Risk Factors for Preoperative and Postoperative Delirium in Elderly Patients with Hip Fracture

Authors

  • Vibeke Juliebø MD,

    1. From the *Department of Geriatric Medicine and Department of Research, Nursing Unit, Ullevaal University Hospital, Oslo, NorwayFaculty of Medicine and §School of Pharmacy, University of Oslo, Oslo, NorwayNorwegian Medicines Agency, Oslo, Norway#Department of Geriatric Medicine, Diakonhjemmet Hospital, Oslo, Norway; and **Kavli Research Center for Ageing and Dementia, Haraldsplass Diacon Hospital, Bergen, Norway.
    Search for more papers by this author
  • Karen Bjøro RN,

    1. From the *Department of Geriatric Medicine and Department of Research, Nursing Unit, Ullevaal University Hospital, Oslo, NorwayFaculty of Medicine and §School of Pharmacy, University of Oslo, Oslo, NorwayNorwegian Medicines Agency, Oslo, Norway#Department of Geriatric Medicine, Diakonhjemmet Hospital, Oslo, Norway; and **Kavli Research Center for Ageing and Dementia, Haraldsplass Diacon Hospital, Bergen, Norway.
    Search for more papers by this author
  • Maria Krogseth MD,

    1. From the *Department of Geriatric Medicine and Department of Research, Nursing Unit, Ullevaal University Hospital, Oslo, NorwayFaculty of Medicine and §School of Pharmacy, University of Oslo, Oslo, NorwayNorwegian Medicines Agency, Oslo, Norway#Department of Geriatric Medicine, Diakonhjemmet Hospital, Oslo, Norway; and **Kavli Research Center for Ageing and Dementia, Haraldsplass Diacon Hospital, Bergen, Norway.
    Search for more papers by this author
  • Eva Skovlund MSc, PhD,

    1. From the *Department of Geriatric Medicine and Department of Research, Nursing Unit, Ullevaal University Hospital, Oslo, NorwayFaculty of Medicine and §School of Pharmacy, University of Oslo, Oslo, NorwayNorwegian Medicines Agency, Oslo, Norway#Department of Geriatric Medicine, Diakonhjemmet Hospital, Oslo, Norway; and **Kavli Research Center for Ageing and Dementia, Haraldsplass Diacon Hospital, Bergen, Norway.
    Search for more papers by this author
  • Anette H. Ranhoff MD, PhD,

    1. From the *Department of Geriatric Medicine and Department of Research, Nursing Unit, Ullevaal University Hospital, Oslo, NorwayFaculty of Medicine and §School of Pharmacy, University of Oslo, Oslo, NorwayNorwegian Medicines Agency, Oslo, Norway#Department of Geriatric Medicine, Diakonhjemmet Hospital, Oslo, Norway; and **Kavli Research Center for Ageing and Dementia, Haraldsplass Diacon Hospital, Bergen, Norway.
    Search for more papers by this author
  • Torgeir Bruun Wyller MD, PhD

    1. From the *Department of Geriatric Medicine and Department of Research, Nursing Unit, Ullevaal University Hospital, Oslo, NorwayFaculty of Medicine and §School of Pharmacy, University of Oslo, Oslo, NorwayNorwegian Medicines Agency, Oslo, Norway#Department of Geriatric Medicine, Diakonhjemmet Hospital, Oslo, Norway; and **Kavli Research Center for Ageing and Dementia, Haraldsplass Diacon Hospital, Bergen, Norway.
    Search for more papers by this author

  • Abstracts with preliminary results were presented at the 19th Nordic Congress of Gerontology in Oslo, Norway, May 2008; at the 5th congress of the European Union Geriatric Medicine Society in Copenhagen, Denmark, September 2008; and at the Third Scientific Meeting of the European Delirium Association in Helsinki, Finland, October 2008.

Address correspondence to Vibeke Juliebø, Department of Geriatric Medicine, University of Oslo, Ullevaal Univerity Hospital, N-0407 Oslo, Norway. E-mail: vibeke.juliebo@medisin.uio.no

Abstract

OBJECTIVES: To evaluate risk factors for preoperative and postoperative delirium.

DESIGN: Prospective cohort study.

SETTING: Departments of orthopedic surgery in two Norwegian hospitals.

PARTICIPANTS: Three hundred sixty-four patients with and without cognitive impairment, aged 65 and older.

MEASUREMENTS: Patients were screened daily for delirium using the Confusion Assessment Method. Established risk factors and risk factors regarded as clinically important according to expert opinion were explored in univariate analyses. Variables associated with the outcomes (P<.05) were entered into multivariate logistic regression models.

RESULTS: Delirium was present in 50 of 237 (21.1%) assessable patients preoperatively, whereas 68 of 187 (36.4%) patients developed delirium postoperatively (incident delirium). Multivariate logistic regression identified four risk factors for preoperative delirium: cognitive impairment (adjusted odds ratio (AOR)=4.7, 95% confidence interval (CI)=1.9–11.3), indoor injury (AOR=3.6, 95% CI=1.1–12.2), fever (AOR=3.4, 95% CI=1.5–7.7), and preoperative waiting time (AOR=1.05, 95% CI=1.0–1.1 per hour). Cognitive impairment (AOR=2.9, 95% CI=1.4–6.2), indoor injury (AOR=2.9, 95% CI=1.1–6.3), and body mass index (BMI) less than 20.0 (AOR=2.9, 95% CI=1.3–6.7) were independent and statistically significant risk factors for postoperative delirium.

CONCLUSION: Time from admission to operation is a risk factor for preoperative delirium, whereas low BMI is an important risk factor for postoperative delirium in hip fracture patients. Cognitive impairment and indoor injury are independent risk factors for preoperative and postoperative delirium.

Ancillary