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Frequency, Risk Factors, and Prognosis of Prolonged Delirium in Elderly Patients After Hip Fracture Surgery

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Delirium in elderly patients after hip fracture surgery is believed to be a transient event, although it frequently lasts for more than 4 weeks.

Questions/purposes

We determined the incidence, risk factors, morbidity, and mortality of prolonged delirium in elderly patients after hip fracture surgery.

Patients and Methods

We evaluated 232 elderly patients (older than 65 years) (232 hips) who underwent hip fracture surgery for the development and duration of delirium and categorized them into three groups; nondelirium group, transient (≤ 4 weeks) delirium group, and prolonged (> 4 weeks) delirium group. Patients underwent a global geriatric evaluation, which included postoperative complications, mortality, and functional and mental status evaluations. The three groups were compared with respect to these variables.

Results

Seventy patients (30.2%) had delirium develop, and among these, 14 (20%) had prolonged delirium with a total incidence of 6%. Multivariate analysis showed preinjury dementia was a risk factor of prolonged delirium. At the final followup, five (62.5%) of the eight patients who were ambulatory outdoors in the prolonged delirium group became housebound, whereas only 18 (16.4%) of the 110 patients who were ambulatory outdoors in the nondelirium group became housebound. Survival at 40 months was 81.0% (95% confidence interval, 72.6%–89.3%) in the nondelirium group and 63.6% (95% confidence interval, 35.2%–92.1%) in the prolonged delirium group.

Conclusions

Prolonged delirium was found to be associated with a poor functional outcome and increased mortality.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Byung-Gun Chang MD, Hyun-Jeong Oh RN, and Sere Noh RN, for their efforts in enrolling and interviewing patients for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea

    Kyung-Hag Lee MD, Young-Kyun Lee MD & Kyung-Hoi Koo MD

  2. Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, South Korea

    Yong-Chan Ha MD

  3. Department of Anesthesiology, Chung-Ang University College of Medicine, Seoul, South Korea

    Hyun Kang MD

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  1. Kyung-Hag Lee MD
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  2. Yong-Chan Ha MD
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  3. Young-Kyun Lee MD
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Corresponding author

Correspondence to Yong-Chan Ha MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Chung-Ang University College of Medicine.

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Lee, KH., Ha, YC., Lee, YK. et al. Frequency, Risk Factors, and Prognosis of Prolonged Delirium in Elderly Patients After Hip Fracture Surgery. Clin Orthop Relat Res 469, 2612–2620 (2011). https://doi.org/10.1007/s11999-011-1806-1

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