Delirium after emergency hip surgery – common and serious, but rarely consented for

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.