BACKGROUND
Delirium is a frequent complication in patients hospitalized with femoral neck fracture, with a prevalence of 13-70%. Its occurrence is associated with increased morbidity and mortality. Several risk factors have been associated with the occurrence of delirium in patients hospitalized for femoral neck fracture, some of these considered modifiable. The aim of this study is to assess the prevalence of delirium in patients with femoral neck fracture (FNF) undergoing reduction and osteosynthesis (RO), and to identify risk factors.

METHODS
Observational, retrospective study of patients with FNF undergoing RO surgery alone, during the year 2016, in a tertiary university hospital. The presence of delirium was considered whenever documented at clinical process: acute cognitive dysfunction and/or psychomotor agitation. Demographic variables, autonomy, institutionalization and previous dementia, treatment with psychoactive drugs, creatinine and pre-operative albumin, and days of hospitalization until surgery were assessed as factors associated with the occurrence of delirium. Univariate analysis with chi-square test was performed to identify risk factors. Subsequently, a multivariate analysis was performed using binary logistic regression. Statistical significance was assumed for p <0.05.

RESULTS AND DISCUSSION
We included 134 patients, mean age 83.46 (±) years, 97 (72%) female. 72 (53.5%) of the patients presented delirium in the perioperative period. Age (OR: 1.08, 95% CI 1.03-1.12, p=0.001), presence of previous dependence (OR: 11.73; 95% CI: 5.12-26.87; p <0.001); (OR: 3.18, 95% CI, 1.17-8.64, p = 0.002), dementia (OR: 40.50, 95% CI: 5.30-309.57, p <0.001) and use of psychoactive drugs (OR: 4.02, 95% CI 1.88-8.60, p <0.001) were associated with a higher probability of delirium. In the multivariate analysis, prior dependence (OR: 7.33, 95% CI: 2.41-2.27, p <0.001) and dementia (OR: 29.59, 95% CI, 3.36-260.45, p <0.001) are independently associated with the occurrence of delirium.

CONCLUSION
In our cohort of patients undergoing femoral neck fracture osteosynthesis 53.5% of the patients presented with delirium. The presence of previous dependence and dementia appear to be independently associated with the occurrence of delirium in this subgroup of patients. The identification of these risk factors may lead to preventive attitudes.


04 / Femoral neck fracture urgent surgery - Prevalence of delirium and risk factors in our population