Derivation and validation of a prediction score for postoperative delirium in geriatric patients undergoing hip fracture surgery or hip arthroplasty
IntroductionPostoperative delirium is a common complication of patients undergoing hip fracture surgery or arthroplasty and is related to decreased survival time and physical function. In this study, we aim to build and validate a prediction score of postoperative delirium in geriatric patients unde...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-08-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2022.919886/full |
| _version_ | 1798042269118365696 |
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| author | Jiawei Shen Youzhong An Baoguo Jiang Baoguo Jiang Baoguo Jiang Peixun Zhang Peixun Zhang Peixun Zhang |
| author_facet | Jiawei Shen Youzhong An Baoguo Jiang Baoguo Jiang Baoguo Jiang Peixun Zhang Peixun Zhang Peixun Zhang |
| author_sort | Jiawei Shen |
| collection | DOAJ |
| description | IntroductionPostoperative delirium is a common complication of patients undergoing hip fracture surgery or arthroplasty and is related to decreased survival time and physical function. In this study, we aim to build and validate a prediction score of postoperative delirium in geriatric patients undergoing hip fracture surgery or hip arthroplasty.MethodsA retrospective cohort of geriatric patients undergoing hip fracture surgery or hip arthroplasty was established. Variables of included patients were collected as candidate predictors of postoperative delirium. The least absolute shrinkage and selection operator (LASSO) regression and logistic regression were used to derive a predictive score for postoperative delirium. The accuracy of the score was evaluated by the area under the curve (AUC) of the receiver operating curve (ROC). We used bootstrapping resamples for model calibration. The prediction score was validated in an extra cohort.ResultsThere were 1,312 patients in the derivation cohort, and the incidence of postoperative delirium was 14.33%. Of 40 variables, 9 were identified as predictors, including preoperative delirium, cerebrovascular accident (CVA) with the modified Rankin scale, diabetes with a random glucose level, Charlson comorbidity index (CCI), age, application of benzodiazepines in surgery, surgical delay ≥2 days, creatine ≥90 μmol/L, and active smoker. The prediction score achieved a mean AUC of 0.848 in the derivation cohort. In the validation cohort, the mean AUC was 0.833. The prediction model was well-calibrated in the two cohorts.ConclusionBased on retrospective data, a prediction score for postoperative delirium in geriatric patients undergoing hip fracture surgery or hip arthroplasty was derived and validated. The performance of the scoring system outperformed the models from previous studies. Although the generalization ability of the score needs to be tested in similar populations, the scoring system will enable delirium risk stratification for hip fracture patients and facilitate the development of strategies for delirium prevention. |
| first_indexed | 2024-04-11T22:33:07Z |
| format | Article |
| id | doaj.art-9b3c28cfdaae4a32ba33515a56339c3e |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-04-11T22:33:07Z |
| publishDate | 2022-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-9b3c28cfdaae4a32ba33515a56339c3e2022-12-22T03:59:18ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2022-08-01910.3389/fsurg.2022.919886919886Derivation and validation of a prediction score for postoperative delirium in geriatric patients undergoing hip fracture surgery or hip arthroplastyJiawei Shen0Youzhong An1Baoguo Jiang2Baoguo Jiang3Baoguo Jiang4Peixun Zhang5Peixun Zhang6Peixun Zhang7Department of Orthopaedics and Trauma, Peking University People's Hospital, Beijing, ChinaDepartment of Critical Care Medicine, Peking University People's Hospital, Beijing, ChinaDepartment of Orthopaedics and Trauma, Peking University People's Hospital, Beijing, ChinaKey Laboratory of Trauma and Neural Regeneration, Peking University, Beijing, ChinaNational Center for Trauma Medicine, Beijing, ChinaDepartment of Orthopaedics and Trauma, Peking University People's Hospital, Beijing, ChinaKey Laboratory of Trauma and Neural Regeneration, Peking University, Beijing, ChinaNational Center for Trauma Medicine, Beijing, ChinaIntroductionPostoperative delirium is a common complication of patients undergoing hip fracture surgery or arthroplasty and is related to decreased survival time and physical function. In this study, we aim to build and validate a prediction score of postoperative delirium in geriatric patients undergoing hip fracture surgery or hip arthroplasty.MethodsA retrospective cohort of geriatric patients undergoing hip fracture surgery or hip arthroplasty was established. Variables of included patients were collected as candidate predictors of postoperative delirium. The least absolute shrinkage and selection operator (LASSO) regression and logistic regression were used to derive a predictive score for postoperative delirium. The accuracy of the score was evaluated by the area under the curve (AUC) of the receiver operating curve (ROC). We used bootstrapping resamples for model calibration. The prediction score was validated in an extra cohort.ResultsThere were 1,312 patients in the derivation cohort, and the incidence of postoperative delirium was 14.33%. Of 40 variables, 9 were identified as predictors, including preoperative delirium, cerebrovascular accident (CVA) with the modified Rankin scale, diabetes with a random glucose level, Charlson comorbidity index (CCI), age, application of benzodiazepines in surgery, surgical delay ≥2 days, creatine ≥90 μmol/L, and active smoker. The prediction score achieved a mean AUC of 0.848 in the derivation cohort. In the validation cohort, the mean AUC was 0.833. The prediction model was well-calibrated in the two cohorts.ConclusionBased on retrospective data, a prediction score for postoperative delirium in geriatric patients undergoing hip fracture surgery or hip arthroplasty was derived and validated. The performance of the scoring system outperformed the models from previous studies. Although the generalization ability of the score needs to be tested in similar populations, the scoring system will enable delirium risk stratification for hip fracture patients and facilitate the development of strategies for delirium prevention.https://www.frontiersin.org/articles/10.3389/fsurg.2022.919886/fullarthroplastycomplicationship fracturedeliriumprognosis |
| spellingShingle | Jiawei Shen Youzhong An Baoguo Jiang Baoguo Jiang Baoguo Jiang Peixun Zhang Peixun Zhang Peixun Zhang Derivation and validation of a prediction score for postoperative delirium in geriatric patients undergoing hip fracture surgery or hip arthroplasty Frontiers in Surgery arthroplasty complications hip fracture delirium prognosis |
| title | Derivation and validation of a prediction score for postoperative delirium in geriatric patients undergoing hip fracture surgery or hip arthroplasty |
| title_full | Derivation and validation of a prediction score for postoperative delirium in geriatric patients undergoing hip fracture surgery or hip arthroplasty |
| title_fullStr | Derivation and validation of a prediction score for postoperative delirium in geriatric patients undergoing hip fracture surgery or hip arthroplasty |
| title_full_unstemmed | Derivation and validation of a prediction score for postoperative delirium in geriatric patients undergoing hip fracture surgery or hip arthroplasty |
| title_short | Derivation and validation of a prediction score for postoperative delirium in geriatric patients undergoing hip fracture surgery or hip arthroplasty |
| title_sort | derivation and validation of a prediction score for postoperative delirium in geriatric patients undergoing hip fracture surgery or hip arthroplasty |
| topic | arthroplasty complications hip fracture delirium prognosis |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2022.919886/full |
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