Tianjin Medical Journal

Tianjin Medical Journal ›› 2021, Vol. 49 ›› Issue (6): 641-645.doi: 10.11958/20201943

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Prediction model construction and preliminary application of postoperative delirium in elderly hip fracture patients #br#

ZHANG Ming-mei, ZHU Xing-bo, HUANG Li-xin #br#   

  1. 1 Department of Orthopedic Surgery, 2 Department of General Surgery, the First Affiliated Hospital of Soochow University,
    Suzhou 215006, China
  • Received:2020-07-12 Revised:2021-03-11 Published:2021-06-15 Online:2021-06-15

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Abstract:

Objective To establish an effective predictive model for assessing the risk of postoperative delirium (POD)
in elderly patients with hip orthopedics and verify its feasibility. Methods A total of 205 elderly patients undergoing hip
surgery in the department of orthopedics were selected. The data of patient age, gender, comorbidities, dystrophia,
debilitation, preoperative albumin, intraoperative blood transfusion, surgical method, operative duration, the American
Society of Anesthesiologists (ASA) grade, anesthesia method and postoperative C-reactive protein (CRP) were collected.
Multivariate Logistic regression was used to screen the influencing factors of POD, and a risk prediction model was
established. The histogram was drawn. Receiver operating characteristic (ROC) curve was used to analyze the prediction
effect of the model. In addition, 80 elderly patients who underwent hip surgery were selected to preliminarily verify the
effectiveness of the prediction model. Results A total of 73 cases occurred POD in 205 elderly patients with hip surgery,
and the incidence rate was 35.61%. Univariate and multivariate Logistic regression analysis showed that age, duration of
operation, complicated cardiovascular and cerebrovascular diseases, anesthesia method, frailty and ASA grade were
influencing factors of POD. The AUC under ROC curve was 0.915 (95%CI: 0.869-0.950), sensitivity was 78.49% and
specificity was 85.97%. In the preliminary validation cohort, 21 cases (80 patients) developed POD, and the model
predicted 24 cases. The sensitivity and specificity were 90.48% and 91.53%, respectively. ConclusionThe prediction
model established in this study is suitable for the risk assessment of perioperative evaluation of elderly hip fracture patients,
which provides reference for clinical medical staff to identify high-risk population and provides targeted preventive
intervention.

Key words: hip fractures, aged, Logistic models, nomograms, postoperative delirium, risk assessment