Frailty and post-operative delirium influence on functional status in patients with hip fracture: the GIOG 2.0 study

• DOI: 10.1007/s40520-023-02522-8
• Publication Date: 2023-08-05T13:01:38Z
• Authors: Chiara Maria Gand...; Antonella Zambon; Maria Cristina Fe...; Elena Tassistro; Giuseppe Castoldi; Francesca Colombo; Chiara Mussi; Emilio Martini; Giuseppe Sergi; Alessandra Coin; Giovanni Zatti; Caterina Trevisan; Stefano Volpato; Andrea Ungar; Giuseppe Bellelli; ; Maria Lia Lunardelli; Enrico Benvenuti; Stefania Maggi; Alberto Pilotto; Antonella Barone; Amedeo Zurlo; Monica Pizzonia; Raffaele Antonell...; Luigi Residori; Paola Cena; Paolo Mazzola; Maurizio Corsi; Alessio Greco; Riccardo Galluccio; Alice Riccò; Luca Molteni; Andrea Poli; Chiara Bendini; Alice Ceccofiglio; Gaia Rubbieri; Giulio Mannarino; Alessandro Cartei; Eleonora Barghini; Ilaria Del Lungo; Silvia Tognelli; Chiara Bandinelli; Giulia Venturelli; Alberto Cella; Chiara Ceolin; Labjona Haxhiaj; Alice Laudisio; Luigi Residori; Martina Bonetto; Maria Grazia Vals...
• Keywords: Aged, 80 and over; Delirium, Frailty, Functional outcome, Hip fracture, Orthogeriatric; Delirium; Frailty; Functional outcome; Hip fracture; Orthogeriatric; Emergence Delirium; Functional Status; Frailty; Hip Fractures; Risk Factors; Humans; Delirium; Delirium; Frailty; Functional outcome; Hip fracture; Orthogeriatric;; Original Article; Prospective Studies

Abstract Background This study analyzes the effect of frailty and Post-Operative Delirium (POD) on the functional status at hospital discharge and at 4-month follow-up in patients with hip fracture (HF).

Methods Multicenter prospective observational study of older patients with HF admitted to 12 Italian Orthogeriatric centers (July 2019-August 2022). POD was assessed using the 4AT. A 26-item Frailty Index (FI) was created using data collected on admission. The outcome measures were Cumulated Ambulation Score (CAS) ≤ 2 at discharge and a telephone-administered CAS ≤ 2 after 4 months. Poisson regression models were used to assess the effect of frailty and POD on outcomes.

Results 984 patients (median age 84 years, IQR = 79–89) were recruited: 480 (48.7%) were frail at admission, 311 (31.6%) developed POD, and 158 (15.6%) had both frailty and POD. In a robust Poisson regression, frailty alone (Relative Risk, RR = 1.56, 95% Confidence Intervals, CI 1.19–2.04, p = 0.001) and its combination with POD (RR = 2.57, 95% CI 2.02–3.26, p < 0.001) were associated with poor functional status at discharge. At 4-month follow-up, the combination of frailty with POD (RR 3.65, 95% CI 1.85–7.2, p < 0.001) increased the risk of poor outcome more than frailty alone (RR 2.38, 95% CI 1.21–4.66, p < 0.001).

Conclusions POD development exacerbates the negative effect that frailty exerts on functional outcomes in HF patients.