Association between different surgical procedures and postoperative delirium in geriatric hip fracture patients:a retrospective cohort study

Background It is still not clear whether there are differences in the occurrence of postoperative delirium(POD) among different surgical procedures in elderly people with hip fractures. This research aimed to investigate the impact of different surgical procedures on POD in elderly people with hip fractures. Methods This retrospective cohort study examined the medical records of patients aged 65 and over who underwent hip fracture surgery at a tertiary medical facility from January 2022 to December 2025. Divided patients into groups according to the surgical procedures they received; those who had intramedullary nailing were put into the internal fixation group, and those who had hip hemiarthroplasty or total hip arthroplasty were put into the arthroplasty group. Utilized multivariate logistic regression and propensity score matching (PSM) analysis to evaluate the relationship between different surgical procedures and POD. Then, subgroup analysis was conducted to further probe the possible connections between different surgical procedures and POD. Results A total of 693 patients took part in this study, and there was a 15.01% (104/693) incidence rate of POD during the postoperative hospitalization period. Multivariate logistic regression analysis indicated that the different surgical procedures' POD incidence rate has a statistically significant(OR: 2.64, 95% CI: 1.61–4.32, P < 0.001), and the internal fixation group was higher than the arthroplasty group. All covariates among the groups were well-balanced after PSM, and the PSM analysis didn't change this statistically significant result, and once again confirmed a strong connection between different surgical procedures and POD. Conclusions Different surgical procedures are associated with the risk of POD in elderly people with hip fractures. Internal fixation is associated with a higher risk of POD compared with arthroplasty.