Bone & joint health Featured Research

Behind the research: hip fracture surgery & delirium risk

Senior woman in bed

The longer surgery for hip fracture repair lasts, the more likely patients are to have delirium after the operation, according to a new study by researchers at ICES and Sunnybrook Health Sciences Centre.

To understand what this means for patients, we spoke with Dr. Bheeshma Ravi, the study’s lead investigator, adjunct scientist at ICES, and an orthopaedic surgeon with the Holland Bone and Joint Program at Sunnybrook.

Why is this study important?

Hip fractures are one of the most common reasons for surgery in older adults. These patients are more likely to have existing medical conditions, have lower physiological reserve, and therefore are more vulnerable to delirium after surgery. If we can gain a fuller understanding of what adds to risk, this will help reduce these experiences for patients, avoid longer hospital stays, and contribute to better outcomes.

What are the main takeaways from the study?

We found that increasing risk for delirium after hip fracture surgery among older adults is strongly associated with longer duration of hip fracture surgery, particularly in patients who undergo a general anaesthetic.

This is a large study looking at surgery activity over an eight-year period. We examined data related to almost 70,000 individuals ages 65 years or older from the general population who had hip repair surgery in 80 hospitals in Ontario, Canada.

How might this study help patients?

The duration of this type of surgery is related to many factors and considerations including the complexity of the injury and the procedure is often unfortunately an urgent one. It may be helpful for patients and or their loved ones to speak with the surgeon if there are known prior episodes of delirium after surgery, and to explore with the anaesthologist the potential use of regional anaesthesia, such as a spinal anaesthetic.

How might this study add to improvements in hip fracture care?

Due to the aging population, hip fractures are one of the most common reasons for urgent surgery, and all practitioners want to continue to provide quality of care. Our hope is that these study findings contribute to the growing body of literature on the effects of general anaesthesia in older patients, and support the notion that these surgeries should ideally be managed expeditiously, by experienced surgeons and anaesthiologists.

This study also builds on previous research about the importance of timely access to hip fracture surgery, supported by the Marvin Tile Chair in Orthopaedic Surgery.

Join the conversation

Join JAMA Network for a live discussion about this research on Twitter or Facebook. Hosts Drs. Seth Trueger and Michael Berkwits will talk about this study on Monday February 25 at 3 p.m. ET.

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About the author

Natalie Chung-Sayers