Today's News

Wednesday, February 28, 2001

Pain a strong risk factor for post-op delirium

A study of pain and delirium in elderly hip fracture patients--poster exhibit 105--finds that inadequately treated postoperative pain is a strong risk factor for postoperative delirium in cognitively intact elderly hip fracture patients. Patients with pre-operative dementia are also high risk.

The coauthors say use of post-operative opioid analgesics did not enhance the risk of developing post-operative delirium.

In the study, 571 patients over age 55 undergoing operative treatment of femoral neck or intertrochanteric fractures were evaluated for the development of postoperative delirium. Patients were assessed with daily pain scoring, the Confusion Assessment Method and record review. Patients with preoperative delirium were excluded.

Forward stepwise multiple logistic regression was employed to evaluate the association between the development of delirium and risk factors. Included were all variables of at least borderline significance (p>.15) by univariate analysis. Mean daily opioid doses in morphine sulfate equivalents were incorporated into the models.

Of the 490 patients included, 57(11.6 percent) developed postoperative delirium. Risk factors included comorbid dementia and greater than three hours spent in the emergency department. As dementia was highly predictive and overwhelmed other variables, separate analyses were performed for cognitively intact patients.

Risk factors for delirium in the cognitively intact subject included poor baseline functional status and severe pain. Good baseline functional status was a risk factor for delirium in dementia subjects. Opioid analgesics were not associated with the development of delirium.

Coauthors of the study are R. Sean Morrison, MD, and Gretchen Orosz, MD, both of the department of geriatrics and adult development, Mount Sinai School of Medicine New York, N.Y.; Marvin Gilbert, MD, and Elton Straus, MD, department of orthopaedics, Mount Sinai School of Medicine, New York; Maryann McLaughlin, MD, MPH, department of health policy, Mount Sinai School of Medicine, New York; Albert Siu, MD, department of medicine, Mount Sinai School of Medicine, New York; Jay Magaziner, PhD, department of epidemiology and preventative medicine, University of Maryland School of Medicine, Baltimore, Md.; and Kenneth J. Koval, MD, Orthopaedic Institute, New York University School of Medicine, New York, N.Y.

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2001 Academy News February 28 Index B

Last modified 20/February/2001 by IS