Title : Postoperative Delirium (POD) after Neck of Femur (NOF) fracture surgery: A comparative analysis of perioperative risk factors
Abstract:
Background: Postoperative Delirium (POD) is a frequent complication following Neck of Femur (NOF) fracture surgery in older adults and is associated with prolonged hospital stay, functional decline and increased mortality. Perioperative contributors remain incompletely characterised in routine practice.
Objective: To compare perioperative factors between delirious and non-delirious patients following NOF fracture surgery, and to identify independent predictors of POD.
Methods: A comparative observational study of 62 patients aged 70 years and over, admitted with NOF fracture and managed operatively between October 2024 and January 2025. Delirium was identified using the 4AT screening tool, yielding 31 patients with POD and 31 without. Demographic and perioperative data were extracted from medical records. Chi-square testing compared groups and multivariable logistic regression identified independent predictors. Analysis used SPSS version 25, with p<0.05 considered significant.
Results: Patients ranged from 70 to 101 years. Female sex was more frequent in the delirious group (64.5% vs 38.7%, p=0.042), as were constipation (41.9% vs 3.2%, p=0.001) and infection (64.5% vs 32.3%, p=0.011). Preoperative and perioperative fascia iliaca block, opiate use with spinal anaesthesia, intraoperative hypotension and postoperative pain did not differ significantly between groups. On logistic regression, constipation was the only independent predictor of POD (OR 18.58, 95% CI 2.04–169.12, p=0.001); infection (OR 2.36, 95% CI 0.68–8.29) and age did not reach significance.
Conclusion: Constipation was independently associated with markedly increased odds of postoperative delirium following NOF fracture surgery, while female sex and infection were more frequent among delirious patients on univariable comparison. Routine bowel monitoring and early treatment of constipation may represent a simple, modifiable target for delirium prevention, although the wide confidence interval warrants confirmation in larger cohorts.
Keywords: Postoperative delirium, Femoral neck fractures, 4AT, Constipation, Perioperative care, Aged
