Incidence, risk factors and clinical impact of postoperative delirium following open reduction and internal fixation (ORIF) for hip fractures: an analysis of 7859 patients from the ACS-NSQIP hip fracture procedure targeted database

  • Azeem Tariq Malik
  • Carmen E. Quatman
  • Laura S. Phieffer
  • Thuan V. Ly
  • Safdar N. KhanEmail author
Original Article • HIP - FRACTURES



Delirium is one of the most common acute psychiatric disturbances taking place in patients, particularly elderly, following hip fractures. Using a validated national surgical database, we sought to define the incidence, risk factors and clinical impact associated with the occurrence of delirium following open reduction and internal fixation (ORIF) for hip fracture.


The 2016 American College of Surgeons—National Surgical Quality Improvement Program (ACS-NSQIP) Hip Fracture Targeted Procedure file—was retrieved and merged with the ACS-NSQIP 2016 file. A total of 7859 patients were finally included in the study.


A total of 2177 (27.7%) patients experienced an episode of delirium following the procedure. Adjusted analysis showed an increasing age ≥ 65 years (p < 0.001), partially dependent functional health status prior to surgery (p = 0.001), bleeding disorder (p = 0.012), preoperative dementia (p < 0.001), preoperative delirium (p < 0.001), being bed-ridden postoperatively (p < 0.001), no weight bearing as tolerated on first postoperative day (p < 0.001), an ASA grade > II (p < 0.001), non-emergency case (p = 0.010) and a prolonged length of stay > 3 days (p < 0.001). In addition, Black or African-American ethnicity had a lower odds of developing postoperative delirium (p = 0.020) as compared to Whites. Moreover, postoperative delirium was significantly associated with non-home discharge disposition (p < 0.001), higher odds of 30-day readmissions (p < 0.001) and 30-day mortality (p < 0.001).


This study identifies several risk factors associated with the occurrence of postoperative delirium in patients undergoing ORIF for hip fracture. Surgeons can utilize these data to risk stratify and consequently tailor an appropriate preoperative and postoperative care protocol to prevent the occurrence of delirium.


Delirium Hip fracture ORIF delirium NSQIP Open reduction internal fixation 


Compliance with ethical standards

Conflict of interest

Author Khan has received research grants from Spinal Kinetics. Authors Malik, Phieffer, Quatman and Ly all declare that they have no conflicts of interest. The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS-NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. Since data were derived from a de-identified database, it was exempt from Institutional Review Board (IRB) approval.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • Azeem Tariq Malik
    • 1
  • Carmen E. Quatman
    • 1
  • Laura S. Phieffer
    • 1
  • Thuan V. Ly
    • 1
  • Safdar N. Khan
    • 1
    • 2
    • 3
    • 4
    Email author
  1. 1.The Ohio State University Wexner Medical CenterColumbusUSA
  2. 2.The Benjamin R. and Helen Slack Wiltberger Endowed Chair in Orthopaedic Spine SurgeryWexner Medical Center at The Ohio State UniversityColumbusUSA
  3. 3.Division of Spine Surgery, Department of Orthopaedic SurgeryWexner Medical Center at The Ohio State UniversityColumbusUSA
  4. 4.Department of Integrated Systems Engineering, Clinical Faculty, Spine Research InstituteWexner Medical Center at The Ohio State UniversityColumbusUSA

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