Postoperative delirium in geriatric patients with hip fractures

Yang Chen, Shuai Liang, Huiwen Wu, Shihao Deng, Fangyuan Wang, Ciren Lunzhu, Jun Li, Yang Chen, Shuai Liang, Huiwen Wu, Shihao Deng, Fangyuan Wang, Ciren Lunzhu, Jun Li

Abstract

Postoperative delirium (POD) is a frequent complication in geriatric patients with hip fractures, which is linked to poorer functional recovery, longer hospital stays, and higher short-and long-term mortality. Patients with increased age, preoperative cognitive impairment, comorbidities, perioperative polypharmacy, and delayed surgery are more prone to develop POD after hip fracture surgery. In this narrative review, we outlined the latest findings on postoperative delirium in geriatric patients with hip fractures, focusing on its pathophysiology, diagnosis, prevention, and treatment. Perioperative risk prediction, avoidance of certain medications, and orthogeriatric comprehensive care are all examples of effective interventions. Choices of anesthesia technique may not be associated with a significant difference in the incidence of postoperative delirium in geriatric patients with hip fractures. There are few pharmaceutical measures available for POD treatment. Dexmedetomidine and multimodal analgesia may be effective for managing postoperative delirium, and adverse complications should be considered when using antipsychotics. In conclusion, perioperative risk intervention based on orthogeriatric comprehensive care is the most effective strategy for preventing postoperative delirium in geriatric patients with hip fractures.

Keywords: geriatric patients; hip fractures; orthogeriatrics; postoperative delirium; prevention; treatment.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Chen, Liang, Wu, Deng, Wang, Lunzhu and Li.

Figures

Figure 1
Figure 1
Neuroinflammation mechanism of postoperative delirium in geriatric patients with hip fractures. PB, peripheral blood; CSF, cerebrospinal fluid. Trauma caused by fracture and surgery is associated with increased systemic inflammatory mediators, which are transported from the periphery to the brain via three primary pathways, resulting in neuroinflammation, and finally lead to POD.
Figure 2
Figure 2
Orthogeriatric comprehensive care in geriatric patients with hip fractures for management of postoperative complication.

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