Prevalence and Outcome of Delirium in Proximal Femur Fracture Patients Undergoing Orthogeriatric Treatment

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Abstract
Background: Geriatric trauma centers (ATZ) in Germany provide interdisciplinary care for elderly trauma patients with the objective of enhancing treatment outcomes following proximal femur fractures. Delirium, a prevalent and grave complication in this patient population, has been associated with elevated mortality and functional limitations. The objective of this study was to examine the prevalence and consequences of delirium in proximal femur fractures by utilizing the Registry for Geriatric Trauma (ATR-DGU). Methods: The study encompassed 32,934 patients aged ≥70 years who sustained proximal femoral fractures during the period 2022–2023. The demographic and clinical parameters, fracture type, time of surgery, mobility, complications, and mortality were meticulously documented. The primary endpoint of the study was the occurrence of delirium and its influence of the outcome of hip fracture patients. Additionally an analysis was conducted to account for peri-implant/periprosthetic fractures. Results: Of the 21,127 patients who underwent screening, 23.6% had already been diagnosed with delirium upon admission. The delirium rate did not differ between hip-/pertrochanteric and peri-implant/periprosthetic fractures. Patients in a delirious state were found to be older, frailer, and more dependent on care. They exhibited more non-surgical complications, poorer mobility, and more frequent transfers to nursing homes. In the context of peri-implant/periprosthetic fractures, delirium showed no significant difference regarding surgical revision (p = 0.192) and mortality rates (p = 0.229). Conclusions: Delirium is therefore a prevalent and clinically significant complication. Its early detection and prevention are essential for proximal femur fracture patients in orthogeriatric care.

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