Preoperative Geriatric Nutritional Risk Index as a Novel Predictive Factor for Postoperative Delirium in Elderly Patients Following Total Hip Arthroplasty: A Retrospective Propensity-matched Study

Abstract

Background

Delirium is a common complication in elderly patients after total hip arthroplasty (THA). Malnutrition is common in the elderly and is closely associated with developing postoperative delirium (POD). Therefore, preoperative assessment of the patient’s nutritional status is necessary. The geriatric nutritional risk index (GNRI) is a reliable indicator of nutritional status in the elderly population, but the relationship with postoperative delirium is not clear.

Purpose

The aim of this study was to determine the effect of preoperative GNRI on postoperative delirium.

Methods

We reviewed 688 elderly patients who underwent primary elective THA at our medical center between 2013 and 2023. Delirium was diagnosed by reviewing postoperative medical records during hospitalization, using diagnostic criteria from the Diagnostic and Statistical Manual IV and the Confusion Assessment Method. Propensity matching was used to match patients in the delirium and non-delirium groups. Multiple logistic regression analysis was used to determine the association between GNRI and postoperative delirium. The validity of the GNRI for predicting POD was assessed by the area under the receiver operating characteristic curve (AUC) and the optimal prediction threshold was calculated.

Results

When matched, the GNRI was significantly higher for the delirium group than the non-delirium group (89.0 ± 8.0 vs. 99.8 ± 8.1, p < 0.001). In multivariate logistic regression analysis, GNRI was an independent risk factor for POD, and the incidence of POD increased with lower GNRI (OR 0.846, 95% CI 0.792–0.904, p < 0.001). The results of the ROC analysis showed an AUC of 0.827 and a prediction cut-off of 95.7 for the GNRI (sensitivity: 85.7%, specificity: 68.6%).

Conclusion

In elderly patients, a lower GNRI was significantly associated with the occurrence of POD after THA. Assessing GNRI prior to THA in elderly patients may be effective in predicting the risk of POD.

Zusammenfassung

Hintergrund

Delir ist eine häufige Komplikation bei älteren Patienten nach einer Hüfttotalendoprothese (THA). Mangelernährung ist bei älteren Menschen weit verbreitet und eng mit der Entwicklung eines postoperativen Delirs (POD) verbunden. Daher ist eine präoperative Bewertung des Ernährungsstatus des Patienten notwendig. Der geriatrische Nahrungsrisikoindex (GNRI) ist ein zuverlässiger Indikator des Ernährungsstatus in der älteren Bevölkerung, seine Beziehung zum postoperativen Delir ist jedoch unklar.

Ziel

Diese Studie zielte darauf ab, den Einfluss des präoperativen GNRI auf das postoperative Delir zu untersuchen.

Methoden

Es wurden 688 ältere Patienten retrospektiv untersucht, die zwischen 2013 und 2023 in unserem medizinischen Zentrum eine primäre elektive THA erhalten hatten. Mithilfe der diagnostischen Kriterien aus dem Diagnostic and Statistical Manual IV und der Confusion-Assessment-Methode wurde das Delir durch eine Überprüfung der postoperativen Krankenhausunterlagen diagnostiziert. Zur Angleichung der Patienten in der Delir- und Nicht-Delir-Gruppe wurde die Propensity-Score-Matching-Methode verwendet. Die Assoziation zwischen GNRI und postoperativem Delir wurde mittels multivariater logistischer Regression analysiert. Die Validität des GNRI zur Vorhersage des POD wurde durch den Bereich unter der Grenzwertoptimierungskurve (AUC) bewertet, und die optimale Vorhersagewertschwelle wurde berechnet.

Ergebnisse

Nach dem Matching war der GNRI in der Delir-Gruppe signifikant höher als in der Nicht-Delir-Gruppe (89,0 ± 8,0 vs. 99,8 ± 8,1; p < 0,001). In der multivariaten logistischen Regressionsanalyse erwies sich der GNRI als unabhängiger Risikofaktor für POD, und die Inzidenz von POD nahm mit einem niedrigeren GNRI zu (OR 0,846; 95%-KI: 0,792–0,904, p < 0,001). Die Ergebnisse der ROC-Analyse zeigten einen AUC-Wert von 0,827 und eine Vorhersagewertschwelle von 95,7 für den GNRI (Sensitivität: 85,7%, Spezifität: 68,6%).

Schlussfolgerung

Bei älteren Patienten war ein niedriger GNRI signifikant mit der Entwicklung eines POD nach THA assoziiert. Die präoperative Bewertung des GNRI bei älteren Patienten vor einer THA könnte zur Vorhersage des POD-Risikos sinnvoll sein.

Keywords

geriatric nutritional risk index - postoperative delirium - total hip arthroplasty - elderly patients

Schlüsselwörter

geriatrischer Nahrungsrisikoindex - postoperatives Delir - totale Hüftendoprothese - ältere Patienten

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