谵妄与更高的发病率相关,死亡率更高,髋部骨折后住院时间更长。关于髋部骨折术后谵妄的研究很多。然而,很少有研究区分术前和术后谵妄.这项研究的目的是比较老年髋部骨折手术患者术前和术后谵妄的危险因素和临床结局。共纳入382例年龄>65岁的髋部骨折手术患者。其中,根据谵妄发生时间分为2组(术前谵妄组和术后谵妄组)。评估术前和术后谵妄的危险因素。我们分析了人口统计数据,术前实验室数据,和围手术期数据。比较术前和术后谵妄的临床结果,我们分析了术后并发症,KOVAL得分,回归,重新接纳,2年生存率。住院期间150例(39.3%)患者被诊断出谵妄。67例(44.6%)和83例(55.4%)患者发生术前和术后谵妄,分别。术前谵妄的独立危险因素包括年龄(比值比:1.47,95%保密区间[CI]:1.13-2.23,P=.004),中风(优势比[OR]:2.70,95%CI:1.11-6.01,P=0.015),美国麻醉医师协会(OR:1.68,95%CI:1.137-2.24,P=0.033),从入院到手术的时间(OR:1.08,95%CI:1.01-1.16,P=0.031)。两组术前KOVAL评分差异无统计学意义。然而,术后KOVAL评分(5.1±2.0vs4.4±2.1,P=.027)和消退率(68.7%vs44.6%,P=0.029)在术前谵妄组明显高于术后谵妄组。此外,术前谵妄组的2年生存率明显低于术后谵妄组(62.7%vs78.3%,P=.046)。特点,危险因素,术前谵妄和术后谵妄患者的预后不同。术前谵妄患者存在不同的危险因素,预后较差,死亡率较高。因此,有术前谵妄危险因素的髋部骨折患者死亡风险较大,因此应更仔细地监测.
Delirium is associated with greater morbidity, higher mortality, and longer periods of hospital day after hip fracture. There are number of studies on postoperative delirium after a hip fracture. However, few studies have made a distinction between preoperative and postoperative delirium. The purpose of this study is to compare risk factors and clinical outcome between preoperative and postoperative delirium in elderly patients with a hip fracture surgery. A total of 382 consecutive patients aged > 65 years who underwent operation for hip fracture were enrolled. Among them, the patients diagnosed with delirium were divided into 2 groups (a preoperative delirium group and a postoperative delirium group) according to the onset time of delirium. To evaluate risk factors for preoperative and postoperative delirium, we analyzed demographic data, preoperative laboratory data, and perioperative data. To compare clinical outcomes between preoperative and postoperative delirium, we analyzed postoperative complications, KOVAL score, regression, readmission, and 2-year survival rate. Delirium was diagnosed in 150 (39.3%) patients during hospitalization. Preoperative and postoperative delirium occurred in 67 (44.6%) and 83 (55.4%) patients, respectively. Independent risk factors of preoperative delirium included age (odds ratio: 1.47, 95% confidential interval [CI]: 1.13-2.23, P = .004), stroke (odds ratio [OR]: 2.70, 95% CI: 1.11-6.01, P = .015), American Society of Anesthesiologist (OR: 1.68, 95% CI: 1.137-2.24, P = .033), and time from admission to operation (OR: 1.08, 95% CI: 1.01-1.16, P = .031). There was no significant difference in preoperative KOVAL score between the 2 groups. However, postoperative KOVAL score (5.1 ± 2.0 vs 4.4 ± 2.1, P = .027) and regression rate (68.7% vs 44.6%, P = .029) were significantly higher in the preoperative delirium group than in the postoperative delirium group. Moreover, the 2-year survival rate was significantly lower in the preoperative delirium group than in the postoperative delirium group (62.7% vs 78.3%, P = .046). Characteristics, risk factors, and prognosis are different for patients with preoperative delirium and postoperative delirium. Preoperative delirium patients showed different risk factors with poorer prognosis and higher mortality. Therefore, hip fracture patients with risk factors for preoperative delirium should be monitored more carefully due to their greater risk of mortality.