Postoperative delirium is a risk factor of institutionalization after hip fracture: an observational cohort study
IntroductionHip fracture is a common clinical problem in geriatric patients often associated with poor postoperative outcomes. Postoperative delirium (POD) and postoperative neurocognitive disorders (NCDs) are particularly frequent. The consequences of these disorders on postoperative recovery and a...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-08-01
|
| Series: | Frontiers in Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2023.1165734/full |
| _version_ | 1797742343980318720 |
|---|---|
| author | François Labaste François Labaste François Delort Fabrice Ferré Fanny Bounes Nicolas Reina Philippe Valet Cédric Dray Vincent Minville Vincent Minville |
| author_facet | François Labaste François Labaste François Delort Fabrice Ferré Fanny Bounes Nicolas Reina Philippe Valet Cédric Dray Vincent Minville Vincent Minville |
| author_sort | François Labaste |
| collection | DOAJ |
| description | IntroductionHip fracture is a common clinical problem in geriatric patients often associated with poor postoperative outcomes. Postoperative delirium (POD) and postoperative neurocognitive disorders (NCDs) are particularly frequent. The consequences of these disorders on postoperative recovery and autonomy are not fully described. The aim of this study was to determine the role of POD and NCDs on the need for institutionalization at 3 months after hip fracture surgery.MethodA population-based prospective cohort study was conducted on hip fracture patients between March 2016 and March 2018. The baseline interview, which included a Mini-Mental State Examination (MMSE), was conducted in the hospital after admission for hip fracture. NCDs were appreciated by MMSE scoring evolution (difference between preoperative MMSE and MMSE at day 5 >2 points). POD was evaluated using the Confusion Assessment Method. The primary endpoint was the rate of new institutionalization at 3 months. We used a multivariate analysis to assess the risk of new institutionalization.ResultsA total of 63 patients were included. Thirteen patients (20.6%) were newly institutionalized at 3 months. Two factors were significantly associated with the risk of postoperative institutionalization at 3 months: POD (OR = 5.23; 95% CI 1.1–27.04; p = 0.04) and IADL evolution (OR = 1.8; 95% CI 1.23–2.74; p = 0.003).ConclusionOnly POD but not NCDs was associated with the risk of dependency and institutionalization after hip fracture surgery. The prevention of POD appears to be essential for improving patient outcomes and optimizing the potential for returning home. |
| first_indexed | 2024-03-12T14:39:29Z |
| format | Article |
| id | doaj.art-ca7d314c854946d9af42c76b00d11558 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-03-12T14:39:29Z |
| publishDate | 2023-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-ca7d314c854946d9af42c76b00d115582023-08-16T14:33:05ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2023-08-011010.3389/fmed.2023.11657341165734Postoperative delirium is a risk factor of institutionalization after hip fracture: an observational cohort studyFrançois Labaste0François Labaste1François Delort2Fabrice Ferré3Fanny Bounes4Nicolas Reina5Philippe Valet6Cédric Dray7Vincent Minville8Vincent Minville9Anesthesiology and Intensive Care Department CHU Toulouse, Toulouse, FranceInstitut RESTORE UMR 1301-Inserm 5070-CNRS EFS Univ. P. Sabatier, Toulouse, FranceAnesthesiology and Intensive Care Department CHU Toulouse, Toulouse, FranceAnesthesiology and Intensive Care Department CHU Toulouse, Toulouse, FranceAnesthesiology and Intensive Care Department CHU Toulouse, Toulouse, FranceOrthopedic Surgery Department, CHU Toulouse, Toulouse, FranceInstitut RESTORE UMR 1301-Inserm 5070-CNRS EFS Univ. P. Sabatier, Toulouse, FranceInstitut RESTORE UMR 1301-Inserm 5070-CNRS EFS Univ. P. Sabatier, Toulouse, FranceAnesthesiology and Intensive Care Department CHU Toulouse, Toulouse, FranceInstitut RESTORE UMR 1301-Inserm 5070-CNRS EFS Univ. P. Sabatier, Toulouse, FranceIntroductionHip fracture is a common clinical problem in geriatric patients often associated with poor postoperative outcomes. Postoperative delirium (POD) and postoperative neurocognitive disorders (NCDs) are particularly frequent. The consequences of these disorders on postoperative recovery and autonomy are not fully described. The aim of this study was to determine the role of POD and NCDs on the need for institutionalization at 3 months after hip fracture surgery.MethodA population-based prospective cohort study was conducted on hip fracture patients between March 2016 and March 2018. The baseline interview, which included a Mini-Mental State Examination (MMSE), was conducted in the hospital after admission for hip fracture. NCDs were appreciated by MMSE scoring evolution (difference between preoperative MMSE and MMSE at day 5 >2 points). POD was evaluated using the Confusion Assessment Method. The primary endpoint was the rate of new institutionalization at 3 months. We used a multivariate analysis to assess the risk of new institutionalization.ResultsA total of 63 patients were included. Thirteen patients (20.6%) were newly institutionalized at 3 months. Two factors were significantly associated with the risk of postoperative institutionalization at 3 months: POD (OR = 5.23; 95% CI 1.1–27.04; p = 0.04) and IADL evolution (OR = 1.8; 95% CI 1.23–2.74; p = 0.003).ConclusionOnly POD but not NCDs was associated with the risk of dependency and institutionalization after hip fracture surgery. The prevention of POD appears to be essential for improving patient outcomes and optimizing the potential for returning home.https://www.frontiersin.org/articles/10.3389/fmed.2023.1165734/fullorthopedic surgeryhip fracturedeliriumdependenceinstitutionalization |
| spellingShingle | François Labaste François Labaste François Delort Fabrice Ferré Fanny Bounes Nicolas Reina Philippe Valet Cédric Dray Vincent Minville Vincent Minville Postoperative delirium is a risk factor of institutionalization after hip fracture: an observational cohort study Frontiers in Medicine orthopedic surgery hip fracture delirium dependence institutionalization |
| title | Postoperative delirium is a risk factor of institutionalization after hip fracture: an observational cohort study |
| title_full | Postoperative delirium is a risk factor of institutionalization after hip fracture: an observational cohort study |
| title_fullStr | Postoperative delirium is a risk factor of institutionalization after hip fracture: an observational cohort study |
| title_full_unstemmed | Postoperative delirium is a risk factor of institutionalization after hip fracture: an observational cohort study |
| title_short | Postoperative delirium is a risk factor of institutionalization after hip fracture: an observational cohort study |
| title_sort | postoperative delirium is a risk factor of institutionalization after hip fracture an observational cohort study |
| topic | orthopedic surgery hip fracture delirium dependence institutionalization |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2023.1165734/full |
| work_keys_str_mv | AT francoislabaste postoperativedeliriumisariskfactorofinstitutionalizationafterhipfractureanobservationalcohortstudy AT francoislabaste postoperativedeliriumisariskfactorofinstitutionalizationafterhipfractureanobservationalcohortstudy AT francoisdelort postoperativedeliriumisariskfactorofinstitutionalizationafterhipfractureanobservationalcohortstudy AT fabriceferre postoperativedeliriumisariskfactorofinstitutionalizationafterhipfractureanobservationalcohortstudy AT fannybounes postoperativedeliriumisariskfactorofinstitutionalizationafterhipfractureanobservationalcohortstudy AT nicolasreina postoperativedeliriumisariskfactorofinstitutionalizationafterhipfractureanobservationalcohortstudy AT philippevalet postoperativedeliriumisariskfactorofinstitutionalizationafterhipfractureanobservationalcohortstudy AT cedricdray postoperativedeliriumisariskfactorofinstitutionalizationafterhipfractureanobservationalcohortstudy AT vincentminville postoperativedeliriumisariskfactorofinstitutionalizationafterhipfractureanobservationalcohortstudy AT vincentminville postoperativedeliriumisariskfactorofinstitutionalizationafterhipfractureanobservationalcohortstudy |