Article

Brief postoperative delirium in hip fracture patients affects functional outcome at three months

Department of Anesthesiology, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224, USA.
Anesthesia & Analgesia (Impact Factor: 3.42). 07/2004; 98(6):1798-802, table of contents. DOI: 10.1213/01.ANE.0000117145.50236.90
Source: PubMed

ABSTRACT It is unclear how brief postoperative delirium (DEL) affects functional outcomes. In this study, we sought to determine if patients with brief postoperative DEL (<6-wk duration) have different living situations when compared with non-DEL patients after hip fracture repair. In a prospective study, patients admitted to the geriatric hip fracture service were assessed every postoperative day for the presence of DEL using the confusion assessment method (CAM) score. Patients were reassessed at 6 wk and 3 mo postoperatively for CAM score, current living situation, and activities of daily living. Group comparisons were tested after dividing patients into two groups: DEL (DEL; [+] CAM at any time during the postoperative period while in the hospital); no-DEL (no DEL; [-] CAM throughout the postoperative period while in the hospital). The study included 92 patients of whom 26 (28%) were CAM (+) after surgery. At 6 wk follow-up, n = 81; at 3 mo follow-up, n = 76. Eight patients died during the study. At 6 wk and 3 mo, a larger percentage of DEL patients were not living with a family member (27% versus 8% patients not living with a family member at 3 mo follow-up in DEL and no-DEL, respectively). There was no difference in activities of daily living by 3 mo. We conclude that brief postoperative DEL lasting <6 wk is a determining factor for poor long-term functional outcome after hip fracture repair, because it significantly impacts the ability to live independently. IMPLICATIONS: Brief postoperative delirium lasting <6 wk is a determining factor for poor long-term functional outcome after hip fracture repair, because it significantly impacts the ability to live independently.

0 Followers
 · 
101 Views
  • Source
    • "POD and POCD complications can be significant because such adverse outcomes can result in an increased length of hospital stay and medical complications (prolonged acute care hospitalization), unmet postoperative analgesic needs, unplanned discharge to a skilled care facility, and even premature death [17]. Patients with POCD are at an increased risk of death in the first year after surgery [18] [19] and economic impact(s) of delirium is also considerable, adding costs to hospitalization, including billions in additional Medicare charges. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background. Elderly patients have unique age-related comorbidities that may lead to an increase in postoperative complications involving neurological, pulmonary, cardiac, and endocrine systems. There has been an increase in the number of elderly patients undergoing surgery as this portion of the population is increasing in numbers. Despite advances in perioperative anesthesia and analgesia along with improved delivery systems, monotherapy with opioids continues to be the mainstay for treatment of postop pain. Reliance on only opioids can oftentimes lead to inadequate pain control or increase in the incidence of adverse events. Multimodal analgesia incorporating regional anesthesia is a promising alternative that may reduce needs for high doses and dependence on opioids along with any potential associated adverse effects. Methods. The following databases were searched for relevant published trials: Cochrane Central Register of Controlled Trials and PubMed. Textbooks and meeting supplements were also utilized. The authors assessed trial quality and extracted data. Conclusions. Multimodal drug therapy and perioperative regional techniques can be very effective to perioperative pain management in the elderly. Regional anesthesia as part of multimodal perioperative treatment can often reduce postoperative neurological, pulmonary, cardiac, and endocrine complications. Regional anesthesia/analgesia has not been proven to improve long-term morbidity but does benefit immediate postoperative pain control. In addition, multimodal drug therapy utilizes a variety of nonopioid analgesic medications in order to minimize dosages and adverse effects from opioids while maximizing analgesic effect and benefit.
    01/2014; 2014:902174. DOI:10.1155/2014/902174
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The relationship between patient trust of nursing staff, postoperative pain, and discharge functional outcomes following a total knee arthroplasty
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This correlational study examined the relationship between patient trust of nurses, level of postoperative pain, and discharge functional outcome following total knee arthroplasty. The study included 68 participants. Participants completed the Trust subscale of the Patient's Opinion of Nursing Care to assess trust of nursing staff. Numeric Analog Scale pain scores measured level of pain. Functional outcome was obtained from knee flexion gain scores. Average trust score was 47.5, average Numeric Analog Scale pain score was 5.0, and average gain score was 26.8. Analysis suggested no statistically significant relationships between patient trust of staff nurses, level of postoperative pain, and discharge functional outcome.
    Orthopaedic nursing / National Association of Orthopaedic Nurses 01/2009; 28(6):295-301. DOI:10.1097/NOR.0b013e3181c015df · 0.60 Impact Factor
Show more

Preview

Download
0 Downloads