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Longer Surgery Time for Hip Fracture Repair Increases Delirium Risk

March 13, 2019

More time in surgery and receiving a general anesthetic were associated with an increased risk for postoperative delirium in older adults who underwent surgical hip fracture repair, according to a study published online in JAMA Network Open.

“Overall, every additional 30 minutes of surgery was associated with an approximate 6% relative increase in the risk for delirium after adjustment,” researchers reported.

The population-based cohort study analyzed 68,131 older adults, 65 years of age and older, who received hip fracture surgery at 80 hospitals in Ontario, Canada, over a span of 8 years. Among them, about 11% experienced postoperative delirium.

“Postoperative delirium in older adults receiving hip fracture surgery is associated with morbidity and increased health care costs, yet little is known of potential modifiable factors that may help limit the risks,” researchers wrote.

Among the nearly 40% of the study population who received general anesthesia, postoperative delirium affected 11.0%. The rate of postoperative delirium in patients who did not receive general anesthesia was 10.2%.

Prolonged surgical duration, too, was linked with a higher incidence of postoperative delirium. The risk was even greater in patients who underwent prolonged surgery with a general anesthetic.

“The findings suggest that prolonged surgery is associated with increased postoperative delirium,” researchers wrote, “particularly when the patient has received a general anesthetic.”

Jolynn Tumolo


Ravi B, Pincus D, Choi S, Jenkinson R, Wasserstein DN, Redelmeier DA. Association of duration of surgery with postoperative delirium among patients receiving hip fracture repair [published online February 22, 2019]. JAMA Netw Open. 2019;2(2):e190111. doi:10.1001/jamanetworkopen.2019.0111

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