Study on the occurrence of delirium in geriatric patients undergoing hip fracture surgery

BACKGROUND: Delirium is an acute state of confusion characterized by altered consciousness. This condition usually appears in hospitalized elderly subjects and increases its frequency as the patient’s age increases. Patients with delirium arising during hospitalization have a higher short-term mortality rate, a higher probability being institutionalized and a higher probability of having a physical disability and exposes patients to a greater risk of developing neurodegenerative disorder. The aim of this study is to specifically analyze the percentage of subjects who have experienced an episode of delirium and therefore required a specialist Geriatric or Psychiatric evaluation within an Orthopedics department following hospitalization for hip and femur fracture. We also analyzed possible correlations with the age of the patients, sex, comorbidity and the type of fracture that requires a different surgical approach. Once delirium occurs, interventions have little effect on severity or duration, emphasizing the importance of primary prevention. This review provides an overview of interventions to prevent postoperative delirium in elderly patients undergoing elective surgery. METHODS: We conducted a retrospective study, analyzing 348 patients (266 women and 82 men) with an average age of 84.37 years, who were hospitalized for femur fracture from Jan. 1st, 2020 to Dec. 31st, 2022. We restricted the sample only to geriatric patients, that is, with an age greater than 65. The average stay in ED was 0.7 days, about 17 hours. The average stay in the Orthopedics department was 10.3 days. Of the 348 elderly patients hospitalized, 59 (about 17.0%) experienced an episode of delirium that required a medical advice by a specialist capable of managing delirium, that is geriatrician or psychiatrist. During the observation period towards the 348 hospitalized patients, a total of 53 geriatric (psychogeriatric) and 10 psychiatric consultations were requested. Since patients experienced an episode of delirium, some (nine patients) underwent multiple evaluations. RESULTS: A total of 348 subjects (266 women and 82 men) with an average age of 84.37 years were analyzed. Firstly, it has become clear that the probability of developing delirium increases with increasing of recovery days, OR 5.28 (95% CI: 1.95-14.26). Another finding from the study is that subjects with depressive syndrome have a higher risk of developing delirium OR 2.3080 (95% CI: 1.1455-4.6500) as well as subjects who already manifested a known dementia OR 4.8468 (95% CI: 2.5266-9.2976). The statistical analysis shows there is no correlation between delirium and the patient’s sex, and patients’ other comorbidities: hypertension, diabetes mellitus, chronic obstructive pulmonary disease, Parkinson disease, dysthyroidism, chronic renal failure, osteoporosis, epileptic disease, pneumonia and COVID-19. CONCLUSIONS: The factors contributing to the development of delirium are advanced age, pre-existing dementia, physical disabilities, and sensory deficits, use of psychoactive drugs and insertion of urinary catheters. The management necessitates a multidisciplinary approach, involving geriatricians and psychiatric specialists that considering both the physical and psychological dimensions of delirium.