Incidence And Predictive Factors Of Postoperative Delirium In Elderly Hip Fracture Patients

Objective 1.To conduct a literature research on relevant factors of postoperative delirium,so as to providereference for the selection of research indexes in this study;2.To describe the occurrence status of postoperative delirium in elderly hip fracture patients andanalyze the risk factors of postoperative delirium as well as these factors’ predictive efficacy,so as to provide reference for the identification of high-risk patients,the prediction ofpostoperative delirium and the development of preventive measures.Method 1.Literature Research on Relevant Factors of Postoperative DeliriumA scoping review was conducted following a methodology framework first developed byArksey and O’Malley and further enhanced by Daudt et al.and was reported following theguidance of the Joanna Briggs Institute Reviewers’ Manual.The enhanced framework consistsof five key stages: identifying the research question;identifying relevant studies;studyselection;charting the data;collating,summarizing and reporting the results.2.Incidence and Predictive Factors of Postoperative DeliriumThis prospective observational study enrolled elderly hip fracture patients who hadconsecutively admitted to a tertiary hospital in Shanghai from November 2017 to April 2018.The research tools included a self-designed postoperative delirium relevant factorsquestionnaire,the FRAIL scale,the mini-mental state examination scale(MMSE)and theconfusion assessment method(CAM)instrument.The evaluation results of the CAMinstrument were used to describe the incidence of postoperative delirium,subsyndromaldelirium and delirium symptoms.Taking each research index as independent variable,theoutcome index as dependent variable,we successively conducted univariate analysis,multivariate logistic regression analysis and ROC curve analysis.The risk factors of PODwere determined by multivariate Logistic regression analysis,and the receiver operatingcharacteristic(ROC)curve was used to evaluate the predictive efficacy and determine thecut-off value.Results 1.Literature Research on Relevant Factors of Postoperative DeliriumA total of 935 articles were initially identified as potentially relevant,and finally 36 articleswere included in this scoping review.It includes 31 original studies,3 systematic reviews and2 guideline articles.According to the multifactorial model for delirium,13 predisposingfactors and 12 precipitating factors that can be further studied were summarized,thus theresearch indexes of this study were preliminarily determined.2.Incidence of Postoperative Delirium(1)POD occurred in 63 of 217 patients with an incidence of 29%.SSD occurred in 29patients with an incidence of 13.4%.(2)The clinical manifestations of delirium symptom in those 63 patients with POD were asfollows(ranked by incidence from high to low): disorganized thinking(88.9%),alteredlevel of consciousness(79.3%),perceptual disturbances(68.3%),disorientation(63.5%),psychomotor agitation(49.2%),psychomotor retardation(47.6%),altered sleep-wakecycle(36.5%),memory impairment(12.7%).3.Predictive Factors of Postoperative Delirium(1)Univariate analysis showed that there were statistically significant differences in age,hematocrit,albumin,serum sodium,pre-fracture mobility status,history of stroke,Parkinson disease,history of mental illness,preoperative frailty,duration of surgery,typeof surgery,intraoperative hypoxia,transfer to ICU after surgery,and length of ICU staybetween non POD and POD group.(2)Multivariate analysis showed that age(P=0.006,OR=1.172),preoperative frailty(P=0.044,OR=2.525),history of stroke(P=0.020,OR=7.423),intraoperative hypoxia(P=0.016,OR=20.020),and length of ICU stay(P=0.012,OR=2.665)were risk factorsfor POD.(3)ROC curve analysis showed that age(AUC=0.822,P<0.001),preoperative frailty(P=0.044,OR=2.525)and length of ICU stay(AUC=0.778,P<0.001)had a moderatepredictive efficacy,history of stroke(AUC=0.590,P=0.050)and intraoperative hypoxia(AUC=0.602,P=0.028)had a low predictive efficacy.The cut-off value of age,preoperative frailty and ICU stay were 80 years old,2(prefrail)and 1 day,respectively.Conclusion The incidence of POD and SSD among elderly hip fracture patients is high.Delirium is a syndrome consisting of a complex set of symptoms.Patients with an age over 80,preoperative frailty,a history of stroke,intraoperative hypoxia and ICU stay for more than 1 day are high-risk groups for POD,which should be paid special attention to.In addition,two of the above risk factors: intraoperative hypoxia and length of ICU stay are precipitating factors,so targeted intervention measures can be developed to prevent the occurrence of POD and ultimately improve the prognosis of patients.