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: 3.47). 07/2004; 98(6):1798-802, table of contents. DOI: 10.1213/01.ANE.0000117145.50236.90
Source: PubMed


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.

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    • "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. "
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    • "Various studies concerning functional outcome of operative treatment of hip fractures have been performed [7, 9,1213141516171819 most of them with less than 5 years follow-up. Several studies identiWed predictors of this functional outcome [16,192021222324. For an elderly patient with a femoral neck fracture, the ability to mobilize in their own home, and their community, would determine their ability to live indepen- dently [24]. "
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    • "In hip fracture surgery, spinal anaesthesia may decrease short-term postoperative cognitive dysfunction (evidence level II–III) [29, 45, 64, 66, 83], indicating that postoperative confusion is transient and there is no major impairment in either group after 7 days (evidence level II–III) [2, 25, 64, 66]. Postoperative delirium usually resolves within 48 h of onset [84]. Nevertheless, one observational study showed profound depression postoperatively to be lower in patients, who underwent spinal anaesthesia (evidence level II) [58]. "
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