Postoperative delirium in geriatric patients with hip fractures

Postoperative delirium (POD) is a frequent complication in geriatric patients with hip fractures, which is linked to poorer functional recovery, longer hospital stays, and higher short-and long-term mortality. Patients with increased age, preoperative cognitive impairment, comorbidities, perioperative polypharmacy, and delayed surgery are more prone to develop POD after hip fracture surgery. In this narrative review, we outlined the latest findings on postoperative delirium in geriatric patients with hip fractures, focusing on its pathophysiology, diagnosis, prevention, and treatment. Perioperative risk prediction, avoidance of certain medications, and orthogeriatric comprehensive care are all examples of effective interventions. Choices of anesthesia technique may not be associated with a significant difference in the incidence of postoperative delirium in geriatric patients with hip fractures. There are few pharmaceutical measures available for POD treatment. Dexmedetomidine and multimodal analgesia may be effective for managing postoperative delirium, and adverse complications should be considered when using antipsychotics. In conclusion, perioperative risk intervention based on orthogeriatric comprehensive care is the most effective strategy for preventing postoperative delirium in geriatric patients with hip fractures.

Automated summary

Postoperative delirium (POD) is a common complication in geriatric patients with hip fractures, associated with poorer functional recovery, longer hospital stays, and higher mortality rates. Various factors such as advanced age, preoperative cognitive impairment, comorbidities, perioperative polypharmacy, and delayed surgery increase the risk of developing POD. Effective interventions such as perioperative risk prediction, avoidance of certain medications, and orthogeriatric comprehensive care can help prevent POD. Anesthesia technique choice does not seem to significantly impact the incidence of postoperative delirium in geriatric patients with hip fractures. There are limited pharmaceutical measures available for POD treatment, with dexmedetomidine and multimodal analgesia showing potential effectiveness but also considering adverse complications when using antipsychotics. In conclusion, perioperative risk intervention based on orthogeriatric comprehensive care is the most effective strategy for preventing postoperative delirium in geriatric patients with hip fractures.