachusetts General Hospital, the data is not available for public use.


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Departments of Anesthesiology, Critical Care and Pain Medicine as well as Orthopaedic Surgery at the Massachusetts General Hospital and the Department of Anesthesiology and Perioperative Medicine at Tufts Medical Center.

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SE and SAQ equally contributed to the conception and design of the research; EFG, OA, MH, and RJA contributed to the design of the research. EFG, OJA, CZ, ES, and SAQ contributed to the acquisition and analysis of the data; ES, EFG, OA, MH, RJA, and SAQ contributed to the interpretation of the data. ES and SAQ drafted the manuscript. All authors critically revised the manuscript, agree to be fully accountable for ensuring the integrity and accuracy of the work, and read and approved the final manuscript.

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Correspondence to Sadeq A. Quraishi.

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Conflict of interest

SAQ received research funding and consulting fees from Abbott Nutrition, Alcresta Therapeutics, and Fresenius Kabi unrelated to this manuscript. SAQ was a former Nestle Nutrition Institute clinical fellow. All other authors report no conflicts.

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Institutional Review Board approvals were granted through the Massachusetts General Hospital and Tufts Medical Center (2016p002331).

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A waiver of individual patient consent was granted.

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Esmaeeli, S., Franco-Garcia, E., Akeju, O. et al. Association of preoperative frailty with postoperative delirium in elderly orthopedic trauma patients. Aging Clin Exp Res 34, 625–631 (2022).

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