Predictors and outcomes of perioperative delirium in older females with fragility hip fractures at a tertiary care centre, Sri Lanka: A case-control study

Introduction: Hip fractures are common in older adults. Perioperative delirium is a common complication following a hip fracture. This study was designed to examine the predictors and outcomes of perioperative delirium following hip fracture in older females.

Methodology: This case-control study was conducted among inward patients in Colombo South Teaching Hospital who were admitted with hip fractures. Data were collected using an interviewer administered questionnaire. Cases were defined as female patients more than 65 years of age diagnosed with perioperative delirium and control group included female patients more than 65 years of age without delirium. Data were collected at two points; during hospital stay and one month following surgery. Data was analysed using SPSS 23.0.

Results: A total of 104 female patients were included (52 in each group). The average age of the study participants was 78.4 years. 53.8% had three or more medical co-morbidities and 64.4% had polypharmacy. The majority were indoor falls (n=69, 66.3%). The average time taken to reach the hospital was 75.5 hours, the mean time taken for the admission to the orthopaedic ward since arrival was 85.5 hours and the mean time to surgery from admission was 111.4 hours. High preoperative pain and having one or more falls during the last year were significantly associated with development of delirium. The cases were observed to have lower Barthel index score and lower level of mobility after 1 month.

Conclusions: Perioperative delirium is strongly associated with pre-operative pain and having one or more falls during last year. A significant waiting time for surgery and late admissions were noted during the study. Implementing protocols to optimize pain management, identification of factors leading to delay in admission and surgery will be potential future interventions for a better outcome.