Prevalence of Postoperative Delirium in Elderly Patients After Hip Fracture Surgery: A Cross-Sectional Study

Abstract

Background: Postoperative delirium represents a frequent but under-recognized complication in elderly patients undergoing hip fracture surgery, contributing to prolonged hospitalization, increased morbidity, and mortality. Despite extensive international research, evidence from South Asian healthcare settings remains limited, where variability in anesthesia practice, medication use, and geriatric co-management may influence delirium risk. Objective: To determine the prevalence of postoperative delirium and identify its associated risk factors among elderly patients undergoing hip fracture surgery in tertiary hospitals in Lahore, Pakistan. Methods: A cross-sectional study was conducted over eight months across two tertiary centers. A total of 244 patients aged ≥65 years with preserved baseline cognition (MMSE ≥24) were consecutively enrolled. Delirium was assessed daily for five days postoperatively using the Confusion Assessment Method (CAM). Demographic, clinical, and perioperative data were collected prospectively. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of delirium. Results: The mean age was 77.6 ± 6.8 years, with 55.7% females. The prevalence of postoperative delirium was 33.2% (81/244). Independent predictors included age ≥80 years (Adjusted OR 2.35; 95% CI: 1.41–3.89; p<0.001), general anesthesia (OR 1.79; 95% CI: 1.02–3.14; p=0.042), polypharmacy (OR 2.14; 95% CI: 1.25–3.66; p=0.005), and Charlson Comorbidity Index ≥5 (OR 1.68; 95% CI: 1.01–2.80; p=0.045). Delirium was associated with longer hospital stay (p<0.001) and higher postoperative complications (p=0.017). Conclusion: Postoperative delirium is a prevalent and clinically significant complication among elderly hip fracture patients in Pakistan. Advanced age, general anesthesia, comorbidity burden, and polypharmacy substantially increase risk. Integrating targeted prevention strategies—such as optimized anesthesia selection, medication review, and structured delirium monitoring—may improve surgical and cognitive outcomes in this vulnerable group.