Opinion Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jun 18, 2019; 10(6): 228-234
Published online Jun 18, 2019. doi: 10.5312/wjo.v10.i6.228
Delirium after emergency hip surgery – common and serious, but rarely consented for
Louis J Koizia, Faye Wilson, Peter Reilly, Michael B Fertleman
Louis J Koizia, Michael B Fertleman, Geriatric Medicine, Imperial College NHS Trust, London W2 1NY, United Kingdom
Faye Wilson, Geriatric Medicine, City Hospitals Sunderland, Sunderland SR4 7TP, United Kingdom
Peter Reilly, Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London W2 1NY, United Kingdom
Author contributions: The authors state equal contribution in the elaboration of this manuscript; Koizia LJ undertook literature review and wrote the manuscript; Wilson F completed literature review and wrote the manuscript; Reilly P edited the final manuscript; Fertleman MB oversaw the project and wrote the manuscript.
Conflict-of-interest statement: The authors each declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Louis J Koizia, MRCP, Doctor, Geriatric Medicine, Imperial College NHS Trust, Praed Street, Paddington, London W2 1NY, United Kingdom. l.koizia@nhs.net
Telephone: +44-20-33121077 Fax: +44-20-33121541
Received: February 3, 2019
Peer-review started: February 11, 2019
First decision: April 15, 2019
Revised: May 10, 2019
Accepted: May 21, 2019
Article in press: May 22, 2019
Published online: June 18, 2019
Processing time: 137 Days and 11.1 Hours
Abstract

A quarter of patients admitted with a proximal femoral fracture suffer from an acute episode of delirium during their hospital stay. Yet it is often unrecognised, poorly managed, and rarely discussed by doctors. Delirium is important not only to the affected individuals and their families, but also socioeconomically to the broader community. Delirium increases mortality and morbidity, leads to lasting cognitive and functional decline, and increases both length of stay and dependence on discharge. Delirium should be routinely and openly discussed by all members of the clinical team, including surgeons when gaining consent. Failing to do so may expose surgeons to claims of negligence. Here we present a concise review of the literature and discuss the epidemiology, causative factors, potential consequences and preventative strategies in the perioperative period.

Keywords: Delirium; Proximal femoral fractures; Consent; Hip surgery; Montgomery; Medicolegal

Core tip: Delirium is defined as a clinical syndrome characterised by disturbed consciousness, cognitive function or perception, which has an acute onset and fluctuating course. Delirium is common amongst patients admitted following proximal femoral fracture but is frequently unrecognised and mismanaged. Delirium can dramatically affect an individual’s stay in hospital. Delirium increases mortality and morbidity, leads to lasting cognitive and functional decline, and increases both length of stay and dependence on discharge. Delirium should be routinely and openly discussed by all members of the clinical team, including surgeons, physicians, anaesthetists, nurses and therapists. Simple strategies can be adopted to try and reduce the risk of delirium occurring and trying to manage delirium once it occurs.