Delirium before and after operation for femoral neck fracture.
OBJECTIVE
The aim of this study was to investigate the differences between preoperative and postoperative delirium regarding predisposing, precipitating factors and outcome in older patients admitted to hospital with femoral neck fractures.


METHODS
A prospective clinical assessment of patients treated for femoral neck fractures.


METHODS
Department of orthopedic surgery at Umeå University Hospital, Sweden.


METHODS
One hundred one patients, age 65 and older admitted to the hospital for treatment of femoral neck fractures.


METHODS
The Organic Brain Syndrome (OBS) Scale.


RESULTS
Thirty patients (29.7%) were delirious before surgery and another 19 (18.8%) developed delirium postoperatively. Of those who were delirious preoperatively, all but one remained delirious postoperatively. The majority of those delirious before surgery were demented, had been treated with drugs with anticholinergic properties (mainly neuroleptics), had had previous episodes of delirium, and had fallen indoors. Patients who developed postoperative delirium had perioperative falls in blood pressure and had more postoperative complications such as infections. Male patients were more often delirious both preoperatively and postoperatively. Patients with preoperative delirium were more often discharged to institutional care and had poorer walking ability both on discharge and after 6 months than did patients with postoperative delirium only.


CONCLUSIONS
Because preoperative and postoperative delirium are associated with different risk factors it is necessary to devise different strategies for their prevention.
Edlund
A
A
Department of Rehabilitation, Piteå River Valley Hospital, Sweden.
Lundström
M
M
Brännström
B
B
Bucht
G
G
Gustafson
Y
Y
D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003693:Delirium / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors