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Treatment and prevention of postoperative complications in hip fracture patients: infections and delirium

Behandlung und Prävention von postoperativen Komplikationen nach Schenkelhalsfraktur: Infektionen und Delirium

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Summary

The course of older patients with hip fractures is often complicated by infections and delirium. Accurate care and high suspicion for these complications are essential, since these conditions are associated with an increase in mortality, length of hospital stay and nursing home placement, poorer mobility, and functional decline. Because of immunosenescence and higher infection rates, older patients need specific care, immediate diagnosis, and treatment of infections. Numerous guidelines of various medical societies outline the management of nosocomial infections, but there is a need of an individualized treatment plan because of comorbidities and polypharmacy. Hygiene measures have first priority to reduce the rate of infections. Treatment of geriatric syndromes like malnutrition, exsiccosis, gait disorders, falls, delirium, urine incontinence, and organ insufficiency are as important as immunization against pneumococci and influenza. Advanced age, cognitive impairment, hearing loss, peripheral vascular disease, prior delirium episodes, sight disorders, and polypharmacy are established risk factors for delirium; thus, older people with several chronic diseases are prone to delirium. A multifactorial approach, comprising standardized screening, oxygen support, intravenous fluid administration and augmented nutrition, monitoring of vital signs, pain treatment, optimized medication, and modification in perioperative management, significantly reduces delirium incidence during hospitalization for hip fracture. An interdisciplinary approach between surgeons and geriatricians may warrant optimized satisfaction of patients’ needs.

Zusammenfassung

Infektionen und Delir komplizieren den Behandlungsverlauf von älteren Patienten mit hüftnahen Frakturen häufig. Eine rasche Behandlung der Komplikationen und eine erhöhte Aufmerksamkeit dafür sind nötig, um die Mortalität und Rate an verlängerten Krankenhausaufenthalten, sowie die Gefahr von Funktionalitätseinbußen zu senken. Eine besondere Behandlung benötigen Ältere wegen der mit dem Alter einhergehenden Immunoseneszenz und der damit verbundenen höheren Infektionsrate. Viele Leitlinien der Fachgesellschaften helfen bei der Versorgung von Patienten mit nosokomialen Infektionen, aber spezielle Daten für Patienten mit Vielfacherkrankungen und Polypharmazie fehlen. Hygienemaßnahmen haben höchste Behandlungspriorität neben den therapeutischen Interventionen von geriatrischen Syndromen wie Exsiccose, Mangelernährung, Gangstörungen, Stürzen, Delir, Inkontinenz und Organinsuffizienzen. Impfungen gegen Influenza und Pneumokokken sind ebenfalls wichtig für dieses Klientel. Höheres Alter, kognitive Einschränkungen, Hörverminderung, arterielle Durchblutungsstörungen, vorangegangene Delir-Episoden, Sehbehinderung und Polypharmazie sind auch Risikofaktoren für ein postoperatives Delir – daher sind ältere Patienten mit vielen chronischen Erkrankungen besonders gefährdet. Ein multifaktorieller Zugang unter Anwendung von standardisierten Screening Methoden, optimierter Sauerstoffversorgung, intravenöser Flüssigkeitsgabe und Nahrungssupplementierung, sowie Überwachung der Vitalfunktionen, optimierter Schmerzbehandlung und Medikation sowie Adaptierung der perioperativen Versorgung reduzieren die Häufigkeit eines Delirs während des Spitalsaufenhaltes wegen einer hüftnahen Fraktur signifikant. Ein interdisziplinäres Management mit unfallchirugischer und geriatrischer Expertise kann den Bedürfnissen von älteren Traumapatienten besser begegnen.

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Conflict of interest

The authors declared no potential conflict of interest with respect to the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Acute Geriatrics, Hospital of Gmunden, Miller von Aichholzstraße 49, 4810, Gmunden, Austria

    Peter Dovjak MD

  2. Department of Geriatric Medicine, Christian-Doppler-Klinik, Paracelsus Medical University, 5020, Salzburg, Austria

    Bernhard Iglseder

  3. Department of Internal Medicine, Hanusch Krankenhaus, 1140, Vienna, Austria

    Peter Mikosch

  4. Department of Internal Medicine, Hospital of Hochzirl, 6170, Zirl, Austria

    Markus Gosch

  5. Department of Trauma Surgery, Klinikum-Klagenfurt, 9020, Klagenfurt am Wörthersee, Austria

    Ernst Müller

  6. Department of Acute Geriatrics, Klinikum-Klagenfurt, 9020, Klagenfurt, Austria

    Georg Pinter MD

  7. Institute of Physics, Sophienspital, 1070, Vienna, Austria

    Katharina Pils MD

  8. Department of Anaesthesia, AUVA-Unfallkrankenhaus Meidling, 1120, Vienna, Austria

    Inge Gerstofer MD

  9. Department of Internal Medicine, AUVA-Unfallkrankenhaus Meidling, 1120, Vienna, Austria

    Heinrich Thaler MD

  10. AUVA-Unfallkrankenhaus Meidling, 1120, Vienna, Austria

    Michaela Zmaritz

  11. Department of Philosophy, Universtity of Vienna, Vienna, Austria

    Monique Weissenberger-Leduc

  12. Department of Acute Geriatrics, Elisabethinen Spital, 9020, Klagenfurt, Austria

    Walter Müller MD

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  1. Peter Dovjak MD
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Correspondence to Peter Dovjak MD.

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Dovjak, P., Iglseder, B., Mikosch, P. et al. Treatment and prevention of postoperative complications in hip fracture patients: infections and delirium. Wien Med Wochenschr 163, 448–454 (2013). https://doi.org/10.1007/s10354-013-0228-y

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  • DOI: https://doi.org/10.1007/s10354-013-0228-y

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