The relevance of preoperative frailty and postoperative delirium in elderly patients undergoing hip surgery

Abstract

Background & Objectives: Frailty status and delirium are common findings in the elderly in the perioperative period, and are associated with higher frequency of complications and poor outcomes after surgery. This study aimed to determine the rate and relationship between preoperative frailty and postoperative delirium (POD) in elderly people scheduled for hip surgery.

Methodology: A cross-sectional observational study was conducted on 104 elderly patients scheduled for hip surgery from October 2022 to November 2023 at the Centre for Anesthesia and Surgical Intensive Care, Bach Mai Hospital. The Modified Frailty Index (mFI) was used to assess the frailty. It includes 22 clinical and paraclinical variables and is useful to assess the preoperative frailty. We assessed postoperative delirium (POD) using the Confusion Assessment Method for the ICU (CAM-ICU) flow sheet during the first 4 days after surgery. Univariate and multivariate regression analyses were used to determine the association between frailty and delirium.

Results: A total of 104 patients were included in the analysis, and the proportion of patients with preoperative frailty (mFI ≥ 0.25) was 36.5%. Postoperative delirium occurred in 32 patients (30.8%). The frail patient group had a higher rate of postoperative delirium and a significantly longer average duration of delirium than the non-frail group (60.5% vs. 13.6% and 1.26 days vs. 0.35 days, respectively, P < 0.05). Multivariate regression analysis showed that mFI ≥ 0.25 was associated with POD status 4 days after surgery (aOR = 6.29; 95% CI = 1.43-27.6; P < 0.05).

Conclusions: The incidences of preoperative frailty and postoperative delirium in elderly patients undergoing elective hip surgery were 36.5% and 30.8%, respectively. Preoperative frailty is an independent risk factor for increased postoperative delirium.

Abbreviations: ADLs - Activities of Daily Living, NMS - New Mobility Score; ASA - American Society of Anesthesiologists, POD - Post-Operative Delirium; mFI - modified Frailty Index

Keywords: Postoperative delirium; Preoperative frailty; Hip fracture surgery; Elderly patient

Citation: Nguyen TT, Khanh HC, Ba TN. The relevance of preoperative frailty and postoperative delirium in elderly patients undergoing hip surgery. Anaesth. pain intensive care 2024;28(3):423−430; DOI: 10.35975/apic.v28i3.2473

Received: April 03, 2024; Revised: April 14, 2024; Accepted: April 15, 2024