Incidence and Risk Factors of Postoperative Delirium in Elderly Patients Following Hip Fracture Surgery: A Nationwide Retrospective Cohort Study in Taiwan

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry Pub Date : 2025-05-12 DOI:10.1002/gps.70094

Chien-An Shih, Deng-Chi Yang, Wei-Ming Wang, Yi-Lin Wu, Yi-Ching Yang, Han-Chang Ku

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引用次数: 0

Abstract

Background

Delirium is an acute cognitive change characterized by behavioral and psychological features, such as visual and auditory hallucinations, sleep disturbances, and emotional confusion. It can lead to extended hospital stays, increased mortality risk, and higher nursing costs. In postoperative hip fracture patients, delirium results in a higher complication rate, poorer functional recovery, increased readmission rates, repeat surgeries, and elevated mortality. Despite these serious consequences, the literature provides limited information on the incidence of postoperative delirium following hip fracture surgeries in Asians. Additionally, there is a lack of long-term, comprehensive nationwide population-based studies, highlighting an important area for future research. This study aims to understand the incidence and risk factors of postoperative delirium in hip fracture patients using representative population data.

Methods

We conducted a retrospective cohort study using the Taiwan National Health Insurance Research Database (NHIRD) from 2009 to 2020. The cohort consisted of 118,682 patients aged 65 years or older who were diagnosed with hip fractures. The delirium incidence was observed per 1000 person-years. The Cox proportional hazards model was used to investigate the incidence of delirium among hip fracture patients.

Results

The incidence of the first episode of delirium after hip surgery in the elderly was 1.87 events per 1000 PYs. Factors associated with delirium included being female (adjusted hazard ratio [aHR]: 0.59; 95% confidence interval [CI]: 0.53–0.64), age ≥ 95 years (aHR: 3.52; 95% CI: 2.74–4.51), comorbid dementia (aHR: 2.63; 95% CI: 2.38–2.92), and ICU stay 2–3 days (aHR: 2.85; 95% CI: 1.28–6.37). The occurrence of delirium was significantly associated with an ICU stay of ≥ 4 days, dementia, as well as 30-day, 90-day, and 1-year mortality (p < 0.001).

Conclusions

This study highlights the relatively low incidence of postoperative delirium in elderly hip fracture patients in Taiwan. Key risk factors identified include advanced age, female gender, comorbid dementia, and prolonged ICU stays. These findings underscore the need for targeted prevention and early intervention strategies to improve patient outcomes.

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老年髋部骨折术后谵妄的发生率及危险因素：台湾一项全国性的回顾性队列研究

谵妄是一种以行为和心理特征为特征的急性认知变化，如视觉和听觉幻觉、睡眠障碍和情绪混乱。它可能导致住院时间延长，死亡风险增加，护理费用增加。在髋部骨折术后患者中，谵妄导致较高的并发症发生率、较差的功能恢复、再入院率增加、重复手术和死亡率升高。尽管有这些严重的后果，文献提供的关于亚洲人髋部骨折术后谵妄发生率的信息有限。此外，缺乏长期的、全面的、基于全国人口的研究，这突出了未来研究的一个重要领域。本研究旨在通过具有代表性的人群数据了解髋部骨折患者术后谵妄的发生率及危险因素。方法采用2009年至2020年台湾全民健康保险研究数据库（NHIRD）进行回顾性队列研究。该队列包括118,682名年龄在65岁或以上的诊断为髋部骨折的患者。谵妄发生率为每1000人年。采用Cox比例风险模型调查髋部骨折患者谵妄的发生率。结果老年髋关节术后首次谵妄的发生率为1.87例/ 1000年。谵妄的相关因素包括女性(校正风险比[aHR]: 0.59；95%可信区间[CI]: 0.53-0.64)，年龄≥95岁(aHR: 3.52；95% CI: 2.74-4.51)，共病性痴呆(aHR: 2.63；95% CI: 2.38-2.92)， ICU住院2-3天(aHR: 2.85；95% ci: 1.28-6.37)。谵妄的发生与ICU住院≥4天、痴呆以及30天、90天和1年死亡率显著相关(p <；0.001)。结论台湾老年髋部骨折患者术后谵妄发生率较低。确定的主要危险因素包括高龄、女性、共病性痴呆和延长ICU住院时间。这些发现强调需要有针对性的预防和早期干预策略来改善患者的预后。

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来源期刊

International Journal of Geriatric Psychiatry 医学-精神病学

CiteScore

6.10

自引率

2.50%

发文量

168

审稿时长

4-8 weeks

期刊介绍： The rapidly increasing world population of aged people has led to a growing need to focus attention on the problems of mental disorder in late life. The aim of the Journal is to communicate the results of original research in the causes, treatment and care of all forms of mental disorder which affect the elderly. The Journal is of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in therapeutic professions, together with general neurobiological researchers. The Journal provides an international perspective on the important issue of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services.