Authors (including presenting author) :
Yuen Tammy(1), Chu HM(1), Liu Sally(2), Chan Iris(2), Leung SN(2)
Affiliation :
(1) Department of Anaesthesia, PYNEH, HKEC, (2)Department of Occupational Therapy, PYNEH, HKEC
Introduction :
Major neurocognitive disorder (NCD), previously known as dementia, and hip fractures are two serious problems in aging population. They are associated with high morbidity in which postoperative delirium (POD) is a major one.
Objectives :
We aimed to look at the prevalence of major NCD in hip fracture patients in our locality and their associated incidence of postoperative delirium comparing to those without pre-existing major NCD.
Methodology :
It was a prospective cohort study. Patients aged ≥ 65 years old with hip fractures who are communicable in Cantonese were included. They were screened with Hong Kong Montreal Cognitive Assessment 5-min protocol (HK-MoCA 5-min protocol) for the major NCD before operation. They were then reviewed postoperatively with 3-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM) to assess the presence of POD. The primary outcome was the incidence of delirium between patients with or without preoperative major NCD. Secondary outcomes including surgical outcomes and length of hospital stay (LOS) were investigated. Inverse propensity score weighting was used to balance the potential confounding.
Result & Outcome :
The study was conducted between November 2020 and March 2021. One hundred ninety-two patients were screened of which 122 patients were included. Among the 192 patients screened, 97 (50.5%) were found to have major NCD. POD was found in 68.1% of patients with major NCD where it was only 21.3% in patients without (Pre-adjusted data, p<0.001) (Adjusted data 66.7% vs 29.1%, p<0.001,). The odds ratio was 4.857 (95% CI 2.046-11.531). Total length of stay in hospital was longer when POD developed (p<0.05). Other surgical outcomes were not significantly different between 2 groups.
High prevalence of major NCD was found in geriatric hip fracture patients. Pre-existing major NCD was shown to be an independent risk factor in developing POD in hip fractures. Both major NCD and POD were commonly seen but have not been sufficiently addressed in our locality. Before we are able to handle POD effectively, the first step should initiate the routine assessment of cognitive function and confusion status. A multidisciplinary approach including anaesthetists, geriatricians and allied health may help to prevent POD and reduce its severity.
