title: Preoperative risk factors for postoperative delirium following hip fracture repair: a systematic review.
abstract: OBJECTIVE
  Systematically identify preoperative clinical risk factors for incident postoperative delirium in individuals undergoing hip fracture repair in order to guide clinicians in identifying high risk patients at admission.
  
  
  METHODS
  This is a systematic review of prospective observational studies with estimation of association between preoperative risk factors and incident postoperative delirium in multivariate models. Electronic searches were conducted in PubMed, Embase, PsycINFO, CINAHL, Cochrane Library, Proquest Dissertations and Theses, and WorldCatDissertations. Hand searches were conducted in selected journals and their supplements.
  
  
  RESULTS
  Search yielded 6380 titles and abstracts from electronic databases and 72 titles from hand searches, and 10 studies met inclusion criteria. The following risk factors were significant in bivariate models: cognitive impairment, age, gender, institutionalization, functional impairment, body mass index (BMI), albumin, comorbidities, American Society of Anesthesiologist classification, acute medical conditions, polypharmacy, and vision impairment. Among all of these risk factors, cognitive impairment most consistently remained statistically significant after adjusting for other risk factors in multivariate models, followed by BMI/albumin and multiple comorbidities.
  
  
  CONCLUSIONS
  In our systematic review, cognitive impairment was one of the strongest preoperative risk factors for postoperative delirium after hip fracture surgery. Preoperative cognitive assessment may be one of the most useful methods of identifying those who are at high risk for postoperative delirium and prioritizing delivery of delirium prevention measures.
authors.affiliation: Department of Medicine, John Hopkins University School of Medicine, Baltimore, MD, USA.|Department of Psychiatry and Behavioral Sciences, John Hopkins University School of Medicine, Baltimore, MD, USA.|Department of Pathology, John Hopkins University School of Medicine, Baltimore, MD, USA.|Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Esther S
authors.initials: ES
authors.lastname: Oh
authors.affiliation: Pharmaceutical Outcomes Research & Policy Program, University of Washington, Seattle, WA, USA.
authors.forename: Meng
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Medicine, John Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Tolulope M
authors.initials: TM
authors.lastname: Fafowora
authors.affiliation: Aging Brain Center, Institute of Aging Research, Hebrew SeniorLife, Boston, MA, USA.|Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Inouye
authors.affiliation: Princeton University, Princeton, NJ, USA.
authors.forename: Cathy H
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Department of Welch Medical Library, John Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Lori M
authors.initials: LM
authors.lastname: Rosman
authors.affiliation: Department of Psychiatry and Behavioral Sciences, John Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Constantine G
authors.initials: CG
authors.lastname: Lyketsos
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, John Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Frederick E
authors.initials: FE
authors.lastname: Sieber
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Institute of Social & Preventive Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Milo A
authors.initials: MA
authors.lastname: Puhan
mesh_terms: D003072:Cognition Disorders / Q000150:complications; D015897:Comorbidity; D003693:Delirium / Q000453:epidemiology*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D015994:Incidence; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors
keywords: delirium; hip fracture; postoperative; risk factors