Highlights
- •Approximately 30% of geriatric patients following hip fracture and hemi-arthroplasty developed in-hospital delirium.
- •Certain patient's characteristics, comorbidities and immobility were associated with higher risk for delirium.
- •Using the DRIGHA score at the bedside can identify the high risk patients early in the hospital coarse and timely intervention may mitigate the overall incidence.
Abstract
Background
In-hospital delirium after hip hemi-arthroplasty results in a prolonged hospital course and an increase in morbidity and
mortality. Early identification of high-risk patients and preventive strategies can
reduce the occurrence of delirium. The purpose of the study is to identify the risk
factors of delirium and create a scoring system for point of care physicians. The
risk factors were created and validated in the study.
Hypothesis
Certain factors are associated with in-hospital delirium after hip hemi-arthroplasty in geriatric patients.
Methods
The National Surgical Quality Improvement Program (NSQIP) database from 2016 to 2019
was accessed for the study. The study included all geriatric patients, ages 65 years
and older, who underwent hip hemi-arthroplasty following a hip fracture. A multivariable
analysis was performed to identify the risk of delirium using all the available information
including patient demography, timing of surgery, comorbidities, and infective complications.
Eighty percent of the data were used to develop a risk model, and 20% of the data
were used to validate the model. A Receiving Operating Characteristics (ROC) curve
was created. The Area Under the Curve (AUC) was calculated with a 95% confidence interval
(CI). A Delirium Risk in Geriatric Hip Hemi-Arthroplasty (DRIGHA) score was created.
Results
Out of 13,174 patients who qualified for the study, 3924 (29.8%) patients developed
in-hospital delirium. The risk model showed advanced age, male gender, prior history
of delirium and dementia, certain comorbidities, and complications were associated
with a higher incidence of in-hospital delirium. The AUC was 0.79 (95% CI, 0.78–0.80).
The DRIGHA score predicted the risk of delirium from 8 to 99.4%.
Conclusion
Certain demography characteristics, comorbidities and infective complications were
associated with a higher risk of developing in-hospital delirium. A DRIGHA score can
be calculated at the bedside through a web-based calculator. Preventive strategies
in high-risk patients will reduce the incidence of delirium.
Keywords
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Article info
Publication history
Published online: January 27, 2022
Accepted:
January 23,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
