title: Duration of postoperative delirium is an independent predictor of 6-month mortality in older adults after hip fracture.
abstract: OBJECTIVE
  To evaluate the association between number of days with delirium and 6-month mortality in elderly adults after hip fracture surgery.
  
  
  METHODS
  Prospective cohort study with 6-month follow-up.
  
  
  METHODS
  Orthogeriatric Unit (OGU).
  
  
  METHODS
  Individuals (mean age = 84.3 ± 6.4) admitted to the OGU between October 2011 and April 2013 with hip fracture (N = 199).
  
  
  METHODS
  Postoperative delirium (POD) was assessed daily using the Confusion Assessment Method algorithm and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria. Multivariable Cox regression models were used to evaluate the association between POD of and 6-month mortality after surgery, after adjustment for covariates including age, prefracture residence, Katz activity of daily living score, New Mobility score, diagnosis of prefracture dementia, American Society of Anesthesiologists score, albumin serum levels, Charlson Comorbidity Index, and length of OGU stay.
  
  
  RESULTS
  Fifty-seven participants (28.6%) developed POD. In the 6-month period after surgery, 35 (17.6%) participants died: 16 of 57 (28.1%) with POD and 19/ of 142 (13.4%) with no POD. The average duration of POD was 2.0 ± 3.2 days for participants who died and 0.7 ± 1.8 days for those who survived (P < .001). After adjusting for covariates, each day of POD in the OGU increased the hazard of dying at 6 months by 17% (hazard ratio = 1.17, 95% confidence interval = 1.07-1.28).
  
  
  CONCLUSIONS
  In older adults undergoing hip fracture surgery, duration of POD is an important prognostic factor for 6-month mortality. Efforts to reduce duration of POD are therefore crucial for these individuals.
authors.affiliation: Department of Health Sciences, University of Milano-Bicocca, Milan, Italy; Geriatric Unit, S. Gerardo Hospital, Monza, Italy; Geriatric Research Group, Brescia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bellelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Mazzola
authors.forename: Alessandro
authors.initials: A
authors.lastname: Morandi
authors.forename: Adriana
authors.initials: A
authors.lastname: Bruni
authors.forename: Lucio
authors.initials: L
authors.lastname: Carnevali
authors.forename: Maurizio
authors.initials: M
authors.lastname: Corsi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Zatti
authors.forename: Antonella
authors.initials: A
authors.lastname: Zambon
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corrao
authors.forename: Birgitta
authors.initials: B
authors.lastname: Olofsson
authors.forename: Yngve
authors.initials: Y
authors.lastname: Gustafson
authors.forename: Giorgio
authors.initials: G
authors.lastname: Annoni
mesh_terms: D000369:Aged, 80 and over; D003693:Delirium / Q000453:epidemiology*; D005260:Female; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors
keywords: delirium; delirium duration; elderly; hip fracture; mortality; orthogeriatric