Key result
Preoperative albumin <30 g/L linked to ~276% higher postoperative delirium risk.
Why the study?
To analyze influencing factors of postoperative delirium after intraspinal anesthesia in elderly patients undergoing femoral neck fracture surgery and construct a prediction model for early identification.
Cohort (n=489)
No
Effect estimate: OR 3.76 (95% CI 1.95-7.25)
p-value: p=<0.001
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.
May aid delirium risk stratification in elderly hip fracture surgery; extends observational data but leaves practice change open pending trials.
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 <90 g/L (OR = 2.11, 95% CI: 1.14–3.90, p = 0.017), preoperative albumin <30 g/L (OR = 3.76, 95% CI: 1.95–7.25, p < 0.001), preoperative waiting time ≥3 days (OR = 2.62, 95% CI: 1.40–4.90, p = 0.003), American Society of Anesthesiologists (ASA) grade ≥III (OR = 2.12, 95% CI: 1.08–4.17, p = 0.029), postoperative hypoxemia (OR = 2.22, 95% CI: 1.22–4.05, p = 0.009), and postoperative visual analog scale (VAS) score ≥4 (OR = 2.55, 95% CI: 1.39–4.68, p = 0.002). The nomogram exhibited strong discriminative ability (area under the curve (AUC) = 0.79 for internal, 0.85 for external validation) and satisfactory calibration (Hosmer–Lemeshow p > 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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Liu et al. (2026) 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.
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