Post-operative Delirium in Orthopedic Fracture Patients: Challenges and Strategies

Post-operative delirium (POD) is a frequent complication among elderly patients undergoing orthopedic fracture surgery, associated with increased morbidity and prolonged hospitalization. Identifying perioperative risk factors is crucial for timely prevention and management.

A prospective observational study was conducted on 100 patients aged ≥50 years undergoing surgical fixation of orthopedic fractures. Baseline demographics, comorbidities, American Society of Anesthesiologists (ASA) class, type of anesthesia, intraoperative hemodynamic parameters, and perioperative factors were recorded. Delirium was assessed daily for 5 post-operative days using the confusion assessment method. Multivariate logistic regression was performed to identify independent risk factors.

POD occurred in 22% of patients. Patients who developed delirium were older (72.4 ± 8.2 vs. 66.1 ± 7.5 years, P = 0.002) and more frequently had ASA class III-IV (54.5% vs. 24.4%, P = 0.01). Delirium was associated with general anesthesia (63.6% vs. 37.2%, P = 0.02), longer surgery duration (128.4 ± 25.2 vs. 108.9 ± 20.5 min, P = 0.001), intraoperative hypotension (50.0% vs. 19.2%, P = 0.005), and perioperative blood transfusion (40.9% vs. 15.4%, P = 0.01). Most cases occurred on the first post-operative day (50%), with a mean duration of 3.2 ± 1.1 days. Independent predictors included age ≥70 years (odds ratio [OR] 2.8), ASA Class III-IV (OR 3.2), general anesthesia (OR 2.6), intraoperative hypotension (OR 3.5), and blood transfusion (OR 2.9).

POD affected one-fifth of orthopedic fracture patients. Advanced age, higher ASA class, general anesthesia, intraoperative hypotension, and blood transfusion were significant independent risk factors. Early identification and targeted perioperative strategies may reduce delirium incidence.