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Delirium risk in geriatric hip hemi-arthroplasty (DRIGHA): Development and validation of a novel score using a national data

  • Nasim Ahmed
    Correspondence
    Corresponding author at: Division of Trauma and Surgical Critical Care, Jersey Shore University Medical Center, Neptune, NJ, United States.
    Affiliations
    Division of Trauma and Surgical Critical Care, Jersey Shore University Medical Center, Neptune, NJ, United States

    Hackensack Meridian School of Medicine, Nutley, NJ, United States
    Search for articles by this author
  • Yen-Hong Kuo
    Affiliations
    Office of Research Administration, Jersey Shore University Medical Center, Neptune, NJ, United States
    Search for articles by this author
Published:January 27, 2022DOI:https://doi.org/10.1016/j.injury.2022.01.041

      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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