Abstract SNACC-67

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Risk factors For Delirium In Elderly Fracture Hip Patients - A Retrospective Study.

1Kichloo A, 2Cong X, 1Ramani R
1Yale University School of Medicine, New Haven, CT, USA; 2Yale University, New haven, CT, USA

BACKGROUD:Postoperative delirium (POD) is commonly encountered in elderly patients and is associated with significant morbidity and mortality. The incidence of POD ranges from 15% to 53% depending on the type of surgery as compared to 1-2% in the general population. POD is acute in onset, fluctuating in course along with inattention and / altered sensorium. POD is also a major public health issue since it increases the duration of stay in the hospital by 2 to 5 days and many patients need long-term rehabilitation care. The projected increase in Medicare cost is around $152 billion per year. Our aim in this study was to identify the risk factors for POD in patients over 65 years of age coming for fracture hip surgery at Yale New Haven Hospital. The reported incidence of POD in this patient population is 35 % to 65 %. In the National Quality Improvement Program guidelines five risk factors for POD have been identified. Methods: The study was approved by the Yale University IRB. The electronic records of 150 patients > 65 years of age who underwent emergency hip fracture surgery in the year 2012 at Yale New Haven Hospital were reviewed from the time of admission to the time of discharge. POD was identified based on the chart review criteria which relies on identifiable characteristics of delirium like mental status change, inattention, disorientation, agitation, and inappropriate behavior in the periop period.1 The information from the chart reviews was categorized as pre-op, intra op and post op (Table 1a &1b) and univariate analysis was done for correlation with POD.
Results:Out of 150 patients’ complete records were available for 138. The incidence of POD was found to be 51.80% (72/138). As shown in table 1a among the pre and intra-op factors age was the only factor associated with an increased risk for POD. In table 1b various co-morbidities, which were identified, is listed and the only factor associated with POD was pre-exiting dementia. In the multivariate analysis both older age (OR 1.075, CI 1.023-1.129) and pre-existing dementia (OR 5.860, CI 2.197-15.634) were found to be independent risk factors for POD. Several other factors reported in literature like cardiovascular comorbidity, functional status, type of anesthesia had no statistical correlation to POD. Specifically the type of anesthetic (GA vs. regional) had no correlation with POD.
Conclusion: Older age and pre-existing dementia were the only factors significantly associated with POD.
Inouye SK et al: A Chart-Based Method for Identification of Delirium: Validation Compared with Interviewer Ratings Using the Confusion Assessment Method. JAGS 53; 312–318: 2005

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