Lack of Association Between Perioperative Medication and Postoperative Delirium in Hip Fracture Patients in an Orthogeriatric Care Pathway

被引：6

作者：

Genet, Bastien ^{[1
]}

Lamy, Tina ^{[1
]}

Cohen-Bittan, Judith ^{[1
]}

Glasman, Pauline ^{[2
]}

Verny, Marc ^{[1
,3
]}

Riou, Bruno ^{[4
]}

Boddaert, Jacques ^{[1
,5
]}

Zerah, Lorene ^{[1
,6
]}

机构：

[1] Hop La Pitie Salpetriere, AP HP, Dept Geriatr Med, Unit Perioperat Geriatr Care, 47-83 Blvd Hop, F-75651 Paris 13, France

[2] Hop La Pitie Salpetriere, AP HP, Dept Anesthesiol & Crit Care, Paris, France

[3] Sorbonne Univ, Team Neuronal Cell Biol & Pathol, UMR CNRS 8256, Paris, France

[4] Sorbonne Univ, Dept Emergency Med & Surg, Hop La Pitie Salpetriere, AP HP,UMRS INSERM 1166,IHU ICAN, Paris, France

[5] Sorbonne Univ, UMR INSERM 1135, Paris, France

[6] Sorbonne Univ, UMRS INSERM 1136, Inst Pierre Louis Epidemiol & Sante Publ, Paris, France

来源：

JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION | 2022年 / 23卷 / 04期

关键词：

Postoperative delirium; hip surgery; perioperative drugs; orthogeriatric care; older person; ELDERLY-PATIENTS; RISK-FACTORS; CARDIAC-SURGERY; ANESTHESIA; CONNECTIVITY; PREDICTION; MANAGEMENT; GUIDELINE; MORTALITY;

D O I：

10.1016/j.jamda.2021.09.022

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

Objectives: Units for perioperative geriatric care are playing a growing role in the care of older patients after hip fracture surgery. Postoperative delirium is one of the most common complications after hip fracture, but no study has assessed the impact of therapeutics received during a dedicated orthogeriatric care pathway on its incidence. Our main objective was to assess the association between drugs used in emergency, operating, and recovery departments and postoperative delirium during the acute stay. Design: Retrospective cohort study. Setting and Participants: All patients >= 70 years old admitted for hip fracture to the emergency department and hospitalized in our unit for perioperative geriatric care after hip fracture surgery under general anesthesia between July 2009 and December 2019 in an academic hospital in Paris. Methods: Demographic, clinical, and biological data and all medications administered pre-, peri-, and postoperatively were prospectively collected by 3 geriatricians. Postoperative delirium in the unit for perioperative geriatric care was assessed by using the confusion assessment method scale. Logistic regression analysis was used to assess variables independently associated with postoperative delirium. Results: A total of 490 patients were included [mean (SD) age 87 (6) years]; 215 (44%) had postoperative delirium. The occurrence was not associated with therapeutics administered during the dedicated orthogeriatric care pathway. Probability of postoperative delirium was associated with advanced age [>90 years, odds ratio (OR) 2.03, 95% confidence interval (CI) 1.07-3.89], dementia (OR 3.51, 95% CI 2.14-5.82), depression (OR 1.85, 95% CI 1.14-3.01), and preoperative use of beta-blockers (OR 1.75, 95% CI 1.10-2.79). Conclusions and implications: No emergency or anesthetic drugs were significantly associated with postoperative delirium. Further studies are needed to demonstrate a possible causal link between preoperative use of beta-blockers and postoperative delirium. (C) 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

引用

页码：623 / +

页数：10