Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Original Investigation

Risk factors associated with treatment of hyperactive postoperative delirium in elderly patients following hip fracture surgery under regional anesthesia: a nationwide population-based study

Fatores de risco associados ao tratamento do delirium hiperativo pós-operatório em pacientes idosos após cirurgia de fratura de quadril sob anestesia regional: um estudo nacional de base populacional

Eun-Jin Ahn; Si Ra Bang

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Background and objectives
Delirium is common but is frequently undetected by clinicians, despite the fact that it can be life-threatening. This study aimed to identify the incidence of delirium and the preoperative factors associated with perioperative use of drugs to treat hyperactive delirium in elderly patients who underwent hip fracture surgery under regional anesthesia.

We retrospectively reviewed records of all patients ≥ 65 years of age who had undergone hip-fracture surgery under regional anesthesia, covered by the Korean National Health Insurance, between January 1, 2009 and December 31, 2015. A univariate and stepwise logistic regression model with the occurrence of hyperactive delirium as the dependent variable was used to identify the perioperative factors for this sample of patients.

Among the 70,696 patients who underwent hip fracture surgery, 58,972 patients who received regional anesthesia were included in our study; of these, perioperative use of drugs to treat hyperactive delirium was diagnosed in 8,680 (14.7%) patients. Performing stepwise logistic regression, preoperative variables found to be associated with delirium were: male sex, age ≥ 85 years, hospital type (medical center), ICU and ventilator care, the presence of a neurodegenerative disorder, uncomplicated diabetes mellitus, peptic ulcer disease, and previously diagnosed psychoses and/or depression (OR = 1.49 [1.42-1.58], 4.7 [4.15-5.37], 13.3 [7.57-23.8], 1.52 [1.43-1.60], 1.19 [1.01-1.40], 1.20 [1.14-1.27], 1.09 [1.04-1.14], 0.87 [0.96-0.00], 2.23 [1.48-3.37], and 1.38 [1.32-1.46], respectively).

Postoperative hyperactive delirium may affect approximately 15% of elderly patients submitted to hip fracture repair under regional anesthesia. This study has identified multiple preoperative risk factors associated with postoperative hyperactive delirium and its pharmacological management strategies.


Hip fracture,  Anesthesia,  Delirium


Justificativa e objetivos: Delírio é comum, mas frequentemente não é detectado pelos médicos, apesar de poder ser fatal. Este estudo teve como objetivo identificar a incidência de delírio e os fatores pré-operatórios associados ao uso perioperatório de medicamentos para tratar delírio hiperativo em pacientes idosos submetidos à cirurgia de fratura de quadril sob anestesia regional. Métodos: Revisamos retrospectivamente os registros de todos os pacientes ≥ 65 anos de idade submetidos a cirurgia de fratura de quadril sob anestesia regional, cobertos pelo Seguro Nacional de Saúde da Coreia, entre 1º de janeiro de 2009 e 31 de dezembro de 2015. Uma regressão logística univariada e gradual modelo com a ocorrência de delirium hiperativo como variável dependente foi utilizado para identificar os fatores perioperatórios para esta amostra de pacientes. Resultados: Entre os 70.696 pacientes submetidos à cirurgia de fratura de quadril, 58.972 pacientes que receberam anestesia regional foram incluídos em nosso estudo; destes, o uso perioperatório de medicamentos para tratar o delirium hiperativo foi diagnosticado em 8.680 (14,7%) pacientes. Realizando a regressão logística stepwise, as variáveis pré-operatórias associadas ao delírio foram: sexo masculino, idade ≥ 85 anos, tipo de hospital (centro médico), UTI e assistência ventilatória, presença de doença neurodegenerativa, diabetes mellitus não complicada, úlcera péptica, e psicoses e/ou depressão previamente diagnosticadas (OR = 1,49 [1,42– 1,58], 4,7 [4,15– 5,37], 13,3 [7,57– 23,8], 1,52 [1,43– 1,60], 1,19 [1,01] – 1,40], 1,20 [1,14– 1,27], 1,09 [1,04– 1,14], 0,87 [0,96---0,00], 2,23 [1,48– 3,37] e 1,38 [1,32– 1,46] ], respectivamente). Conclusões: O delírio hiperativo pós-operatório pode afetar aproximadamente 15% dos pacientes idosos submetidos à correção de fratura de quadril sob anestesia regional. Este estudo identificou vários fatores de risco pré-operatórios associados ao delirium hiperativo pós-operatório e suas estratégias de manejo farmacológico.


Fratura do quadril; Anestesia; Delírio.


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