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Risk Factors of Postoperative Delirium in Elderly Patients with Hip Fracture
elderly patients,hip fracture,post-operative delirium,risk factors,
|Publication Year :||2018|
【研究方法】本研究為前瞻性、描述性、相關性之觀察研究，自2017年4月1日至12月31日依方便取樣方式選取高齡髖部骨折病人，以混亂評估法(confusion assessment method, CAM)為工具，調查高齡髖部骨折術後譫妄症發生率，並收集引發術後譫妄症之風險因子-人口學特性、病人原有因子、手術相關因子，以分析驗證每個風險因子之勝算比Odds Ratio(OR)。
【研究結果】篩選102位病人，排除術前發生譫妄症9位，共93位研究對象納入分析；術後譫妄症發生率為54.8%，平均年齡84.5歲，譫妄症持續時間24~72小時佔84.4%，發生譫妄症組術後有延後下床活動，及每日離床活動時間較短的情形。有發生術後譫妄症男性佔較多，平均年齡較大；風險因子單變項分析顯示，年齡越大者越傾向發生術後譫妄症，有宗教信仰者、Mini-Mental State Examination (MMSE)分數越高者、入院時血紅素與血比容檢驗值越高者較不傾向發生術後譫妄症。多變項邏輯式迴歸模式分析發現，MMSE分數越高者越不傾向發生術後譫妄症，MMSE每增加1分減少38 %發生譫妄症的風險 (OR=0.62)
Background: Orthopedic surgery is the best treatment recommended for hip fractures, however, the procedure often induce postoperative delirium. Any age group is susceptible to postoperative delirium, but high prevalence rates of post-operative delirium have been found in geriatric patients with hip fracture.
Purpose: There is a lack of research focused on the geriatric population with hip fracture. The purpose of this study was to establish the incidence rate of post-operative delirium among elderly patients and to identify risk factors.
Methods: A prospective observational design with repeated measures was used. Subjects older than 65 years who had suffer from hip fracture due to fall will be recruited when admitted in orthopedic ward. The Confusion Assessment Method will be the study tool to assess twice a day to identify subjects experiencing delirium by research team. The demographic data, history of illness, operation process, and laboratory data of the patients were recorded. The demographic data of participants were analyzed to obtain the logistic regression to identify factors associated with the odds ratio.
Result: There were One hundred-and-two participants had been screened, and nine of whom was excluded due to the pre-existing delirium. Ninety-three participants with hip fracture were included. The incidence rate of delirium was 54.8%. The average age was 84.5. When postoperative delirium occurred, time to ambulation after surgery was delayed and the average ambulation time per day was decreased. The risk factors were analyzed by logistic regression. Univariate regression suggested age, religion, MMSE (Mini-Mental State Examination), hemoglobin, and hematocrit may be associated to postoperative delirium. Multivariate regression suggested MMSE was a significant risk factor of postoperative delirium in hip fracture.
Conclusion: Postoperative delirium has significant impacts on the recovery and long term well-being of elderly patients. Significant predictive risk factors can be parsed out to help practitioners identify patients who are more susceptible to postoperative delirium before they receiving surgery. Recognizing patients who are more likely to develop delirium can also help practitioners develop individualized management to extend postoperative monitoring as needed and mitigate surgical risk factors.
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