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GENERAL ARTICLES

Brief Postoperative Delirium in Hip Fracture Patients Affects Functional Outcome at Three Months

Khwaja Zakriya, MD^*, Frederick E. Sieber, MD^*, Colleen Christmas, MD, James F. Wenz, Sr., MD, and Shawn Franckowiak, BS

*Department of Anesthesiology, School of Medicine, Division of Geriatrics and Gerontology, and Department of Orthopedics, Johns Hopkins Bayview Medical Center, Baltimore, Maryland

Address correspondence and reprint requests to Frederick E. Sieber, MD, Department of Anesthesiology, Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., Baltimore, MD 21224. Address e-mail to fsieber{at}jhmi.edu

It is unclear how brief postoperative delirium (DEL) affects functional outcomes. In this study, we sought to determine if patients with brief postoperative DEL (<6-wk duration) have different living situations when compared with non-DEL patients after hip fracture repair. In a prospective study, patients admitted to the geriatric hip fracture service were assessed every postoperative day for the presence of DEL using the confusion assessment method (CAM) score. Patients were reassessed at 6 wk and 3 mo postoperatively for CAM score, current living situation, and activities of daily living. Group comparisons were tested after dividing patients into two groups: DEL (DEL; [+] CAM at any time during the postoperative period while in the hospital); no-DEL (no DEL; [–] CAM throughout the postoperative period while in the hospital). The study included 92 patients of whom 26 (28%) were CAM (+) after surgery. At 6 wk follow-up, n = 81; at 3 mo follow-up, n = 76. Eight patients died during the study. At 6 wk and 3 mo, a larger percentage of DEL patients were not living with a family member (27% versus 8% patients not living with a family member at 3 mo follow-up in DEL and no-DEL, respectively). There was no difference in activities of daily living by 3 mo. We conclude that brief postoperative DEL lasting <6 wk is a determining factor for poor long-term functional outcome after hip fracture repair, because it significantly impacts the ability to live independently.

IMPLICATIONS: Brief postoperative delirium lasting <6 wk is a determining factor for poor long-term functional outcome after hip fracture repair, because it significantly impacts the ability to live independently.

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