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=])
Kat et al.([FOOTNOTE=Kat MG, Vreeswijk R, de Jonghe JF, et al. Long-term cognitive outcome of delirium in elderly hip surgery patients. A prospective matched controlled study over two and a half years. Dement Geriatr Cogn Disord. 2008;26(1):1-8.],[ANCHOR=],[LINK=]) prospectively matched 71 patients diagnosed with postoperative delirium with 41 controls without postoperative delirium who had a similar risk factor profile. Outcome was assessed in all patients 30 months after discharge. A significantly greater proportion of patients with postoperative delirium died, were diagnosed with dementia or mild cognitive impairment (MCI), or were institutionalized at 30 months.
|Diagnosis of dementia or MCI||1.8|
Bickel et al.([FOOTNOTE=Bickel H, Gradinger R, Kochs E, Forstl H. High risk of cognitive and functional decline after postoperative delirium. A three-year prospective study. Dement Geriatr Cogn Disord. 2008;26(1):26-31.],[ANCHOR=],[LINK=]) conducted preoperatively and postoperatively daily assessments of cognitive function in hip surgery patients aged 60 years or greater (n=200). Patient outcome was assessed among patients with and without postoperative delirium 8 and 38 months after discharge. Adjusted* logistic regression analysis established associations between delirium and cognitive impairment, subjective memory decline, and incident need for long-term care at 38 months.
|Adjusted* odds ratio 8 months after discharge||Adjusted* odds ratio 38 months after discharge|
|Complaints about memory decline after surgery||4.7||6.2|
|Incident need for long-term care||NS||5.7|
|*Adjusted for age, sex, medical comorbidity, and preoperative cognitive performance|
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.