title: Health economic implications of perioperative delirium in older patients after surgery for a fragility hip fracture.
abstract: BACKGROUND
  Patients who experience a fragility hip fracture are at high risk for perioperative delirium. The purpose of the present study was to evaluate the impact, from a hospital perspective, of perioperative delirium on the length of the hospital stay and episode-of-care costs for elderly patients who underwent surgical treatment of a fragility hip fracture.
  
  
  METHODS
  A total of 242 patients sixty-five years of age or older (mean age, eighty-two years; range, sixty-five to 103 years) who underwent surgical treatment of a fragility hip fracture at a single center between January 2011 and December 2012 were evaluated. Demographic, clinical, surgical, and adverse-events data were extracted and analyzed. The confusion assessment method (CAM) was used prospectively to detect perioperative delirium.
  
  
  RESULTS
  One hundred and sixteen (48%) of the 242 patients developed perioperative delirium during their stay in the hospital. Compared with patients with no delirium, delirium was associated with a mean incremental total length of hospital stay of 7.4 days (95% confidence interval [CI] = 3.7 to 11.2 days; p < 0.001), a mean incremental length of stay following surgery of 7.4 days (95% CI = 3.8 to 11.1 days; p < 0.001), and a mean incremental episode-of-care cost (in 2012 Canadian dollars) of $8286 (95% CI = $3690 to $12,881; p < 0.001). The total incremental episode-of-care cost attributable to delirium over the study period was $961,131 in 2012 Canadian dollars.
  
  
  CONCLUSIONS
  Nearly 50% of elderly patients who underwent surgery for a fragility hip fracture developed perioperative delirium, which was associated with a significant incremental in-hospital length of stay and significant incremental episode-of-care costs. These findings highlight the importance of implementing cost-effective interventions to reduce the prevalence of perioperative delirium in elderly patients with a low-energy hip fracture.
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, 1E441, Toronto, ON M5T 2S8, Canada. E-mail address for M.G. Zywiel: mike@zywiel.net. E-mail address for Y.R. Rampersaud: raja.rampersaud@uhn.ca.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Zywiel
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, 1E441, Toronto, ON M5T 2S8, Canada. E-mail address for M.G. Zywiel: mike@zywiel.net. E-mail address for Y.R. Rampersaud: raja.rampersaud@uhn.ca.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Hurley
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, 1E441, Toronto, ON M5T 2S8, Canada. E-mail address for M.G. Zywiel: mike@zywiel.net. E-mail address for Y.R. Rampersaud: raja.rampersaud@uhn.ca.
authors.forename: Anthony V
authors.initials: AV
authors.lastname: Perruccio
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th floor, Toronto, ON M5T 3M6, Canada.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Hancock-Howard
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th floor, Toronto, ON M5T 3M6, Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Coyte
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, 1E441, Toronto, ON M5T 2S8, Canada. E-mail address for M.G. Zywiel: mike@zywiel.net. E-mail address for Y.R. Rampersaud: raja.rampersaud@uhn.ca.
authors.forename: Y Raja
authors.initials: YR
authors.lastname: Rampersaud
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003365:Costs and Cost Analysis; D003693:Delirium / Q000191:economics*; D005260:Female; D005598:Fractures, Spontaneous / Q000191:economics / Q000523:psychology / Q000601:surgery*; D006620:Hip Fractures / Q000191:economics / Q000523:psychology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D019990:Perioperative Care / Q000191:economics; D011183:Postoperative Complications / Q000191:economics* / Q000523:psychology; D057216:Propensity Score; D011446:Prospective Studies