Risk Factors for Postoperative Delirium in Elderly Hip Fracture Patients: A Prospective Observational Analysis

Background Postoperative Delirium (POD) is a relatively common acute neurocognitive complication in elderly patients with hip fractures. However, its exact incidence rate and risk factors have not been fully elucidated. Methods This prospective study enrolled 238 elderly patients undergoing surgical repair for hip fractures between January 2022 and September 2024. Using univariate and multivariate logistic regression analyses, we identified factors associated with POD and evaluated its correlation with intensive care unit (ICU) length of stay, total hospitalization duration, and postoperative complications. Results The incidence of POD was 31.9% (76/238). Multivariate analysis revealed that advanced age (> 82 years; adjusted OR = 2.25, 95% CI: 1.13–4.45, P = 0.020), prolonged preoperative waiting time (> 90 hours; OR = 2.65, 95% CI: 1.30–5.37, P = 0.007), and frailty (OR = 2.40, 95% CI: 1.08–5.32, P = 0.031) were independently associated with POD. Patients with POD exhibited significantly prolonged ICU stays (median 17.8 days vs. 0 days, P < 0.001) and total hospitalization (13 days vs. 10 days, P < 0.001), along with higher rates of postoperative infections (urinary tract infections: 47.4% vs. 20.4%, P < 0.001). Conclusion POD is highly prevalent in elderly hip fracture patients and strongly linked to frailty, prolonged preoperative waiting time, and advanced age. These factors substantially increase healthcare burden, highlighting the need for optimized preoperative assessment, reduced waiting times, and multidisciplinary interventions to mitigate POD risk.