Development of a Preoperative Clinical Risk Assessment Tool for Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery
Keywords:
Clinical prediction score, Elderly, Hip fracture, Postoperative delirium, Preoperative risk assessmentAbstract
Postoperative delirium (POD) is a prevalent and severe complication in elderly patients undergoing hip fracture surgery. This retrospective cohort study aimed to develop a practical clinical risk prediction score for POD. We evaluated 115 patients (aged ≥60 years) who underwent hip fracture repair. Clinical data were retrospectively extracted and analyzed using multivariable logistic regression to identify independent predictors. The retained variables were assigned weighted points to construct a simple integer-based scoring system. The model's discriminative performance was assessed utilizing the area under the receiver operating characteristic curve (AUC), alongside calibration analysis.
The overall incidence of POD was 36.52%. The final prediction model incorporated seven preoperative predictors: advanced age (≥80 years), ASA physical status III–IV, dementia, urinary catheter use, insomnia, benzodiazepine use, and antipsychotic drug use. The total risk score ranged from 0 to 37 points. The model demonstrated excellent discriminative ability (AUC = 0.88) and adequate calibration. The optimal cut-off score of ≥11 achieved a sensitivity of 69.05%, specificity of 95.89%, and overall accuracy of 86.09%. Furthermore, a high-risk threshold of ≥13 provided an excellent specificity of 98.63% and a markedly elevated positive likelihood ratio of 46.92. In conclusion, this highly practical preoperative bedside tool effectively stratifies POD risk, facilitating early identification and the implementation of targeted prevention strategies in geriatric surgical care.
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