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Purpose <p>Evidence on how the timing of delirium onset influences functional outcomes after hip fracture is scarce, yet is crucial for informing service planning and optimizing orthogeriatric care pathways. We therefore examined the association between delirium occurring at distinct perioperative phases and functional status at discharge in older patients undergoing hip fracture surgery.</p> Methods <p>This multicenter prospective cohort study included patients aged ≥ 65 years who underwent hip fracture surgery between July 2019 and June 2024 at 12 Italian orthogeriatric centers. Delirium was assessed with the 4AT from the day before surgery through postoperative day three<b>.</b> Poor functional status at discharge was defined as a Cumulated Ambulation Score ≤ 2. Associations of preoperative, postoperative, and preoperative + postoperative delirium with poor functional status were examined using multivariable logistic regression adjusted for age, sex, comorbidity, pre-fracture activities of daily living, pre-fracture ambulation, and time-to-surgery &gt; 48 h.</p> Results <p>A total of 1492 patients were included (median age 84 years, Q1–Q3: 79–89; 76.9% female). Delirium occurred in 444 (29.8%) patients: 34 (2.3%) had preoperative delirium, 182 (12.2%) postoperative delirium, and 228 (15.3%) both. The combined presence of preoperative and postoperative delirium was significantly associated with higher odds of poor functional status at discharge (Odds Ratio: 1.57; 95% Confidence Interval: 1.13–2.20) versus no delirium.</p> Conclusion <p>Delirium persisting from the preoperative to the postoperative phase was associated with poor functional status at discharge. Systematic assessment of delirium in both phases may help identify older hip fracture patients at increased risk of poor functional outcome.</p> Graphical abstract <p></p>

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Association of pre- and postoperative delirium with functional status at discharge after hip fracture: findings from the Gruppo Italiano di Ortogeriatria (GIOG 2.0) study

  • 期刊论文

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  • 发表日期：

    2026年3月13日

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  • Maria Cristina Ferrara,
  • Francesca Remelli,
  • Caterina Trevisan,
  • Federico Triolo,
  • Elena Tassistro,
  • Antonella Zambon,
  • Chukwuma Okoye,
  • Elena Pinardi,
  • Alice Margherita Ornago,
  • Alberto Finazzi,
  • Luca Tinelli,
  • Wenxiang Guo,
  • Eleonora Cucini,
  • Elena Page,
  • Maria Grazia Valsecchi,
  • Paolo Mazzola,
  • Giuseppe Castoldi,
  • Chiara Mussi,
  • Monica Pizzonia,
  • Paola Cena,
  • Giuseppe Sergi,
  • Andrea Ungar,
  • Raffaele Antonelli Incalzi,
  • Stefano Volpato,
  • Giuseppe Bellelli,
  • Alice Rivolta,
  • Martina Marelli,
  • Leonardo Barbieri,
  • Giorgio Mauri,
  • Alberto Saporito,
  • Camilla Tocci,
  • Emanuela Rossi,
  • Maurizio Corsi,
  • Francesca Colombo,
  • Luca Molteni,
  • Maria Lia Lunardelli,
  • Chiara Bendini,
  • Pierfederico Scaroni,
  • Alice Ceccofiglio,
  • Alessandro Cartei,
  • Gaia Rubbieri,
  • Giulio Mannarino,
  • Enrico Benvenuti,
  • Simone Pupo,
  • Silvia Tognelli,
  • Chiara Bandinelli,
  • Emilio Martini,
  • Elisa Crocetti,
  • Elena Sperti,
  • Luca Tagliafico,
  • Stefania Peruzzo,
  • Alberto Pilotto,
  • Antonella Barone,
  • Alberto Cella,
  • Chiara Ceolin,
  • Labjona Haxhiaj,
  • Cristina Simonato,
  • Antonio De Vincentis,
  • Andrea Cavalli,
  • Alice Laudisio,
  • Filippo Fimognari,
  • Martina Bonetto,
  • Maria Garro,
  • Andrea Rossi

摘要

Purpose

Evidence on how the timing of delirium onset influences functional outcomes after hip fracture is scarce, yet is crucial for informing service planning and optimizing orthogeriatric care pathways. We therefore examined the association between delirium occurring at distinct perioperative phases and functional status at discharge in older patients undergoing hip fracture surgery.

Methods

This multicenter prospective cohort study included patients aged ≥ 65 years who underwent hip fracture surgery between July 2019 and June 2024 at 12 Italian orthogeriatric centers. Delirium was assessed with the 4AT from the day before surgery through postoperative day three. Poor functional status at discharge was defined as a Cumulated Ambulation Score ≤ 2. Associations of preoperative, postoperative, and preoperative + postoperative delirium with poor functional status were examined using multivariable logistic regression adjusted for age, sex, comorbidity, pre-fracture activities of daily living, pre-fracture ambulation, and time-to-surgery > 48 h.

Results

A total of 1492 patients were included (median age 84 years, Q1–Q3: 79–89; 76.9% female). Delirium occurred in 444 (29.8%) patients: 34 (2.3%) had preoperative delirium, 182 (12.2%) postoperative delirium, and 228 (15.3%) both. The combined presence of preoperative and postoperative delirium was significantly associated with higher odds of poor functional status at discharge (Odds Ratio: 1.57; 95% Confidence Interval: 1.13–2.20) versus no delirium.

Conclusion

Delirium persisting from the preoperative to the postoperative phase was associated with poor functional status at discharge. Systematic assessment of delirium in both phases may help identify older hip fracture patients at increased risk of poor functional outcome.

Graphical abstract