What does this research mean for the field?

Independent risk factors for postoperative delirium after intraspinal anesthesia in elderly patients undergoing femoral neck fracture surgery include age >80 years, diabetes, low preoperative hemoglobin and albumin levels, prolonged preoperative waiting time, higher ASA grade, postoperative hypoxemia, and higher postoperative VAS scores. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

February 11, 2026Open Access

Analysis of Influencing Factors and Construction of Prediction Model for Delirium After Intraspinal Anesthesia in Elderly Patients Undergoing Femoral Neck Fracture Surgery

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Femoral neck fracture (FNF) requiring surgery under intraspinal anesthesia (n=489). Intervention: Risk factors for postoperative delirium (e.g., preoperative albumin <30 g/L) vs. Patients without risk factors. Primary outcome: Postoperative delirium (POD) associated with preoperative albumin <30 g/L (OR 3.76, 95% CI 1.95-7.25, p=<0.001).

Key Result

Preoperative albumin <30 g/L (OR 3.76), age >80 years, and other clinical variables were identified as independent risk factors for postoperative delirium, forming a predictive nomogram with an external validation AUC of 0.85.

Key Points

The study aims to analyze factors influencing postoperative delirium after intraspinal anesthesia in elderly patients undergoing femoral neck fracture surgery and to develop a prediction model.
Retrospective analysis of 407 elderly patients undergoing femoral neck fracture surgery under spinal anesthesia.
Collect data from electronic medical records to identify risk factors for postoperative delirium.
Conduct univariate and multivariate logistic regression analyses to determine independent risk factors.
Construct and validate a nomogram prediction model internally and externally.
Postoperative delirium occurred in 16.95% of patients.
Identified risk factors include age >80 years, diabetes, hemoglobin <90 g/L, albumin <30 g/L, waiting time ≥3 days, ASA grade ≥III, postoperative hypoxemia, and VAS score ≥4.
Nomogram showed strong predictive ability with AUC of 0.79 for internal and 0.85 for external validation.

Study Design

Type

Cohort (n=489)

Multicenter

Structured PICO

Population

489 elderly patients (aged ≥60 years) who underwent femoral neck fracture (FNF) surgery under intraspinal anesthesia, without pre-existing severe cognitive dysfunction or psychiatric disorders.

Outcome

Postoperative delirium (POD) assessed daily from postoperative day 1 until discharge or postoperative day 7 using the Confusion Assessment Method (CAM).

A nomogram incorporating age, diabetes, hemoglobin, albumin, waiting time, ASA grade, hypoxemia, and pain scores accurately predicts postoperative delirium in elderly patients undergoing femoral neck fracture surgery under intraspinal anesthesia.

Main Result

Effect estimate: OR 3.76 (95% CI 1.95-7.25)

p-value: p=<0.001

Limitations

Single-center retrospective study design leading to potential selection and information biases
Lack of data on baseline cognitive status, drug exposure, and intraoperative blood pressure fluctuations
Small sample size of the external validation cohort (n=82)
Did not include potential influencing factors such as preoperative sleep quality, medication dosage, and genetic factors

Abstract

AIM: To analyze the influencing factors of postoperative delirium (POD) after intraspinal anesthesia in elderly patients undergoing femoral neck fracture (FNF) surgery and to construct a prediction model for early identification of high-risk patients. METHODS: This retrospective study included 407 elderly patients who underwent FNF surgery under spinal anesthesia from January 2020 to January 2024 as the modeling cohort; and another 82 patients who underwent similar surgery under spinal anesthesia between February 2024 and February 2025, according to the same inclusion and exclusion criteria, as an independent time-limited external validation cohort. Data were collected from the hospital's electronic medical records. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for POD. A nomogram prediction model was constructed and validated internally and externally. RESULTS: The incidence of POD was 16.95% (69/407). Independent risk factors identified were age >80 years (odds ratio (OR) = 2.25, 95% CI: 1.25–4.05, p = 0.007), diabetes (OR = 1.91, 95% CI: 1.03–3.56, p = 0.041), preoperative hemoglobin 0.05). CONCLUSIONS: This study identified independent risk factors for POD after intraspinal anesthesia in elderly FNF patients and established a nomogram with excellent predictive ability, offering a reliable tool for early detection of high-risk cases and facilitating implementation of targeted preventive measures.

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Cite This Study

Liu et al. (Mon,) conducted a cohort in Femoral neck fracture (FNF) requiring surgery under intraspinal anesthesia (n=489). Risk factors for postoperative delirium (e.g., preoperative albumin <30 g/L) vs. Patients without risk factors was evaluated on Postoperative delirium (POD) associated with preoperative albumin <30 g/L (OR 3.76, 95% CI 1.95-7.25, p=<0.001). Preoperative albumin <30 g/L (OR 3.76), age >80 years, and other clinical variables were identified as independent risk factors for postoperative delirium, forming a predictive nomogram with an external validation AUC of 0.85.

synapsesocial.com/papers/698c1cd3267fb587c655f815 https://doi.org/https://doi.org/10.62713/aic.4257

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