title: Impact of Delirium After Hip Fracture Surgery on One-Year Mortality in Patients With or Without Dementia: A Case of Effect Modification.
abstract: OBJECTIVE
  We evaluated whether delirium after hip fracture repair modifies the relationship between baseline dementia and one-year mortality after surgery.
  
  
  METHODS
  Patients age 65 years and older undergoing hip fracture repair surgery at John Hopkins Bayview Medical Center between 1999 and 2009 were eligible for this prospective cohort study. Baseline probable dementia was defined as either preoperatively diagnosed dementia per geriatrician or score less than 24 on the Mini-Mental State Examination. Delirium was assessed using the Confusion Assessment Method. Four cognitive groups were defined: 1) neither probable dementia nor delirium (NDD), 2) probable dementia only, 3) delirium only, or 4) delirium superimposed on dementia (DSD). Primary outcome of mortality was obtained through hospital records, obituaries, the National Death Index, and Social Security Death Index.
  
  
  RESULTS
  The current sample comprises 466 subjects (average age: 80.8 ± 7.0 years; 73.6% female). Of these, 77 (17%) were categorized as DSD, 68 (15%) probable dementia only, 73 (16%) delirium only, and 248 (53%) NDD. Cox regression revealed that DSD subjects had a significantly higher hazard of one-year mortality than NDD subjects (hazard ratio [HR]: 1.71, 95% CI: 1.06, 2.77) after adjusting for age, sex, medical comorbidity, and surgery duration. Trends toward greater mortality for probable-dementia and delirium only subjects were not significant (HR: 1.42 [95% CI: 0.80, 2.52] and 1.12 [95% CI: 0.64, 1.95], respectively).
  
  
  CONCLUSIONS
  Delirium after hip fracture repair surgery in patients with preoperative dementia modifies the risk of mortality over the first postoperative year. Patients with DSD have a nearly two-fold greater odds of one-year mortality than those without dementia or delirium.
authors.affiliation: From the Department of Psychiatry, Yale School of Medicine, New Haven, CT.
authors.forename: Hochang B
authors.initials: HB
authors.lastname: Lee
authors.affiliation: From the Department of Psychiatry, Yale School of Medicine, New Haven, CT. Electronic address: mark.oldham@yale.edu.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Oldham
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Frederick E
authors.initials: FE
authors.lastname: Sieber
authors.affiliation: Department of Medicine (ESO), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Esther S
authors.initials: ES
authors.lastname: Oh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003693:Delirium / Q000401:mortality*; D003704:Dementia / Q000401:mortality*; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D011446:Prospective Studies; D013997:Time Factors
keywords: Delirium; dementia; hip fracture repair surgery; mortality; neurocognitive impairment; survival