Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Aug 19, 2023; 13(8): 533-542
Published online Aug 19, 2023. doi: 10.5498/wjp.v13.i8.533
Effects of surgical treatment modalities on postoperative cognitive function and delirium in elderly patients with extremely unstable hip fractures
Xue Zhou, Xiao-Hua Chen, Sheng-Hua Li, Nan Li, Feng Liu, Hao-Ming Wang
Xue Zhou, Department of Operating Room, Chongqing University Three Gorges Hospital, Chongqing 404000, China
Xiao-Hua Chen, Sheng-Hua Li, Nan Li, Feng Liu, Hao-Ming Wang, Department of Orthopedics, Chongqing University Three Gorges Hospital, Chongqing 404000, China
Xiao-Hua Chen, Sheng-Hua Li, Hao-Ming Wang, Chongqing Municipality Clinical Research Center for Geriatric Diseases, Chongqing University Three Gorges Hospital, Chongqing 404000, China
Author contributions: Zhou X and Wang HM contributed to the research design and thesis writing; Zhou X, Chen XH, and Li SH collected and analyzed the data; Zhou X, Li N and Liu F contributed to the data collection; Zhou X and Wang HM overall supervise the study; and all authors contributed to the article and approved the submitted version.
Supported by the Chongqing Medical Scientific Research Project (Joint Project of Chongqing Health Commission and Science and Technology Bureau), No. 2020FYYX211; and Medical Research Project of Wanzhou District (Joint Project of Health Commission and Science and Technology Bureau), No. wzstc-kw2020023.
Institutional review board statement: The study was reviewed and approved by the Chongqing University Three Gorges Hospital (Approval No. 2020 Scientific Research 67).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There is no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hao-Ming Wang, PhD, Doctor, Department of Orthopedics, Chongqing University Three Gorges Hospital, No. 165 Xincheng Road, Wanzhou District, Chongqing 404000, China. wanghaoming1227@163.com
Received: May 6, 2023
Peer-review started: May 6, 2023
First decision: May 19, 2023
Revised: June 15, 2023
Accepted: July 5, 2023
Article in press: July 5, 2023
Published online: August 19, 2023
Abstract
BACKGROUND

As the perioperative risk of elderly patients with extremely unstable hip fractures (EUHFs) is relatively high and therapeutic effect is not satisfactory, new thera-peutic strategies need to be proposed urgently to improve the efficacy and clinical outcomes of such patients.

AIM

To determine the influence of two surgical treatment modalities on postoperative cognitive function (CF) and delirium in elderly patients with EUHFs.

METHODS

A total of 60 elderly patients consecutively diagnosed with EUHF between September 2020 and January 2022 in the Chongqing University Three Gorges Hospital were included. Of them, 30 patients received conventional treatment (control group; general consultation + fracture type-guided internal fixation), and the other 30 received novel treatment (research group; perioperative multidisciplinary treatment diagnosis and treatment + individualized surgical plan + risk prediction). Information on hip function [Harris hip score (HHS)], perioperative risk of orthopedic surgery [Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM)], CF [Montreal cognitive assessment scale (MoCA)], postoperative delirium [mini-cognitive (Mini-Cog)], adverse events (AEs; internal fixation failure, infection, nonunion, malunion, and postoperative delirium), and clinical indicators [operation time (OT), postoperative hospital length of stay (HLOS), ambulation time, and intraoperative blood loss (IBL)] were collected from both groups for comparative analyses.

RESULTS

The HHS scores were similar between both groups. The POSSUM score at 6 mo after surgery was significantly lower in the research group compared with the control group, and MoCA and Mini-Cog scores were statistically higher. In addition, the overall postoperative complication rate was significantly lower in the research than in the control group, including reduced OT, postoperative HLOS, ambulation time, and IBL.

CONCLUSION

The new treatment modality has more clinical advantages over the conventional treatment, such as less IBL, faster functional recovery, more effectively optimized perioperative quality control, improved postoperative CF, mitigated postoperative delirium, and reduced operation-related AEs.

Keywords: Extremely unstable hip fracture, Elderly, Multidisciplinary treatment, Cognitive function, Postoperative delirium

Core Tip: Characterized by severe fragmentation, extreme instability, and treatment-refractory, extremely unstable hip fractures (EUHFs) in the elderly population carry a higher perioperative risk. Given the unsatisfactory treatment outcomes of EUHFs in the elderly, there is an urgent need to develop new therapeutic strategies to improve the efficacy and clinical outcomes in these patients, thus providing a guarantee for their life, health, and quality of life.