Higher Delirium Risk Among OAs Receiving Prolonged Hip Fracture Surgery

According to recent study posted online in JAMA Network Open, older adults receiving prolonged hip fracture surgery, especially those that received a general anesthetic, are at a higher risk for postoperative delirium.  

“Postoperative delirium in older adults receiving hip fracture surgery is associated with morbidity and increased health care costs, yet little is known of potential modifiable factors that may help limit the risks,” explained lead author Bheeshma Ravi, MD, PhD, of the Division of Orthopedic Surgery and Department of Surgery at the University of Toronto, and colleagues.  

In order to understand how prolonged surgical times and type of anesthesia impacted delirium risk, the team of researchers conducted a retrospective population-based cohort study that analyzed patients 65 years and older. The patient population analyzed received hip fracture surgery between April 1, 2009 and March 30, 2017 within 80 hospitals in Ontario, Canada.

The researchers identified 68,131 patients with surgically managed hip fracture. Of those patients, 7150 experienced postoperative delirium. Finally, 26,853 patients received general anesthesia.

According to the findings, use of general anesthesia was associated with a slightly higher rate of postoperative delirium compared with patients that did not receive general anesthesia (2943 [11.0%] vs 4207 [10.2%]; P = .001). Further, the researchers found that the risk of delirium increased with longer surgical duration. The findings showed that every 30-minute increase in the duration of surgery was associated with a 6% increase in the risk for delirium (adjusted odds ratio, 1.06; 95% CI, 1.03-1.08; P < .001).

“Among older adults receiving hip fracture surgery, both an increased duration of surgery and receiving a general anesthetic were associated with an increased risk for postoperative delirium,” concluded Dr Ravi and colleagues.  

—Julie Gould 

Reference:

Ravi B, Pincus D, Cho S, et al. Association of Duration of Surgery With Postoperative Delirum Among Patients Receving Hip Fracture Repair [published online February 22, 2019]. JAMA Netw Open. 2019;2(2):e190111. doi:10.1001/jamanetworkopen.2019.0111