Aims: To compare the profiles of patients with and without delirium, admitted with hip fracture under an Acute Orthogeriatrics model.
Methods: Retrospective cross-sectional study of 471 patients 65years, with hip fracture at John Hunter Hospital, May 2021-May 2022.
Results: Delirium was identified in 249(52.87%) patients, 148(31.42%) had prevalent delirium, majority was hyperactive (59.04%) which presented day1 to day4 postoperatively(Table1.1). The patients with delirium were older (86years) and from RACF and patients without delirium were younger (81years) and living independently. Majority are female. Patients with delirium had higher rates of cognitive impairment (66.94% vs 10.86%), frailty (88% vs 56.11%), functional impairment (64.6% vs 21.72%), incontinence (43.5% vs 21.26%) and comorbidities(Table 2). Precipitating factors include pain(61.85%), fluid and electrolyte disturbances(56.22%), low perfusion states(54.62%), constipation(53%) and infection(49.8%). Surgical delay is more common in patients with delirium(27.08 vs 24.2%) (Table 3). CAM was underutilised(41.24%). Antipsychotics were used in 20.9% with delirium(Table 4). Patients with delirium had shorter LOS, higher mortality, higher readmission rate and higher new RACF admission(Table 5). Majority of the variables are statistically significant to increase likelihood of delirium(Table 6).
Conclusions: Delirium after hip fracture is associated with advanced age, cognitive impairment, frailty, polypharmacy, incontinence, needing RACF and poorer health outcomes. An increased risk of delirium is precipitated by pain, fluid and electrolyte imbalances, poor perfusion, constipation, and infection. This emphasise the importance of routine screening for risk factors and precipitants of delirium in orthogeriatric patients from admission to four days postoperatively. This could help with outcomes prediction and discharge planning.