Postoperative delirium in geriatric patients undergoing surgery after a hip joint fracture or femur fracture

Introduction: Postoperative delirium is an acute confusional state that can develop immediately after surgery. It is not a rare complication in geriatric patients undergoing major surgical procedures. Risk factors include: patient characteristics - advanced years, polymorbidity, surgical and anesthetic factors. In geriatric surgical patient care it is important to detect patients at increased risk and recognize the clinical features of delirium, because unrecognized and inadequately treated increases postoperative complications, prolonged hospitalization stay, costs, leaves long-term sequelae and decreases life quality. Aim: To determine the incidence, age structure and patient characteristics, surgical and anesthetic procedures, detection, medical treatment and importance of postoperative delirium. Material and methods: Retrospective and statistic analysis of data using χ2-test, from anesthesia records and medical histories of patients operated due to hip joint fracture and femur fracture at Orthopedic Department of the Negotin Health Center, in 2017 who developed postoperative delirium. Results: Among 195 treated patients, 16 (8.20%) developed postoperative cognitive deficit. All 16 were hospitalized for surgical hip fracture or femur fracture treatment. There were no cases of cognitive deficits in other types of fractures and localization. Two patients developed alcohol withdrawal syndrome, and other 14/195 (7,2%) postoperative delirium. A total of 50 patients (50/195 (25,6%)) underwent surgical treatment of fracture of the hip or femur joint. After surgery, 14/50 patients (28%) developed postoperative delirium. Following parameters were analyzed: the age of patients, sex, ASA status, comorbidities, surgical procedure duration, blood transfusions during surgery, type of anesthesia, type of surgery. The average age of patients who developed postoperative delirium is 82.78 years. All patients are at advanced age, ASA status 3 and 4, with significant cardiac and neurological comorbidities. Among 14 patients who developed postoperative delirium, 13/14 (92.86%) were female and 1/14 (7.14%) male. Surgery lasted between 90 and 120 minutes. 6 patients underwent femur osteosynthesis (DHS), and in 8 patients implantation of hip endoprothesis was performed. 7/14 (50%) of patients received blood transfusion and fresh frozen plasma in operating room. 10/14(71.42%) of patients received spinal anesthesia, and 4/14(28.57%) general endotracheal anesthesia. Symptoms of postoperative delirium in 9/14 (64.29%) patients lasted three days, on average, and have been successfully cured with haloperidol, symptomatic and supportive therapy. In 5 patients (35.71%) the signs of cognitive dysfunction persist until discharge. All of them had neurological and mental deficits (M. Alzheimer, Dementia senilis, Parkinson's disease) on admission. Conclusion: Postoperative delirium is often complication in geriatric patients with polymorbidity, undergoing extensive surgical procedures. Ethiologically it is multifactorial. Detection of patients at increased risk and prompt pharmacological and nonpharmacological measures can contribute to the reduction of the incidence of postoperative complications, immediate and long-term sequelae. Assessment of cognitive function in geriatric patients should become a routine part of clinical preoperative evaluation.