Delirium after Intertrochanteric Fractures of Femur in Elderly Patients

Kyu Bok Kang; Dong Hun Suh; Seong Rok Oh

doi:10.12671/jkfs.2011.24.2.131

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Kang, Suh, and Oh: Delirium after Intertrochanteric Fractures of Femur in Elderly Patients

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2011; 24(2): 131-137.

Published online: 19 April 2011

DOI: https://doi.org/10.12671/jkfs.2011.24.2.131

Delirium after Intertrochanteric Fractures of Femur in Elderly Patients

Kyu Bok Kang, M.D., Dong Hun Suh, M.D.^*, Seong Rok Oh, M.D.

Department of Orthopaedic Surgery, Seoul Veterans Hospital, Seoul, Korea.

^*Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan, Korea.

Address reprint requests to: Dong Hun Suh, M.D. Department of Orthopaedic Surgery, Korea University Ansan Hospital, 516, Gojan 1-dong, Danwon-gu, Ansan 425-707, Korea. Tel: 82-31-412-5043, Fax: 82-31-487-9502, mayhap00@naver.com

Received 1 November 2010 Revised 13 December 2010 Accepted 3 January 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the incidence, risk factors and prognosis of delirium in elderly patients with intertrochanteric fractures of femur.

Materials and Methods

162 patients who underwent operation for intertrochanteric fracture of femur from July 2005 to January 2007 were reviewed retrospectively. Delirium was diagnosed by using Confusion Assessment Method (CAM). Medical records were reviewed for the information of the patients, Gross motor function classification of Palisano et al. was used for the evaluation of ambulatory status. Univariate analysis and multivariate analysis were done to find out the risk factors.

Results

2 cases out of 162 (1.2%) met the criteria of delirium at admission, and 39 cases (24.1%) after surgery. Univariate analysis and multivariate analysis identified age, hematocrit, dementia, the duration of opiate use, and pulmonary complication as risk factors. Hospital stay was longer and postoperative ambulatory status was worse in the patients with delirium.

Conclusion

Delirium is a frequent complication of intertrochanteric fractures of old age and associated with worse results. Cognitive function as well as physical status should be evaluated before and after surgery. Delirium needs more active prevention and treatment for better results.

Keywords: Delirium, Intertrochanteric fracture, Incidence, Risk factors

Figures and Tables

Table 1

Confusion assessment method (CAM). The diagnosis of delirium by CAM requires the presence of features 1 and 2 and either 3 or 4

Table 2

Continuous and categorical variables used in analysis

Table 3

Demographics of the patients

^*Body Mass Index, ^†American Society of Anesthesiologists' physical status classification, ^‡Results of univariate analysis.

Table 4

Laboratory values

^*Alanine aminotransferase, ^†Aspartate aminotransferase, ^‡Results of univariate analysis.

Table 5

Patients medical factors

^*Moderate to severe, ^†Results of univariate analysis.

Table 6

Surgery related factors

^*Decrease of hemoglobin after operation, ^†Results of univariate analysis.

Table 7

Results of multivariate test

Table 8

Prognosis factors

^*Results of univariate analysis.

References

1. Bergström U, Jonsson H, Gustafson Y, Pettersson U, Stenlund H, Svensson O. The hip fracture incidence curve is shifting to the right. Acta Orthop. 2009. 80:520–524.

2. Björkelund KB, Hommel A, Thorngren KG, Gustafson L, Larsson S, Lundberg D. Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention study. Acta Anaesthesiol Scand. 2010. 54:678–688.

3. Cole MG, Primeau FJ. Prognosis of delirium in elderly hospital patients. CMAJ. 1993. 149:41–46.

4. Dasgupta M, Dumbrell AC. Preoperative risk assessment for delirium after noncardiac surgery: a systematic review. J Am Geriatr Soc. 2006. 54:1578–1589.

5. Furlaneto ME, Garcez-Leme LE. Delirium in elderly individuals with hip fracture: causes, incidence, prevalence, and risk factors. Clinics (Sao Paulo). 2006. 61:35–40.

6. George J, Bleasdale S, Singleton SJ. Causes and prognosis of delirium in elderly patients admitted to a district general hospital. Age Ageing. 1997. 26:423–427.

7. Inouye SK. Predisposing and precipitating factors for delirium in hospitalized older patients. Dement Geriatr Cogn Disord. 1999. 10:393–400.

8. Inouye SK, Bogardus ST Jr, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999. 340:669–676.

9. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990. 113:941–948.

10. Juliebø V, Bjøro K, Krogseth M, Skovlund E, Ranhoff AH, Wyller TB. Risk factors for preoperative and postoperative delirium in elderly patients with hip fracture. J Am Geriatr Soc. 2009. 57:1354–1361.

11. Kim KH, Kho DH, Shin JY, Choi JY, Kim ES, Kim DH. Risk factors of postoperative delirium in elderly patients with hip fractures. J Korean Fract Soc. 2008. 21:189–194.

12. Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc. 2001. 49:516–522.

13. McNicoll L, Fitzgibbons PG. Optimal hip fracture management in high-risk frail older adults. Med Health R I. 2009. 92:250–252.

14. Morrison RS, Magaziner J, Gilbert M, et al. Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol A Biol Sci Med Sci. 2003. 58:76–81.

15. Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH. Content validity of the expanded and revised gross motor function classification system. Dev Med Child Neurol. 2008. 50:744–750.

16. Pedersen SJ, Borgbjerg FM, Schousboe B, et al. A comprehensive hip fracture program reduces complication rates and mortality. J Am Geriatr Soc. 2008. 56:1831–1838.

17. Robertson BD, Robertson TJ. Postoperative delirium after hip fracture. J Bone Joint Surg Am. 2006. 88:2060–2068.

18. Saxena S, Lawley D. Delirium in the elderly: a clinical review. Postgrad Med J. 2009. 85:405–413.

19. Song WS, Choi JC, Lee YS, et al. The risk factors of delirium in elderly patients with hip fracture: a prospective study. J Korean Hip Soc. 2008. 20:293–298.

20. Trzepacz PT. Delirium. Advances in diagnosis, pathophysiology, and treatment. Psychiatr Clin North Am. 1996. 19:429–448.

21. van der Mast RC. Pathophysiology of delirium. J Geriatr Psychiatry Neurol. 1998. 11:138–145.

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