title: Postoperative opioid consumption and its relationship to cognitive function in older adults with hip fracture.
abstract: OBJECTIVE
  To determine the relationship between opioid consumption and cognitive impairment after hip fracture repair.
  
  
  METHODS
  Prospective study of consecutive patients.
  
  
  METHODS
  Johns Hopkins Bayview Medical Center, Baltimore, Maryland.
  
  
  METHODS
  Two hundred thirty-six participants aged 65 and older undergoing hip fracture repair.
  
  
  METHODS
  Older adults without preoperative delirium who underwent hip fracture repair between April 2005 and July 2009 were followed for pain, opioid consumption, and postoperative delirium. Participants were tested for delirium using the Confusion Assessment Method preoperatively and midmorning on Postoperative Day 2. The nursing staff assessed pain on a numeric oral scale (range 0-10). Opioid analgesia was provided in response to pain at rest to achieve scores of 3 or less. Opioid consumption was analyzed with respect to the occurrence of incident postoperative delirium, presence of dementia, and other demographic variables.
  
  
  RESULTS
  Of the 236 participants, 66 (28%) had dementia, and 213 (90%) received opioids postoperatively, including 55 (83%) with dementia and 158 (93%) without. There was no association between the use of any postoperative opioid and incident delirium (P = .61) in participants with (P = .33) and without (P = .40) dementia. Dementia, but not postoperative delirium, was associated with less opioid use (P < .001 for dementia; P = .12 for delirium; P = .04, for their interaction; Wald chi-square = 142.8, df = 7). Opioid dose (P ≥ .59) on Postoperative Days 1 and 2 was not predictive of incident delirium. Dementia (P < .001) and intensive care unit admission (P = .006), not opioid consumption, were the most important predictors of incident postoperative delirium.
  
  
  CONCLUSIONS
  Concern for postoperative delirium should not prevent the use of opioid analgesic therapy sufficient to achieve a generally accepted level of comfort in individuals with or without preexisting cognitive impairment.
authors.affiliation: Department of Anesthesiology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland 21224, USA. fsieber1@jhmi.edu
authors.forename: Frederick E
authors.initials: FE
authors.lastname: Sieber
authors.forename: Simon
authors.initials: S
authors.lastname: Mears
authors.forename: Hochang
authors.initials: H
authors.lastname: Lee
authors.forename: Allan
authors.initials: A
authors.lastname: Gottschalk
mesh_terms: D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000009:adverse effects*; D003072:Cognition Disorders / Q000139:chemically induced*; D005260:Female; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid
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