Predictors of Postoperative Delirium in Elderly Patients Undergoing Hemiarthroplasty for Intertrochanteric Femur Fractures: A Prospective Observational Study
Radhika Vishveshwar, Collin J. Tharakan, Anu Gaikwad, Aniketh HiremathAbstract
Background:
Postoperative delirium (POD) is a frequent complication following hip fracture surgery in older adults and is associated with adverse clinical outcomes. Early identification of high-risk patients using the Comprehensive Geriatric Assessment (CGA) may improve perioperative management and reduce morbidity.
Objectives:
To determine POD incidence and identify clinical, geriatric, and perioperative predictors using CGA-based assessment.
Materials and Methods:
This prospective observational study included 350 patients aged ≥65 years who underwent hemiarthroplasty at a tertiary care hospital. Preoperative CGA assessed cognition, frailty, nutrition, functional status, comorbidity burden, and delirium risk. POD was evaluated using the Confusion Assessment Method on postoperative days 1, 3, and 5. Logistic regression identified independent predictors, and model performance was assessed using the Receiver-Operating-Characteristic analysis.
Results:
POD occurred in 74 (21.1%) patients. Patients with POD were older and had higher frailty, greater comorbidity burden, lower cognitive scores, higher functional dependence, poorer nutritional status, and higher 4-A’s test (4AT) scores (all
Conclusion:
POD is common after hemiarthroplasty in elderly patients and is influenced by both vulnerability and perioperative factors. CGA-based screening facilitates early risk stratification and targeted preventive strategies.