Association Between Preoperative Malnutrition And Postoperative Delirium After Hip Fracture Surgery In Older Adults

ObjectiveTo investigate the relationship between preoperative malnutrition and postoperative delirium incidence in elderly hip fracture patients in Department of Orthopaedics of Guangdong Provincial Hospital of traditional Chinese Medicine.To provide a new intervention point for the prevention and treatment of delirium after hip fracture in the elderly.MethodsT Included in the elderly hip fractures(including femoral neck fractures)admitted to the Department of Bone of Guangdong Provincial Hospital of traditional Chinese Medicine from December 2016 to January 2018.Mini nutritional assessment shortform(MNA-SF)was used to evaluate the nutritional status of patients with hip fractures.The patients were divided into three groups according to their nutritional status.CAM was used to determine whether the patient was in delirium state or not,and the patient was excluded from delirium state 1-7 days after operation.Data of the patients were collected: sex,age,fracture site,ADL score,MMES score,anaesthesia score,anaesthesia method,operation method,operation time,and so on.Intraoperative bleeding was analyzed by t test,chi-square test and multivariate logistic regression analysis.ResultsA total of 270 patients were included in this study,of whom 14 were excluded because of the history of dementia and delirium before operation,the remaining 256 were all included in the trial,and the data of the patients were recorded.There were 205 female patients,including 147 patients aged 80 to 90 years old and 76 patients aged less than 80 years,including 115 patients with femoral neck fracture,141 cases of intertrochanteric fracture of femur,84 cases of joint replacement(including artificial femoral head replacement and total hip replacement),141 cases of pfna internal fixation,11 cases of hollow screw internal fixation;Among them,236 patients were anesthetized by spinal anesthesia,the remaining 20 patients by general anesthesia in tracheal intubation.According to the preoperative mna-sf score(score ≥ 12 points,indicating good nutritional status,score 9-11,indicating general nutritional status,score ≤ 8 points),There were 93 cases in the group of good nutritional status,103 cases in the general group and 60 cases in the group of malnutrition,among which 20 cases of delirium occurred after operation in the group of good nutritional status.The incidence of postoperative delirium was 21.51.The incidence of postoperative delirium and postoperative delirium were 41 cases and 39.81% respectively in the nutritional status group,and 34 cases in the malnutrition group.The incidence of postoperative delirium was 56.67.By comparing the incidence of postoperative delirium,it was concluded that the p value of the comparison between the groups was less than 0.05,which indicated that the comparison between the groups had significance,so we can conclude that the worse the nutritional status,the higher the incidence of postoperative delirium.ConclusionThere was a significant correlation between preoperative malnutrition and postoperative delirium in elderly patients with hip fracture.The lower the preoperative nutritional status,the higher the risk of postoperative delirium.MNA-SF score should be routinely used for preoperative evaluation of elderly patients with hip fracture to determine whether they are at risk of postoperative delirium.