A predictive scoring system for postoperative delirium in the elderly patients with intertrochanteric fracture

作者全名："Hu, Yunjiu; Yang, Mingming"

作者地址："[Hu, Yunjiu] Chongqing Med Univ, Dept Emergency Med, Affiliated Hosp 1, Chongqing 400016, Peoples R China; [Yang, Mingming] Chongqing Med Univ, Dept Orthoped, Affiliated Hosp 1, Chongqing 400016, Peoples R China; [Yang, Mingming] Chongqing Med Univ, Orthoped Lab, Chongqing 400016, Peoples R China"

通信作者："Yang, MM (通讯作者)，Chongqing Med Univ, Dept Orthoped, Affiliated Hosp 1, Chongqing 400016, Peoples R China.; Yang, MM (通讯作者)，Chongqing Med Univ, Orthoped Lab, Chongqing 400016, Peoples R China."

来源：BMC SURGERY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001002662800001

JCR分区：Q2

影响因子：1.6

年份：2023

卷号：23

期号：1

开始页：　

结束页：　

文献类型：Article

关键词：Intertrochanteric fracture; Reduction and internal fixation; Postoperative delirium; Elderly; Prediction; Scoring system

摘要："ObjectiveTo establish a scoring system to predict the postoperative delirium in elderly patients with intertrochanteric fracture.Materials and methodsWe retrospectively reviewed 159 elderly patients with a diagnosis of intertrochanteric fracture and underwent closed reduction and intramedullary nail fixation, and then divided them into two groups including the delirium group (23 cases) or non-delirium group (136 cases) in our hospital from January 2017 to December 2019. The following clinical characteristics were recorded and analyzed: age, gender, fracture classification, body mass index (BMI), history of diabetes mellitus, history of stroke, preoperative albumin, preoperative hemoglobin (Hb), preoperative arterial partial pressure of oxygen (PaO2), time between admission and surgery, lower limb thrombosis, American Society of Anesthesiologists (ASA) grade, operative time, operative blood loss, and intraoperative blood transfusion. The prevalence of these clinical characteristics in delirium group was evaluated, and the scoring system was established using logistic regression analysis. The performance of the scoring system was also prospectively validated.ResultsThe predictive scoring system was based on five clinical characteristics confirmed as significant predictors of postoperative delirium, namely, age > 75 years, history of stroke, preoperative Hb <= 100 g/L, preoperative PaO2 <= 60 mmHg, and time between admission to surgery > 3 days. Delirium group showed a significant higher score than non-delirium (6.26 vs. 2.29, P < 0.001), and the optimal cut-off value for the scoring system was 4 points. The sensitivity and specificity of the scoring system for predicting postoperative delirium were 82.61% and 81.62% in derivation set, respectively, and 72.71% and 75.00% in validation set.ConclusionThe predictive scoring system confirmed with achieve satisfactory sensitivity and specificity in predicting postoperative delirium in the elderly with intertrochanteric fracture. The risk of postoperative delirium in patients with the score of 5 to 11 is high, while the score of 0 to 4 is low."

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