Risk factors associated with treatment of hyperactive postoperative delirium in elderly patients following hip fracture surgery under regional anesthesia: a nationwide population-based study

Background and objectives: Delirium is common but is frequently undetected by clinicians, despite the fact that it can be life-threatening. This study aimed to identify the incidence of delirium and the preoperative factors associated with perioperative use of drugs to treat hyperactive delirium in...

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Main Authors: Eun-Jin Ahn, Si Ra Bang
Format: Article
Language:English
Published: Elsevier 2022-03-01
Series:Brazilian Journal of Anesthesiology
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S0104001421001603
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author Eun-Jin Ahn
Si Ra Bang
author_facet Eun-Jin Ahn
Si Ra Bang
author_sort Eun-Jin Ahn
collection DOAJ
description Background and objectives: Delirium is common but is frequently undetected by clinicians, despite the fact that it can be life-threatening. This study aimed to identify the incidence of delirium and the preoperative factors associated with perioperative use of drugs to treat hyperactive delirium in elderly patients who underwent hip fracture surgery under regional anesthesia. Methods: We retrospectively reviewed records of all patients ≥ 65 years of age who had undergone hip-fracture surgery under regional anesthesia, covered by the Korean National Health Insurance, between January 1, 2009 and December 31, 2015. A univariate and stepwise logistic regression model with the occurrence of hyperactive delirium as the dependent variable was used to identify the perioperative factors for this sample of patients. Results: Among the 70,696 patients who underwent hip fracture surgery, 58,972 patients who received regional anesthesia were included in our study; of these, perioperative use of drugs to treat hyperactive delirium was diagnosed in 8,680 (14.7%) patients. Performing stepwise logistic regression, preoperative variables found to be associated with delirium were: male sex, age ≥ 85 years, hospital type (medical center), ICU and ventilator care, the presence of a neurodegenerative disorder, uncomplicated diabetes mellitus, peptic ulcer disease, and previously diagnosed psychoses and/or depression (OR = 1.49 [1.42–1.58], 4.7 [4.15–5.37], 13.3 [7.57–23.8], 1.52 [1.43–1.60], 1.19 [1.01–1.40], 1.20 [1.14–1.27], 1.09 [1.04–1.14], 0.87 [0.96–0.00], 2.23 [1.48–3.37], and 1.38 [1.32–1.46], respectively). Conclusions: Postoperative hyperactive delirium may affect approximately 15% of elderly patients submitted to hip fracture repair under regional anesthesia. This study has identified multiple preoperative risk factors associated with postoperative hyperactive delirium and its pharmacological management strategies.
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spelling doaj.art-b2cb1e60f304436db2d5018ae20f70cf2022-12-22T04:32:48ZengElsevierBrazilian Journal of Anesthesiology0104-00142022-03-01722213219Risk factors associated with treatment of hyperactive postoperative delirium in elderly patients following hip fracture surgery under regional anesthesia: a nationwide population-based studyEun-Jin Ahn0Si Ra Bang1Chung-Ang University College of Medicine, Chung-Ang University Medical Center, Department of Anesthesiology and Pain Medicine, Seoul, KoreaInje University Seoul Paik Hospital, Department of Anesthesiology and Pain Medicine, Seoul, Korea; Corresponding author.Background and objectives: Delirium is common but is frequently undetected by clinicians, despite the fact that it can be life-threatening. This study aimed to identify the incidence of delirium and the preoperative factors associated with perioperative use of drugs to treat hyperactive delirium in elderly patients who underwent hip fracture surgery under regional anesthesia. Methods: We retrospectively reviewed records of all patients ≥ 65 years of age who had undergone hip-fracture surgery under regional anesthesia, covered by the Korean National Health Insurance, between January 1, 2009 and December 31, 2015. A univariate and stepwise logistic regression model with the occurrence of hyperactive delirium as the dependent variable was used to identify the perioperative factors for this sample of patients. Results: Among the 70,696 patients who underwent hip fracture surgery, 58,972 patients who received regional anesthesia were included in our study; of these, perioperative use of drugs to treat hyperactive delirium was diagnosed in 8,680 (14.7%) patients. Performing stepwise logistic regression, preoperative variables found to be associated with delirium were: male sex, age ≥ 85 years, hospital type (medical center), ICU and ventilator care, the presence of a neurodegenerative disorder, uncomplicated diabetes mellitus, peptic ulcer disease, and previously diagnosed psychoses and/or depression (OR = 1.49 [1.42–1.58], 4.7 [4.15–5.37], 13.3 [7.57–23.8], 1.52 [1.43–1.60], 1.19 [1.01–1.40], 1.20 [1.14–1.27], 1.09 [1.04–1.14], 0.87 [0.96–0.00], 2.23 [1.48–3.37], and 1.38 [1.32–1.46], respectively). Conclusions: Postoperative hyperactive delirium may affect approximately 15% of elderly patients submitted to hip fracture repair under regional anesthesia. This study has identified multiple preoperative risk factors associated with postoperative hyperactive delirium and its pharmacological management strategies.http://www.sciencedirect.com/science/article/pii/S0104001421001603Hip fractureAnesthesiaDelirium
spellingShingle Eun-Jin Ahn
Si Ra Bang
Risk factors associated with treatment of hyperactive postoperative delirium in elderly patients following hip fracture surgery under regional anesthesia: a nationwide population-based study
Brazilian Journal of Anesthesiology
Hip fracture
Anesthesia
Delirium
title Risk factors associated with treatment of hyperactive postoperative delirium in elderly patients following hip fracture surgery under regional anesthesia: a nationwide population-based study
title_full Risk factors associated with treatment of hyperactive postoperative delirium in elderly patients following hip fracture surgery under regional anesthesia: a nationwide population-based study
title_fullStr Risk factors associated with treatment of hyperactive postoperative delirium in elderly patients following hip fracture surgery under regional anesthesia: a nationwide population-based study
title_full_unstemmed Risk factors associated with treatment of hyperactive postoperative delirium in elderly patients following hip fracture surgery under regional anesthesia: a nationwide population-based study
title_short Risk factors associated with treatment of hyperactive postoperative delirium in elderly patients following hip fracture surgery under regional anesthesia: a nationwide population-based study
title_sort risk factors associated with treatment of hyperactive postoperative delirium in elderly patients following hip fracture surgery under regional anesthesia a nationwide population based study
topic Hip fracture
Anesthesia
Delirium
url http://www.sciencedirect.com/science/article/pii/S0104001421001603
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