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European Journal of Orthopaedic Surgery & Traumatology

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01-02-2019 | Original Article • HIP - FRACTURES

Incidence, risk factors and clinical impact of postoperative delirium following open reduction and internal fixation (ORIF) for hip fractures: an analysis of 7859 patients from the ACS-NSQIP hip fracture procedure targeted database

Authors: Azeem Tariq Malik, Carmen E. Quatman, Laura S. Phieffer, Thuan V. Ly, Safdar N. Khan

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 2/2019

Abstract

Objective

Delirium is one of the most common acute psychiatric disturbances taking place in patients, particularly elderly, following hip fractures. Using a validated national surgical database, we sought to define the incidence, risk factors and clinical impact associated with the occurrence of delirium following open reduction and internal fixation (ORIF) for hip fracture.

Methods

The 2016 American College of Surgeons—National Surgical Quality Improvement Program (ACS-NSQIP) Hip Fracture Targeted Procedure file—was retrieved and merged with the ACS-NSQIP 2016 file. A total of 7859 patients were finally included in the study.

Results

A total of 2177 (27.7%) patients experienced an episode of delirium following the procedure. Adjusted analysis showed an increasing age ≥ 65 years (p < 0.001), partially dependent functional health status prior to surgery (p = 0.001), bleeding disorder (p = 0.012), preoperative dementia (p < 0.001), preoperative delirium (p < 0.001), being bed-ridden postoperatively (p < 0.001), no weight bearing as tolerated on first postoperative day (p < 0.001), an ASA grade > II (p < 0.001), non-emergency case (p = 0.010) and a prolonged length of stay > 3 days (p < 0.001). In addition, Black or African-American ethnicity had a lower odds of developing postoperative delirium (p = 0.020) as compared to Whites. Moreover, postoperative delirium was significantly associated with non-home discharge disposition (p < 0.001), higher odds of 30-day readmissions (p < 0.001) and 30-day mortality (p < 0.001).

Conclusion

This study identifies several risk factors associated with the occurrence of postoperative delirium in patients undergoing ORIF for hip fracture. Surgeons can utilize these data to risk stratify and consequently tailor an appropriate preoperative and postoperative care protocol to prevent the occurrence of delirium.

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Title: Incidence, risk factors and clinical impact of postoperative delirium following open reduction and internal fixation (ORIF) for hip fractures: an analysis of 7859 patients from the ACS-NSQIP hip fracture procedure targeted database
Authors: Azeem Tariq Malik
Carmen E. Quatman
Laura S. Phieffer
Thuan V. Ly
Safdar N. Khan
Publication date: 01-02-2019
Publisher: Springer Paris
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 2/2019
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-018-2308-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Incidence, risk factors and clinical impact of postoperative delirium following open reduction and internal fixation (ORIF) for hip fractures: an analysis of 7859 patients from the ACS-NSQIP hip fracture procedure targeted database

Abstract

Objective

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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