Evaluation of the Efficiency of Neutrophil-Lymphocyte Ratio in Predicting Delirium in Geriatric Patients Undergoing Hip Fracture Surgery

Materials and Methods:

Our study is a single-center, prospective, observational study. Our study included 100 patients aged 65 and over, with a Mini Mental Test (MMT) score of 24 and above, who would undergo hip fracture surgery, who -or their legal guardian- could give voluntary consent, with ASA scores of I-IV. Routine preoperative anesthesia evaluation of all patients was performed, and age, gender, type of hip fracture and the surgical procedure to be performed, the degree of kinship with the people they co-live and those who will accompany them in the hospital, height, weight, body mass index (BMI), level of education, existing comorbid diseases, presence of pressure ulcers, history of smoking and alcohol use, medications taken routinely, American Society of Anesthesiologists (ASA) score, and length of preoperative hospital stay were recorded. The patients' basic cognitive functions were evaluated by utilizing the Mini Mental Test (MMT) at the preoperative visit. The routine preoperative blood tests of the patients, including leukocyte, neutrophil, lymphocyte, hemoglobin, hematocrit, platelet, glucose, BUN (blood urea nitrogen), creatinine, albumin, sodium, potassium, liver function tests, C-reactive protein (CRP), and procalcitonin results were recorded. Preoperative NLR was calculated. NLR was calculated as the ratio of neutrophil count to lymphocyte count. Postoperative delirium occurrence was evaluated using the Confusion Assessment Method (CAM) twice a day in the first 3 postoperative days. The place where the delirium developed (postoperative intensive care unit or ward), the time when delirium developed, and the type of delirium were recorded in patients diagnosed with postoperative delirium by CAM. NLR was calculated and recorded from the routine hemogram results taken at the 1st, 16th and 24th hours in the postoperative period. In addition, the postoperative hospital stay of the patients was recorded.

Inclusion criteria

• Patients aged 65 and over
• Patients who will undergo hip fracture surgery
• Patients who or their relatives can give voluntary consent
• ASA I-IV patients
• Patients with a Preoperative Mini Mental Test (MMT) score of 24 and above

Exclusion criteria

• Under 65 years old
• Patients who did not agree to participate in the study
• Unconscious
• Patients with a preoperative Mini Mental Test (MMT) score below 24
• Visually, hearing and speech impaired
• Chronic alcohol user
• Patients with cognitive or psychiatric disorders such as known dementia, Parkinson's, Alzheimer's
• Patients who need postoperative mechanical ventilation support
• A history of acute myocardial infarction in the last 6 months
• Patients with chronic renal failure undergoing regular dialysis
• Patients using oxygen concentrators at home