Prolonged hip fracture surgery is associated with increased postoperative delirium, particularly under general anesthetic

The longer surgery for hip fracture repair lasts, the more likely patients are to have delirium after the operation, according to a new study by researchers at ICES and Sunnybrook Health Sciences Centre.

Postoperative delirium can be described as a state of confusion or agitation, and is common for older adults after surgery. It is unpleasant but almost always temporary. It has been linked, however, to longer stays in intensive care units, more total days in the hospital, and even a higher risk of death.

The study published today in JAMA Network, showed that increasing surgery duration was associated with a higher likelihood of postoperative delirium, with a six per cent increase in delirium risk per additional half hour of surgery. This risk was higher in patients that received a general anesthetic.

“Our findings show that nearly 11 per cent of older adults who underwent hip fracture surgery were diagnosed with postoperative delirium. We found that every half hour of additional surgery time increased the risk of postoperative delirium by 6 per cent,” says Dr. Bheeshma Ravi, lead author on the study, adjunct scientist at ICES and an orthopaedic surgeon with the Holland Bone and Joint Program at Sunnybrook Health Sciences Centre.

The researchers looked at the data for 68,131 patients aged 65 or older who had hip fracture surgery between April 1, 2009 and March 31, 2017 at 80 hospitals in Ontario, Canada. They found approximately 11 per cent of patients experienced postoperative delirium.

“We found that general anaesthesia is also associated with increased risk of delirium after surgery when compared to patients who undergo regional anesthesia, such as spinal anaesthetic,” adds Dr. Ravi.

The researchers point out that the duration of surgery is affected by factors such as the complexity of the injury, the difficult of the procedure and the technical expertise of the surgical team, and recommend that hip fractures should be managed in an expedited way by experienced surgeons and anaesthetists.

This study was generously supported by Marvin Tile Chair in Orthopaedic Surgery, at Sunnybrook Health Sciences Centre.

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Natalie Chung-Sayers
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Sunnybrook Health Sciences Centre
natalie.chung-sayers@sunnybrook.ca
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