title: Factors predicting incidence of post-operative delirium in older people following hip fracture surgery: a systematic review and meta-analysis.
abstract: Delirium is one of the most common complications following hip fracture surgery in older people. This study identified pre- and peri-operative factors associated with the development of post-operative delirium following hip fracture surgery.
  
  
  
  Published and unpublished literature were searched to identify all evidence reporting variables on patient characteristics, on-admission, intra-operative and post-operative management assessing incident delirium in older people following hip fracture surgery. Pooled odds ratio (OR) and mean difference of those who experienced delirium compared to those who did not were calculated for each variable. Evidence was assessed using the Downs and Black appraisal tool and interpreted using the GRADE approach.
  
  
  
  A total of 6704 people (2090 people with post-operative delirium) from 32 studies were analysed. There was moderate evidence of nearly a two-times greater probability of post-operative delirium for those aged 80 years and over (OR: 1.77; 95% CI: 1.09, 2.87), whether patients lived in a care institution pre-admission (OR: 2.65; 95% CI: 1.79, 3.92), and a six-times greater probability of developing post-operative delirium with a pre-admission diagnosis of dementia (OR: 6.07, 95% CI: 4.84, 7.62). There was no association with intra-operative variables and probability of delirium.
  
  
  
  Clinicians treating people with a hip fracture should be vigilant towards post-operative delirium if their patients are older, have pre-existing cognitive impairment and poorer overall general health. This is also the case for those who experience post-operative complications such as pneumonia or a urinary tract infection. Copyright © 2017 John Wiley & Sons, Ltd.
authors.affiliation: School of Health Sciences, University of East Anglia, Norwich, UK.
authors.forename: T O
authors.initials: TO
authors.lastname: Smith
authors.affiliation: School of Health Sciences, University of East Anglia, Norwich, UK.
authors.forename: A
authors.initials: A
authors.lastname: Cooper
authors.affiliation: School of Health Sciences, University of East Anglia, Norwich, UK.
authors.forename: G
authors.initials: G
authors.lastname: Peryer
authors.affiliation: Department of Anaesthesia, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, UK.
authors.forename: R
authors.initials: R
authors.lastname: Griffiths
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: C
authors.initials: C
authors.lastname: Fox
authors.affiliation: School of Health Sciences, University of East Anglia, Norwich, UK.
authors.forename: J
authors.initials: J
authors.lastname: Cross
mesh_terms: D000369:Aged, 80 and over; D060825:Cognitive Dysfunction / Q000150:complications; D003693:Delirium / Q000453:epidemiology*; D006304:Health Status; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D015994:Incidence; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors
keywords: anaesthetic; delirium; fractured neck of femur; orthogeriatric care; proximal femoral fracture; surgical optimisation