Postoperative delirium is a risk factor of institutionalization after hip fracture: an observational cohort study

Frontiers in Medicine

Medicine

Fanny Bounes¹  Fabrice Ferré¹  François Delort¹  François Labaste²  Vincent Minville²  Cédric Dray³  Philippe Valet³  Nicolas Reina⁴ 

[1] Anesthesiology and Intensive Care Department CHU Toulouse, Toulouse, France;Anesthesiology and Intensive Care Department CHU Toulouse, Toulouse, France;Institut RESTORE UMR 1301-Inserm 5070-CNRS EFS Univ. P. Sabatier, Toulouse, France;Institut RESTORE UMR 1301-Inserm 5070-CNRS EFS Univ. P. Sabatier, Toulouse, France;Orthopedic Surgery Department, CHU Toulouse, Toulouse, France;

关键词: orthopedic surgery;    hip fracture;    delirium;    dependence;    institutionalization;   

DOI  :  10.3389/fmed.2023.1165734

 received in 2023-02-21, accepted in 2023-07-10,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionHip fracture is a common clinical problem in geriatric patients often associated with poor postoperative outcomes. Postoperative delirium (POD) and postoperative neurocognitive disorders (NCDs) are particularly frequent. The consequences of these disorders on postoperative recovery and autonomy are not fully described. The aim of this study was to determine the role of POD and NCDs on the need for institutionalization at 3 months after hip fracture surgery.MethodA population-based prospective cohort study was conducted on hip fracture patients between March 2016 and March 2018. The baseline interview, which included a Mini-Mental State Examination (MMSE), was conducted in the hospital after admission for hip fracture. NCDs were appreciated by MMSE scoring evolution (difference between preoperative MMSE and MMSE at day 5 >2 points). POD was evaluated using the Confusion Assessment Method. The primary endpoint was the rate of new institutionalization at 3 months. We used a multivariate analysis to assess the risk of new institutionalization.ResultsA total of 63 patients were included. Thirteen patients (20.6%) were newly institutionalized at 3 months. Two factors were significantly associated with the risk of postoperative institutionalization at 3 months: POD (OR = 5.23; 95% CI 1.1–27.04; p = 0.04) and IADL evolution (OR = 1.8; 95% CI 1.23–2.74; p = 0.003).ConclusionOnly POD but not NCDs was associated with the risk of dependency and institutionalization after hip fracture surgery. The prevention of POD appears to be essential for improving patient outcomes and optimizing the potential for returning home.

【 授权许可】

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Copyright © 2023 Labaste, Delort, Ferré, Bounes, Reina, Valet, Dray and Minville.