Sex Differences in Hip Fracture Surgery: Preoperative Risk Factors for Delirium and Postoperative Outcomes

J Am Geriatr Soc. 2016 Aug;64(8):1616-21. doi: 10.1111/jgs.14243. Epub 2016 Jul 7.


Objectives: To describe the differences observed in risk factors for delirium and outcomes between men and women undergoing hip fracture repair surgery.

Design: Prospective cohort study.

Setting: Academic medical center.

Participants: Individuals with acute hip fracture admitted to an academic medical center (N = 431).

Measurements: Information on preoperative demographic characteristics, medical history, laboratory results, and postoperative outcomes was obtained according to history and chart review. Delirium was assessed using the Confusion Assessment Method.

Results: The overall incidence of postoperative delirium was 34%, with men more likely to experience postoperative delirium (44.8%) than women (30.2%) (P = .004). Male sex was associated with postoperative delirium in individuals with hip fracture, even after adjusting for other preoperative risk factors. Other significant preoperative risk factors included age, dementia, Parkinson's disease, and American Society of Anesthesiologists classification. Men were also more likely to experience other postoperative complications and have longer hospital length of stay.

Conclusion: Men are at higher risk of postoperative delirium after hip fracture repair than women and have more postoperative surgical complications. Their higher risk of postoperative delirium may be due to their underlying preoperative disease severity.

Keywords: delirium; hip fracture; postoperative; risk factors; sex.

MeSH terms

  • Age Factors
  • Alzheimer Disease / complications
  • Alzheimer Disease / epidemiology
  • Cohort Studies
  • Delirium / complications*
  • Delirium / epidemiology*
  • Female
  • Hip Fractures / epidemiology*
  • Hip Fractures / surgery*
  • Humans
  • Incidence
  • Male
  • Outcome Assessment, Health Care*
  • Parkinson Disease / complications
  • Parkinson Disease / epidemiology
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology*
  • Prospective Studies
  • Risk Factors
  • Sex Factors