Abstract
Background: Delirium is a common adverse consequence in the hip fracture population. Many medications can affect the emergence of the perioperative delirium but the data in older hip fracture patients is lacking.
Objective: To investigate the association between the type and amount of the selected medication classes and the occurrence of perioperative delirium in older hip fracture patients.
Methods: This is a cross-sectional study which collected data from patients aged ≥ 65 years who underwent hip surgery at King Chulalongkorn Memorial Hospital. The Delirium Rating Scale–Revised-98-Thai version (DRS-R-98-T) was used to assess the delirium one day before the surgery, and 2 and 4 after the surgery. Independent T-test, Pearson’s Chi–square test, and linear regression model were used to investigate the association between different clinical variables.
Results: Forty patients (33.33 %) from 120 older hip fracture patients developed delirium during the hospital stay. Regarding the association between pre-operative medications and pre-operative delirium in linear regression model; benzodiazepine decreased DRS-R-98-T score 2.935 points with p-value at 0.004, beta-blocker decreased DRS-R-98-T score 2.098 points with p-value at 0.038, while antibiotic exposure increased DRS-R-98-T score 2.129 points with p-value at 0.035. Post-operative delirium was directly associated with exposure to antipsychotic drugs (pre- and post-operative use) with p-value at 0.045 and < 0.001 respectively, but inversely associated with benzodiazepines (pre- and post-operative use) with p-value at 0.04 and 0.024 respectively, and inversely associated with anticonvulsant (post-operative use) with p-value < 0.001. Age, dementia, gastrointestinal diseases, body mass index, history of life-time delirium, use of restraints, and history of blood transfusion were associated with increased DRS-R-98-T score.
Conclusion: Antibiotic exposure is associated with increased preoperative delirium symptoms, while benzodiazepines and beta blocker are associated with decreased preoperative delirium symptoms in older adults with hip fracture. Benzodiazepines and anticonvulsants might decrease symptoms of postoperative delirium. These medications are modifiable precipitating factors for delirium prevention, so they should be cautiously use in older hip fracture patients.
DOI
10.56808/2673-060X.1032
Recommended Citation
Wannarong, Krittin; Thipakorn, Yanin; Prasartpornsirichoke, Jirada; Sitthisarunkul, Warong; Suraphanphairoj, Chumpol; and Thisayakorn, Paul
(2024)
"The Association between Medication Use and Peri-operative Delirium in Older Hip Fracture Adult Patients at King Chulalongkorn Memorial Hospital,"
Chulalongkorn Medical Journal: Vol. 67:
Iss.
4, Article 2.
DOI: https://doi.org/10.56808/2673-060X.1032
Available at:
https://digital.car.chula.ac.th/clmjournal/vol67/iss4/2