Reduce the postoperative delirium risk

Increased risk for postoperative delirium has been documented in elderly patients undergoing hip fracture repair.([FOOTNOTE=Zywiel MG, Hurley RT, Perruccio AV, Hancock-Howard RL, Coyte PC, Rampersaud YR. Health economic implications of perioperative delirium in older patients after surgery for a fragility hip fracture. J Bone Joint Surg Am. 2015;97(10):829-836.],[ANCHOR=],[LINK=])

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Hip Fracture Repair Incidence

High, low, and mean incidence of postoperative delirium in hip fracture repair.

CLINICAL EVIDENCE

CLINICAL EVIDENCE
Study Procedure Incidence of Delirium Elderly? N
Gottschalk 2015([FOOTNOTE=Gottschalk A, Hubbs J, Vikani AR, Gottschalk LB, Sieber FE. The Impact of Incident Postoperative Delirium on Survival of Elderly Patients After Surgery for Hip Fracture Repair. Anesth Analg. 2015;121(5):1336-1343.],[ANCHOR=],[LINK=]) Hip fracture repair 32.90% Yes 459
Guo 2016([FOOTNOTE=Guo Y, Jia P, Zhang J, Wang X, Jiang H, Jiang W. Prevalence and risk factors of postoperative delirium in elderly hip fracture patients. J Int Med Res. 2016;44(2):317-327.],[ANCHOR=],[LINK=]) Hip fracture repair 21% Yes 572
Lee 2011([FOOTNOTE=Lee KH, Ha YC, Lee YK, Kang H, Koo KH. Frequency, risk factors, and prognosis of prolonged delirium in elderly patients after hip fracture surgery. Clin Orthop Relat Res. 2011;469(9):2612-2620.],[ANCHOR=],[LINK=]) Hip fracture repair 30.20% Yes 232
Mosk 2017([FOOTNOTE=Mosk CA, Mus M, Vroemen JP, et al. Dementia and delirium, the outcomes in elderly hip fracture patients. Clin Interv Aging. 2017;12:421-430.],[ANCHOR=],[LINK=]) Hip fracture repair 35% Yes 566
Yang 2017([FOOTNOTE=Yang Y, Zhao X, Dong T, Yang Z, Zhang Q, Zhang Y. Risk factors for postoperative delirium following hip fracture repair in elderly patients: a systematic review and meta-analysis. Aging Clin Exp Res. 2017;29(2):115-126.],[ANCHOR=],[LINK=]) Hip fracture repair 24% Yes 5364
Zywiel 20151 Hip fracture repair 48% Yes 242

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CLINICAL AND ECONOMIC BURDEN

REDUCING THE RISK OF POSTOPERATIVE DELIRIUM VIA BIS™-GUIDED ANESTHESIA

Sieber 2010

Elderly patients undergoing hip fracture repair (n=114) under propofol sedation with spinal anesthesia were randomized to receive either deep (BIS™ index values≈50) or light (BIS™ index values ≥80) sedition.([FOOTNOTE=Sieber FE, Zakriya KJ, Gottschalk A, et al. Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Mayo Clin Proc. 2010;85(1):18-26.],[ANCHOR=],[LINK=])  Postoperative delirium was assessed after the second day postoperatively.   The light sedation group had a 50% reduction in delirium compared to the deep sedation group.  

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