Association of cognitive impairment with postoperative mortality risk in patients with geriatric hip fractures.

Association of cognitive impairment with postoperative mortality risk in patients with geriatric hip fractures. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association of cognitive impairment with postoperative mortality risk in patients with geriatric hip fractures. Qian Jianrong This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4216036/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 3 You are reading this latest preprint version Abstract Objective To evaluate the association between cognitive impairment and postoperative mortality risk in patients with geriatric hip fractures. Methods From Jan 2018 to Dec 2019, 109 older patients with hip fractures were retrospectively enrolled from the Department of Orthopedics of Beijing Fengtai Hospital. Based on their cognitive function, all patients were categorized into cognitive impairment and normal groups. Postoperative mortality risk was regarded as the primary outcome. Multivariate Cox regression analysis and survival curves were generated to explore the effect of cognitive impairment. The results A total of 103 patients were followed up with a mean follow-up time of 33 months. Twenty-seven patients (22 females, mean age 84.59 ± 6.68 years) were in the cognitive impairment group, while 76 patients (51 females, mean age 79.89 ± 7.83 years) were in the normal group. The cognitive impairment group had a significantly greater mortality rate than the normal group did (21 (77.8%) vs. 24 (31.6%), P<0.001). A significant association between cognitive impairment and mortality risk still remained even after adjustments for potential covariates (HR 2.5, 95% CI 1.28~4.88, P=0.007). Conclusion Cognitive impairment was significantly associated with postoperative mortality risk in patients with geriatric hip fractures. Cognitive impairment may be an independent risk factor for death after hip fracture. Hip fracture Elderly Cognitive impairment Mortality Figures Figure 1 Introduction Since China became an aging society at the beginning of this century, the degree of aging in China has accelerated and deepened, and the diseases that develop with increasing age have imposed a large burden on the social medical system [1, 2] . Hip fracture and cognitive dysfunction are common and serious conditions in elderly people, and the former directly leads to mobility dysfunction in elderly people. According to statistics, the fatality rate within one year after hip fracture is as high as 20-40% [3] , which is also known as "the last fracture in life". The latter, as a chronic progressive mental decline disease, directly affects elderly people's working ability, social communication ability and judgment ability about their surroundings, which requires special care [4, 5] . Previous studies have shown that cognitive dysfunction is an important risk factor for elderly people to fall and hip fracture [6] , and the incidence of cognitive dysfunction in elderly people with hip fracture accounts for approximately 20% [7, 8] and seriously affects the prognosis of hip fracture. In their early study, Holmes et al. [9] reported that cognitive dysfunction significantly increased the risk of early death from hip fracture. Scandol [8] , Sebastian [10] and other scholars also found that cognitive impairment or dementia was closely related to long-term postoperative death when exploring the correlation between cognitive function and the medium- and long-term prognosis of hip fracture patients. Similar findings were also found in relevant domestic studies [11-13] , but the number of studies was small, and long-term follow-up results were lacking, resulting in insufficient clinical evidence. In this study, a retrospective cohort of elderly patients (65 years old) with hip fractures who underwent surgical treatment at the Department of Orthopedics of Beijing Fengtai Hospital from January 2018 to December 2019 was included to analyze the impact of cognitive dysfunction on the prognosis of patients with hip fractures. It was assumed that cognitive impairment would significantly increase the risk of death after hip fracture in elderly patients. Data And Methods 1. Research subjects In this retrospective cohort study, 127 elderly patients with hip fractures who underwent surgical treatment at the Department of Orthopedics of Beijing Fengtai Hospital from January 2018 to December 2019 were included. The inclusion criteria were as follows: ① patients with hip fracture (femoral neck fracture or intertrochanteric fracture) who underwent surgical treatment and ② patients aged ≥65 years. The exclusion criteria for patients were as follows: ① whose time from injury to treatment was > 3 weeks; ② had other site fractures or multiple traumas; ③ had open fractures; and ④ had incomplete clinical data. A total of 18 patients who did not meet the inclusion criteria were excluded, and a total of 109 patients participated in the final follow-up. 2. Methods 2.1 General Information All patients were evaluated by the Mini Mental State Examination (MMSE) [14] on the first day of admission (before surgery). According to the preoperative cognitive function status, 109 patients were divided into cognitive dysfunction (cognitive impairment group) and normal cognitive function (cognitive normal group) groups, which included 31 patients with cognitive impairment (6 males and 25 females). There were 78 patients in the cognitively normal group (26 males and 52 females). The MMSE scale includes 30 questions on 7 aspects, namely, time orientation, place orientation, immediate and delayed memory, attention and computation, language and visual space. A question was rated as 1 point if it was answered correctly; if there was no answer or wrong answer, it was rated as 0 points. A total possible score of 0 to 30 points was given; a score ≤23 points was considered to indicate cognitive dysfunction and was included in the cognitive impairment group. A score of 24 to 30 points indicated that the patient’s cognitive function was still normal, and these individuals were included in the cognitively normal group. This study was approved by the Ethics Committee of Beijing Fengtai Hospital (201815), and all patients provided informed consent. 2.2 Data collection The medical records of all patients were collected, and demographic data such as age, sex, height, weight, smoking status, and basic diseases such as hypertension, diabetes, and heart disease were collected. The perioperative medical data and injuries collected included hip fracture type and fracture side. Preoperative anesthesia evaluation by the American Society of Anesthesiologists (ASA) classification, method of anesthesia, method of operation (internal fixation or artificial joint replacement) and time from injury to operation were used to calculate the length of hospital stay according to the time of exit and admission. 2.3 Outcome indicators The 109 patients were followed up by telephone for 2 to 4 years after the operation by trained professional follow-up personnel, and the occurrence of death events (whether and when death occurred) was recorded. In this study, death events were the primary outcome, death risk was analyzed, and length of stay was the secondary outcome. 3. Statistical processing The Kolmogorov‒Smirnov test was first used to determine whether the measurement data were normally distributed. For normally distributed data, the t test was used for two independent samples. For the normally distributed data (injury to operation time and length of hospital stay), the rank sum test was used. In the analysis of influencing factors and variable correction, multivariate Cox regression was used to establish the model and compare the differences between the cognitive impairment group and the cognitively normal group; the models were adjusted for age, sex, fracture type, ASA grade and the time from injury to surgery. The survival curve drawing method was used to visually compare the difference in death risk between the two groups, and the log-rank test was used to test whether the difference was statistically significant. All the statistical analyses were performed using R 4.1.1 (http://www.R-project.org, The R Foundation) software. The α value of the test was 0.05 on both sides, and P < 0.05 on both sides was considered to indicate statistical significance. Results During the follow-up of this study, 6 (5.5%) patients were lost to follow-up, and complete data were obtained and analyzed for 103 patients, including 27 patients in the cognitive impairment group (22 females, mean age 84.59 ± 6.68 years) and 76 patients in the cognitively normal group (51 females, mean age 79.89 ± 7.83 years). The mean follow-up time was 33 months. According to the comparison of baseline data (Table 1), the age of the individuals in the cognitive impairment group was significantly greater than that of the individuals in the cognitive normal group, and the time from injury to operation was significantly greater than that of the individuals in the normal group (P=0.007 and 0.026, respectively). Table 1 Comparison of general data, perioperative data and length of stay between the two groups total (n = 103) cognitive impairment group (n = 27) Normal group (n = 76) P value statistical value Age， ±s 81.13 ± 7.79 84.59 ± 6.68 79.89 ± 7.83 0.007 7.718 Gender，cases %) 0.158 1.995 male 30 (29.1) 5 (18.5) 25 (32.9) female 73 (70.9) 22 (81.5) 51 (67.1) Weight， ±s 59.30 ± 11.27 56.44 ± 10.54 60.31 ± 11.41 0.126 2.376 Height， ±s 161.05 ± 8.14 159.04 ± 6.69 161.76 ± 8.52 0.136 2.264 Body mass index， ±s 22.82 ± 3.78 22.23 ± 3.26 23.03 ± 3.95 0.348 0.89 Smoking，cases (%) 27 (26.2) 6 (22.2) 21 (27.6) 0.583 0.301 Hypertension, cases (%) 33 (32.0) 5 (18.5) 28 (36.8) 0.08 3.072 Diabetes mellitus, cases (%) 59 (57.3) 16 (59.3) 43 (56.6) 0.809 0.058 Heart disease, cases (%) 27 (26.2) 6 (22.2) 21 (27.6) 0.583 0.301 Fracture type, cases (%) 0.62 0.246 Fracture of femoral neck 50 (48.5) 12 (44.4) 38 (50) Intertrochanteric fracture 53 (51.5) 15 (55.6) 38 (50) Fracture side, cases (%) 0.026 4.951 Left 47 (45.6) 13 (48.1) 34(44.7) right 56 (54.4) 14 (51.9) 42(55.3) ASA，cases(%) 0.082 Fisher Ⅰ 4 (3.9) 1 (3.7) 3 (3.9) Ⅱ 27 (26.2) 3 (11.1) 24 (31.6) Ⅲ 72 (69.9) 23 (85.2) 49 (64.5) Method of anesthesia, cases (%) 0.262 Fisher Lumbar anesthesia 102 (99.0) 26 (96.3) 76 (100) General anesthesia 1 (1.0) 1 (3.7) 0 (0) Type of surgery, cases(%) 0.837 0.042 Internal fixation 67 (65.0) 18 (66.7) 49 (64.5) Artificial joint replacement 36 (35.0) 9 (33.3) 27 (35.5) Injury to surgery，Median (IQR) 3.0 (2.0, 4.6) 3.3 (2.3, 6.0) 2.6 (1.5, 4.0) 0.026 4.96 Length of stay，Median (IQR) 5.1 (4.0, 6.9) 5.8 (4.7, 7.7) 4.9 (3.8, 6.6) 0.098 2.734 ASA: American Society of Anesthesiologists In terms of death events, 77.8% (21 patients) of the patients died in the cognitive impairment group, which was significantly greater than that in the cognitive normal group (31.6% (24 patients) (P<0.001). Cox multivariate regression revealed that the risk of death in the cognitively impaired group was significantly greater than that in the cognitively normal group according to the different models, even after adjusting for age, sex, fracture type, American Society of Anesthesiologists (ASA) grade, and time to surgery (HR 2.5, 95% CI 1.28-4.88; P=0.007; Table 2). The survival curve revealed that more than half of the patients in the cognitive impairment group died nearly 2 years after surgery, and the difference between the two groups gradually increased with time (P<0.001). In terms of hospital stay, the cognitive impairment group was slightly longer than the normal cognitive group was (P=0.098). Table 2 Risk ratios and 95% confidence intervals of cognitive impairment for mortality events Death vs Survival (45 vs 58) uncorrected result Model 1 * Model 2 * HR (95% CI) P value HR (95% CI) P value HR (95% CI) P value Cognitively normal group Reference Reference Reference Cognitive impairment group 3.78 (2.09~6.82) <0.001 2.9 (1.56~5.4) 0.001 2.5 (1.28~4.88) 0.007 * Model 1 corrects for age and sex; Model 2 corrected for age, sex, fracture type, ASA grade, and time from injury to surgery Figure 1. Survival curves of the cognitively impaired and cognitively normal groups Discussion Cognitive dysfunction seriously affects patients' ability to communicate with the outside world, resulting in communication difficulties and difficulty cooperating with various rehabilitation exercises, which directly increases the difficulty of diagnosis and treatment during perioperative and postoperative rehabilitation for elderly hip fracture patients with cognitive impairment and threatens patients' health recovery [15, 16] . A decrease in physical function after a hip fracture can also aggravate original cognitive impairment, resulting in further deterioration of physical and mental health. A retrospective cohort study was conducted to investigate the effect of cognitive impairment on the risk of death after hip fracture in elderly patients. We found that among elderly hip fracture patients who underwent surgery, the risk of postoperative death was significantly greater in elderly fracture patients with cognitive impairment than in those with cognitive impairment, and the association between cognitive impairment and postoperative death events was statistically significant even after adjusting for potential covariates. As the main course of dementia, cognitive impairment is often neglected in clinical diagnosis and treatment. In this study, the prevalence of cognitive impairment defined by the MMSE (<24 points) in the study population (elderly patients with hip fracture) was 26.2%, similar to that reported in other studies [7, 8]. In a comparative study on prevalence rates by Yiannopoulou et al. [17], cognitive function assessment and dementia diagnosis were performed on 80 elderly patients with hip fracture and 80 elderly patients hospitalized for other reasons by using brain CT combined with clinical symptoms and scale evaluation. The results of the present study showed that the prevalence of dementia in elderly patients with hip fractures was as high as 85%, which was significantly greater than the 61.5% prevalence in the control group. Current clinical studies mostly use scale forms to determine whether cognitive impairment should be suspected or diagnosed based on score truncation values; however, due to differences in the scales and diagnostic criteria used, the prevalence rates of various studies differ [15] . At present, cognitive dysfunction is still a difficult frontier in the elderly population, and the diagnosis and treatment of such neurological diseases still need additional basic and clinical research to provide supporting evidence. The results of this study showed that cognitive impairment was closely related to the risk of death in the middle period after hip fracture surgery. Nearly half of the patients with cognitive impairment died within 2 years after surgery, and 77.8% of the hip fracture mortalities associated with cognitive impairment were found during an average follow-up of nearly 3 years. Some scholars believe that because more patients with cognitive impairment are complicated by more underlying disease, the risk of death indirectly increases [18] . According to the results of the present study, the correlation between cognitive function and death was still significant after correcting for key covariates, which was consistent with the findings of several other scholars [9, 10, 19-23] . In Mukka et al.’s [10] study of 188 elderly patients with femoral neck fracture, 38% of patients with cognitive dysfunction died within 1 year after surgery, and cognitive dysfunction significantly increased the risk of postoperative death. In a 10-year prospective cohort study conducted in Beijing and surrounding cities based on 4499 elderly people, Li et al. [24] combined the MMSE assessment score and education level to define cognitive impairment and reported that the 10-year all-cause mortality of patients with cognitive impairment was approximately 15.8%. After fully considering confounding factors, compared with patients with normal cognition, people with cognitive impairment had a 33% increased risk of all-cause death. However, according to the results of this study, the adjusted risk ratio (RR) between cognitive impairment and death was 2.5 (1.28-4.88), and the three-year postoperative mortality of elderly patients with hip fracture complicated with cognitive impairment was as high as 77.8%, which was significantly greater than the mortality of patients with hip fracture or cognitive impairment alone reported in the literature [3, 24, 25] . This suggests a potentially harmful interaction between the two, resulting in a "1+1>2" relationship between them. Future studies need to further analyze such synergistic injuries and explore the existence of effective interventions to improve the prognosis of elderly patients with hip fractures and cognitive impairment. The time from injury to surgery in the cognitive impairment group was significantly longer than that in the cognitively normal group. We speculated that on the one hand, this might be because patients with cognitive impairment have difficulty expressing the injury and symptoms, which directly leads to low medical efficiency and late treatment time. On the other hand, during the preoperative waiting period after injury, people with cognitive impairment are more likely to have perioperative neurological complications, such as delirium [26, 27] , which complicates preoperative management. This may also partly explain the slightly longer hospital stay in the cognitively impaired group than in the cognitively normal group in this study. In terms of limitations, this study has the following limitations. First, the retrospective cohort method was adopted in this study, and the data records were limited, making it difficult to collect data on the remaining factors (such as preinjury mobility and depression) and potential confounding factors affecting postoperative death after fracture surgery. Second, the sample size of this study is limited, but the medium- and long-term follow-up results provided can effectively supplement the existing relevant research evidence. Third, because perioperative complications were not recorded, the association between cognitive impairment and complications could not be analyzed. Future prospective studies with larger sample sizes, as well as high-quality randomized controlled trials, could provide strong support for exploring effective interventions and identifying adverse effects of cognitive impairment. In conclusion, cognitive impairment is closely related to the risk of death after hip fracture in elderly people, and cognitive impairment may be an independent risk factor for death after hip fracture. Declarations Author contributions Jianrong Qian designed the study, wrote the paper and performed the surgeries; Gong Li and Xiongying Song were involved in the acquisition, analysis, or interpretation of the data，reviewed and corrected the manuscript. Funding Declaration ：This work was supported by our hospital -Beijing Fengtai Hospital. We thank our hospital for its generous support, without which this research would not have been possible." References ZHOU Y, LI C, WANG M, et al. Universal health coverage in China: a serial national cross-sectional study of surveys from 2003 to 2018 [J]. Lancet Public Health, 2022, 7(12): e1051-e63. GONG J, WANG G, WANG Y, et al. Nowcasting and forecasting the care needs of the older population in China: analysis of data from the China Health and Retirement Longitudinal Study (CHARLS) [J]. Lancet Public Health, 2022, 7(12): e1005-e13. SEYEDI H R, MAHDIAN M, KHOSRAVI G, et al. Prediction of mortality in hip fracture patients: role of routine blood tests [J]. Arch Bone Jt Surg, 2015, 3(1): 51-5. RUDY C C, HUNSBERGER H C, WEITZNER D S, et al. The role of the tripartite glutamatergic synapse in the pathophysiology of Alzheimer's disease [J]. Aging Dis, 2015, 6(2): 131-48. KAWAGUCHI A, WATANABE K, YOSHIMURA T, et al. [Current status of dementia in admitions to national leprosariums nationwide] [J]. Nihon Hansenbyo Gakkai Zasshi, 2014, 83(3): 7-14. HUANG S W, LIN J W, LIOU T H, et al. Cohort study evaluating the risk of hip fracture among patients with dementia in Taiwan [J]. Int J Geriatr Psychiatry, 2015, 30(7): 695-701. SEITZ D P, ADUNURI N, GILL S S, et al. Prevalence of dementia and cognitive impairment among older adults with hip fractures [J]. Journal of the American Medical Directors Association, 2011, 12(8): 556-64. SCANDOL J P, TOSON B, CLOSE J C. Fall-related hip fracture hospitalizations and the prevalence of dementia within older people in New South Wales, Australia: an analysis of linked data [J]. Injury, 2013, 44(6): 776-83. HOLMES J, HOUSE A. Psychiatric illness predicts poor outcome after surgery for hip fracture: a prospective cohort study [J]. Psychol Med, 2000, 30(4): 921-9. MUKKA S, KNUTSSON B, KRUPIC F, et al. The influence of cognitive status on outcome and walking ability after hemiarthroplasty for femoral neck fracture: a prospective cohort study [J]. Eur J Orthop Surg Traumatol, 2017, 27(5): 653-8. Yan-hui Guo, Tian-Sheng Sun, Zhi Liu et al. Observation of the effect of dementia on surgical outcomes of patients with hip fracture aged 60 years and above [J]. Chinese Journal of General Practitioners, 2022, 21(3): 258-63. Cheng Peng, Xiaowei Wang, Jianzheng Zhang , et al. Effects of dementia on prognosis of elderly hip fracture and analysis of risk factors for prognosis of elderly hip fracture [J]. 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ROCHE J J, WENN R T, SAHOTA O, et al. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study [J]. BMJ, 2005, 331(7529): 1374. BELLELLI G, FRISONI G B, TURCO R, et al. Depressive symptoms combined with dementia affect 12-months survival in elderly patients after rehabilitation posthip fracture surgery [J]. Int J Geriatr Psychiatry, 2008, 23(10): 1073-7. MORRISON R S, SIU A L. A comparison of pain and its treatment in advanced dementia and cognitively intact patients with hip fracture [J]. J Pain Symptom Manage, 2000, 19(4): 240-8. GUO Y, SUN T, WANG X, et al. Cognitive impairment and 1-year outcome in elderly patients with hip fracture [J]. Medical science monitor : international medical journal of experimental and clinical research, 2014, 20: 1963-8. RUGGIERO C, BONAMASSA L, PELINI L, et al. Early postsurgical cognitive dysfunction is a risk factor for mortality among hip fracture hospitalized older persons [J]. Osteoporos Int, 2017, 28(2): 667-75. BENEDETTI M G, GINEX V, MARIANI E, et al. Cognitive impairment is a negative short-term and long-term prognostic factor in elderly patients with hip fracture [J]. European journal of physical and rehabilitation medicine, 2015, 51(6): 815-23. LI Z, GONG X, WANG S, et al. Cognitive impairment assessed by Mini-Mental State Examination predicts all-cause and CVD mortality in Chinese older adults: A 10-year follow-up study [J]. Front Public Health, 2022, 10: 908120. CHAUDHRY H, DEVEREAUX P J, BHANDARI M. Cognitive dysfunction in hip fracture patients [J]. Orthop Clin North Am, 2013, 44(2): 153-62. MUTCHIE H L, ALBRECHT J S, ORWIG D L, et al. Differential misclassification of cognitive impairment by sex among hip fracture patients [J]. J Am Geriatr Soc, 2022, 70(3): 838-45. BEISHUIZEN S J, SCHOLTENS R M, VAN MUNSTER B C, et al. Unraveling the Relationship Between Delirium, Brain Damage, and Subsequent Cognitive Decline in a Cohort of Individuals Undergoing Surgery for Hip Fracture [J]. J Am Geriatr Soc, 2017, 65(1): 130-6. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editor assigned by journal 18 Apr, 2024 Submission checks completed at journal 17 Apr, 2024 First submitted to journal 04 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4216036","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":292722295,"identity":"60187d5d-a9a0-4ff3-af92-a97663190f1a","order_by":0,"name":"Qian Jianrong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvklEQVRIiWNgGAWjYFCCA4wPPhjYyLGxNx8gWguz4YyCNGM+nmMJRFvDJszx4XDiPIkcBeLU8x08+4yZweBwehtDDgPDj4pthLVIHjhu9rjAID23jeHsAcaeM7cJazE4cIzdeIaBdW4bY18CM2MbcVrYpHkMmNPZmIEkKVqcE9jYiNUieeAYMJAN0gzbeNgSDhLlF74bx4BR+cdGXn7+44MPflQQoYXhxgEE+wAuRajgfANx6kbBKBgFo2AEAwCdEz8Nj8mfFwAAAABJRU5ErkJggg==","orcid":"","institution":"Beijing Fengtai Hospital","correspondingAuthor":true,"prefix":"","firstName":"Qian","middleName":"","lastName":"Jianrong","suffix":""}],"badges":[],"createdAt":"2024-04-04 06:50:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4216036/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4216036/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55512777,"identity":"912111e2-37de-4ca8-824b-41b6304cf6a8","added_by":"auto","created_at":"2024-04-29 12:50:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":213337,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSurvival curves of the cognitively impaired and cognitively normal groups\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4216036/v1/c6736fce478aadcd76f94f46.png"},{"id":55512800,"identity":"139b53a6-abac-4206-b735-f74dafc561c5","added_by":"auto","created_at":"2024-04-29 12:50:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":442378,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4216036/v1/20999549-47f8-4390-8c86-72510c77cbee.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association of cognitive impairment with postoperative mortality risk in patients with geriatric hip fractures.","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSince China became an aging society at the beginning of this century, the degree of aging in China has accelerated and deepened, and the diseases that develop with increasing age have imposed a large burden on the social medical system\u003csup\u003e\u0026nbsp;[1, 2]\u003c/sup\u003e. Hip fracture and cognitive dysfunction are common and serious conditions in elderly people, and the former directly leads to mobility dysfunction in elderly people. According to statistics, the fatality rate within one year after hip fracture is as high as 20-40%\u003csup\u003e\u0026nbsp;[3]\u003c/sup\u003e, which is also known as \u0026quot;the last fracture in life\u0026quot;. The latter, as a chronic progressive mental decline disease, directly affects elderly people\u0026apos;s working ability, social communication ability and judgment ability about their surroundings, which requires special care\u003csup\u003e\u0026nbsp;[4, 5]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003ePrevious studies have shown that cognitive dysfunction is an important risk factor for elderly people to fall and hip fracture\u003csup\u003e\u0026nbsp;[6]\u003c/sup\u003e, and the incidence of cognitive dysfunction in elderly people with hip fracture accounts for approximately 20%\u003csup\u003e[7, 8]\u003c/sup\u003e and seriously affects the prognosis of hip fracture. In their early study, Holmes et al. \u003csup\u003e[9]\u003c/sup\u003e reported that cognitive dysfunction significantly increased the risk of early death from hip fracture. Scandol\u003csup\u003e[8]\u003c/sup\u003e, Sebastian\u003csup\u003e[10]\u0026nbsp;\u003c/sup\u003eand other scholars also found that cognitive impairment or dementia was closely related to long-term postoperative death when exploring the correlation between cognitive function and the medium- and long-term prognosis of hip fracture patients. Similar findings were also found in relevant domestic studies \u003csup\u003e[11-13]\u003c/sup\u003e, but the number of studies was small, and long-term follow-up results were lacking, resulting in insufficient clinical evidence.\u003c/p\u003e\n\u003cp\u003eIn this study, a retrospective cohort of elderly patients (65 years old) with hip fractures who underwent surgical treatment at the Department of Orthopedics of Beijing Fengtai Hospital from January 2018 to December 2019 was included to analyze the impact of cognitive dysfunction on the prognosis of patients with hip fractures. It was assumed that cognitive impairment would significantly increase the risk of death after hip fracture in elderly patients.\u003c/p\u003e"},{"header":"Data And Methods","content":"\u003cp\u003e\u003cstrong\u003e1. Research subjects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this retrospective cohort study, 127 elderly patients with hip fractures who underwent surgical treatment at the Department of Orthopedics of Beijing Fengtai Hospital from January 2018 to December 2019 were included. The inclusion criteria were as follows: ① patients with hip fracture (femoral neck fracture or intertrochanteric fracture) who underwent surgical treatment and ② patients aged\u0026nbsp;\u0026ge;65 years. The exclusion criteria for patients were as follows: ① whose time from injury to treatment was \u0026gt; 3 weeks;\u0026nbsp;②\u0026nbsp;had other site fractures or multiple traumas;\u0026nbsp;③\u0026nbsp;had open fractures; and ④ had incomplete clinical data. A total of 18 patients who did not meet the inclusion criteria were excluded, and a total of 109 patients participated in the final follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e2.1 General Information\u003c/p\u003e\n\u003cp\u003eAll patients were evaluated by the Mini Mental State Examination (MMSE) \u003csup\u003e[14]\u003c/sup\u003e on the first day of admission (before surgery). According to the preoperative cognitive function status, 109 patients were divided into cognitive dysfunction (cognitive impairment group) and normal cognitive function (cognitive normal group) groups, which included 31 patients with cognitive impairment (6 males and 25 females). There were 78 patients in the cognitively normal group (26 males and 52 females). The MMSE scale includes 30 questions on 7 aspects, namely, time orientation, place orientation, immediate and delayed memory, attention and computation, language and visual space. A question was rated as 1 point if it was answered correctly; if there was no answer or wrong answer, it was rated as 0 points. A total possible score of 0 to 30 points was given; a score\u0026nbsp;\u0026le;23 points was considered to indicate cognitive dysfunction and was included in the cognitive impairment group. A score of 24 to 30 points indicated that the patient\u0026rsquo;s cognitive function was still normal, and these individuals were included in the cognitively normal group.\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Beijing Fengtai Hospital (201815), and all patients provided informed consent.\u003c/p\u003e\n\u003cp\u003e2.2 Data collection\u003c/p\u003e\n\u003cp\u003eThe medical records of all patients were collected, and demographic data such as age, sex, height, weight, smoking status, and basic diseases such as hypertension, diabetes, and heart disease were collected. The perioperative medical data and injuries collected included hip fracture type and fracture side. Preoperative anesthesia evaluation by the American Society of Anesthesiologists (ASA) classification, method of anesthesia, method of operation (internal fixation or artificial joint replacement) and time from injury to operation were used to calculate the length of hospital stay according to the time of exit and admission.\u003c/p\u003e\n\u003cp\u003e2.3 Outcome indicators\u003c/p\u003e\n\u003cp\u003eThe 109 patients were followed up by telephone for 2 to 4 years after the operation by trained professional follow-up personnel, and the occurrence of death events (whether and when death occurred) was recorded. In this study, death events were the primary outcome, death risk was analyzed, and length of stay was the secondary outcome.\u003c/p\u003e\n\u003cp\u003e3. Statistical processing\u003c/p\u003e\n\u003cp\u003eThe Kolmogorov‒Smirnov test was first used to determine whether the measurement data were normally distributed. For normally distributed data, the t test was used for two independent samples. For the normally distributed data (injury to operation time and length of hospital stay), the rank sum test was used. In the analysis of influencing factors and variable correction, multivariate Cox regression was used to establish the model and compare the differences between the cognitive impairment group and the cognitively normal group; the models were adjusted for age, sex, fracture type, ASA grade and the time from injury to surgery. The survival curve drawing method was used to visually compare the difference in death risk between the two groups, and the log-rank test was used to test whether the difference was statistically significant.\u003c/p\u003e\n\u003cp\u003eAll the statistical analyses were performed using R 4.1.1 (http://www.R-project.org, The R Foundation) software. The \u0026alpha; value of the test was 0.05 on both sides, and P \u0026lt; 0.05 on both sides was considered to indicate statistical significance.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDuring the follow-up of this study, 6 (5.5%) patients were lost to follow-up, and complete data were obtained and analyzed for 103 patients, including 27 patients in the cognitive impairment group (22 females, mean age 84.59 \u0026plusmn; 6.68 years) and 76 patients in the cognitively normal group (51 females, mean age 79.89 \u0026plusmn; 7.83 years). The mean follow-up time was 33 months. According to the comparison of baseline data (Table 1), the age of the individuals in the cognitive impairment group was significantly greater than that of the individuals in the cognitive normal group, and the time from injury to operation was significantly greater than that of the individuals in the normal group (P=0.007 and 0.026, respectively).\u003c/p\u003e\n\u003cp\u003eTable 1 Comparison of general data, perioperative data and length of stay between the two groups\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003etotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n = 103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ecognitive impairment group (n = 27)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal group\u0026nbsp;(n = 76)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003estatistical value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge， \u003cimg src=\"data:image/jpeg;base64,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\" alt=\"image\"\u003e\u0026plusmn;s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e81.13 \u0026plusmn; 7.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e84.59 \u0026plusmn; 6.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e79.89 \u0026plusmn; 7.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.718\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGender，cases\u0026nbsp;%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.995\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30 (29.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25 (32.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e73 (70.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22 (81.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51 (67.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWeight，\u003cimg src=\"data:image/jpeg;base64,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\" alt=\"image\"\u003e\u0026plusmn;s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e59.30 \u0026plusmn; 11.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e56.44 \u0026plusmn; 10.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e60.31 \u0026plusmn; 11.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.376\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHeight，\u003cimg src=\"data:image/jpeg;base64,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\" alt=\"image\"\u003e\u0026plusmn;s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e161.05 \u0026plusmn; 8.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e159.04 \u0026plusmn; 6.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e161.76 \u0026plusmn; 8.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.264\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBody mass index，\u003cimg src=\"data:image/jpeg;base64,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\" alt=\"image\"\u003e\u0026plusmn;s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22.82 \u0026plusmn; 3.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22.23 \u0026plusmn; 3.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23.03 \u0026plusmn; 3.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.348\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSmoking，cases\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27 (26.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21 (27.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.583\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.301\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHypertension, cases\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33 (32.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28 (36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.072\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDiabetes mellitus, cases\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e59 (57.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16 (59.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43 (56.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.809\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHeart disease, cases\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27 (26.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21 (27.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.583\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.301\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFracture type, cases\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.246\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Fracture of femoral neck\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50 (48.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIntertrochanteric fracture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e53 (51.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15 (55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFracture side, cases\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.951\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Left\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47 (45.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13 (48.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34(44.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; right\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e56 (54.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14 (51.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42(55.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eASA，cases(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFisher\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Ⅰ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Ⅱ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27 (26.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Ⅲ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e72 (69.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23 (85.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49 (64.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMethod of anesthesia, cases\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFisher\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Lumbar anesthesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e102 (99.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26 (96.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e76 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; General anesthesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eType of surgery, cases(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.837\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Internal fixation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e67 (65.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49 (64.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eArtificial joint replacement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36 (35.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27 (35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInjury to surgery，Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.0 (2.0, 4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.3 (2.3, 6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.6 (1.5, 4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLength of stay，Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.1 (4.0, 6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.8 (4.7, 7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.9 (3.8, 6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.734\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eASA: American Society of Anesthesiologists\u003c/p\u003e\n\u003cp\u003eIn terms of death events, 77.8% (21 patients) of the patients died in the cognitive impairment group, which was significantly greater than that in the cognitive normal group (31.6% (24 patients) (P\u0026lt;0.001). Cox multivariate regression revealed that the risk of death in the cognitively impaired group was significantly greater than that in the cognitively normal group according to the different models, even after adjusting for age, sex, fracture type, American Society of Anesthesiologists (ASA) grade, and time to surgery (HR 2.5, 95% CI 1.28-4.88; P=0.007; Table 2). The survival curve revealed that more than half of the patients in the cognitive impairment group died nearly 2 years after surgery, and the difference between the two groups gradually increased with time (P\u0026lt;0.001). In terms of hospital stay, the cognitive impairment group was slightly longer than the normal cognitive group was (P=0.098).\u003c/p\u003e\n\u003cp\u003eTable 2 \u0026nbsp;Risk ratios and 95% confidence intervals of cognitive impairment for mortality events\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeath vs Survival\u0026nbsp;(45 vs 58)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003euncorrected result\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel\u0026nbsp;1\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel\u0026nbsp;2\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCognitively normal group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCognitive impairment group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.78 (2.09~6.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.9 (1.56~5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.5 (1.28~4.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003csup\u003e*\u003c/sup\u003e \u003cstrong\u003eModel 1 corrects for age and sex; Model 2 corrected for age, sex, fracture type, ASA grade, and time from injury to surgery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 1. Survival curves of the cognitively impaired and cognitively normal groups\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCognitive dysfunction seriously affects patients\u0026apos; ability to communicate with the outside world, resulting in communication difficulties and difficulty cooperating with various rehabilitation exercises, which directly increases the difficulty of diagnosis and treatment during perioperative and postoperative rehabilitation for elderly hip fracture patients with cognitive impairment and threatens patients\u0026apos; health recovery \u003csup\u003e[15, 16]\u003c/sup\u003e. A decrease in physical function after a hip fracture can also aggravate original cognitive impairment, resulting in further deterioration of physical and mental health. A retrospective cohort study was conducted to investigate the effect of cognitive impairment on the risk of death after hip fracture in elderly patients. We found that among elderly hip fracture patients who underwent surgery, the risk of postoperative death was significantly greater in elderly fracture patients with cognitive impairment than in those with cognitive impairment, and the association between cognitive impairment and postoperative death events was statistically significant even after adjusting for potential covariates.\u003c/p\u003e\n\u003cp\u003eAs the main course of dementia, cognitive impairment is often neglected in clinical diagnosis and treatment. In this study, the prevalence of cognitive impairment defined by the MMSE (\u0026lt;24 points) in the study population (elderly patients with hip fracture) was 26.2%, similar to that reported in other studies \u003csup\u003e[7, 8].\u003c/sup\u003e In a comparative study on prevalence rates by Yiannopoulou et al.\u003csup\u003e\u0026nbsp;[17],\u003c/sup\u003e cognitive function assessment and dementia diagnosis were performed on 80 elderly patients with hip fracture and 80 elderly patients hospitalized for other reasons by using brain CT combined with clinical symptoms and scale evaluation. The results of the present study showed that the prevalence of dementia in elderly patients with hip fractures was as high as 85%, which was significantly greater than the 61.5% prevalence in the control group. Current clinical studies mostly use scale forms to determine whether cognitive impairment should be suspected or diagnosed based on score truncation values; however, due to differences in the scales and diagnostic criteria used, the prevalence rates of various studies differ \u003csup\u003e[15]\u003c/sup\u003e. At present, cognitive dysfunction is still a difficult frontier in the elderly population, and the diagnosis and treatment of such neurological diseases still need additional basic and clinical research to provide supporting evidence.\u003c/p\u003e\n\u003cp\u003eThe results of this study showed that cognitive impairment was closely related to the risk of death in the middle period after hip fracture surgery. Nearly half of the patients with cognitive impairment died within 2 years after surgery, and 77.8% of the hip fracture mortalities associated with cognitive impairment were found during an average follow-up of nearly 3 years. Some scholars believe that because more patients with cognitive impairment are complicated by more underlying disease, the risk of death indirectly increases\u003csup\u003e\u0026nbsp;[18]\u003c/sup\u003e. According to the results of the present study, the correlation between cognitive function and death was still significant after correcting for key covariates, which was consistent with the findings of several other scholars \u003csup\u003e[9, 10, 19-23]\u003c/sup\u003e. In Mukka et al.\u0026rsquo;s \u003csup\u003e[10]\u0026nbsp;\u003c/sup\u003estudy of 188 elderly patients with femoral neck fracture, 38% of patients with cognitive dysfunction died within 1 year after surgery, and cognitive dysfunction significantly increased the risk of postoperative death. In a 10-year prospective cohort study conducted in Beijing and surrounding cities based on 4499 elderly people, Li et al.\u003csup\u003e\u0026nbsp;[24]\u003c/sup\u003e combined the MMSE assessment score and education level to define cognitive impairment and reported that the 10-year all-cause mortality of patients with cognitive impairment was approximately 15.8%. After fully considering confounding factors, compared with patients with normal cognition, people with cognitive impairment had a 33% increased risk of all-cause death. However, according to the results of this study, the adjusted risk ratio (RR) between cognitive impairment and death was 2.5 (1.28-4.88), and the three-year postoperative mortality of elderly patients with hip fracture complicated with cognitive impairment was as high as 77.8%, which was significantly greater than the mortality of patients with hip fracture or cognitive impairment alone reported in the literature\u003csup\u003e\u0026nbsp;[3, 24, 25]\u003c/sup\u003e. This suggests a potentially harmful interaction between the two, resulting in a \u0026quot;1+1\u0026gt;2\u0026quot; relationship between them. Future studies need to further analyze such synergistic injuries and explore the existence of effective interventions to improve the prognosis of elderly patients with hip fractures and cognitive impairment.\u003c/p\u003e\n\u003cp\u003eThe time from injury to surgery in the cognitive impairment group was significantly longer than that in the cognitively normal group. We speculated that on the one hand, this might be because patients with cognitive impairment have difficulty expressing the injury and symptoms, which directly leads to low medical efficiency and late treatment time. On the other hand, during the preoperative waiting period after injury, people with cognitive impairment are more likely to have perioperative neurological complications, such as delirium \u003csup\u003e[26, 27]\u003c/sup\u003e, which complicates preoperative management. This may also partly explain the slightly longer hospital stay in the cognitively impaired group than in the cognitively normal group in this study.\u003c/p\u003e\n\u003cp\u003eIn terms of limitations, this study has the following limitations. First, the retrospective cohort method was adopted in this study, and the data records were limited, making it difficult to collect data on the remaining factors (such as preinjury mobility and depression) and potential confounding factors affecting postoperative death after fracture surgery. Second, the sample size of this study is limited, but the medium- and long-term follow-up results provided can effectively supplement the existing relevant research evidence. Third, because perioperative complications were not recorded, the association between cognitive impairment and complications could not be analyzed. Future prospective studies with larger sample sizes, as well as high-quality randomized controlled trials, could provide strong support for exploring effective interventions and identifying adverse effects of cognitive impairment.\u003c/p\u003e\n\u003cp\u003eIn conclusion, cognitive impairment is closely related to the risk of death after hip fracture in elderly people, and cognitive impairment may be an independent risk factor for death after hip fracture.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJianrong Qian designed the study, wrote the paper and performed the surgeries; Gong Li and Xiongying Song were involved in the acquisition, analysis, or interpretation of the data，reviewed and corrected the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e：This work was supported by our hospital -Beijing Fengtai Hospital. We thank our hospital for its generous support, without which this research would not have been possible.\u0026quot;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZHOU Y, LI C, WANG M, et al. Universal health coverage in China: a serial national cross-sectional study of surveys from 2003 to 2018 [J]. Lancet Public Health, 2022, 7(12): e1051-e63.\u003c/li\u003e\n\u003cli\u003eGONG J, WANG G, WANG Y, et al. Nowcasting and forecasting the care needs of the older population in China: analysis of data from the China Health and Retirement Longitudinal Study (CHARLS) [J]. Lancet Public Health, 2022, 7(12): e1005-e13.\u003c/li\u003e\n\u003cli\u003eSEYEDI H R, MAHDIAN M, KHOSRAVI G, et al. Prediction of mortality in hip fracture patients: role of routine blood tests [J]. Arch Bone Jt Surg, 2015, 3(1): 51-5.\u003c/li\u003e\n\u003cli\u003eRUDY C C, HUNSBERGER H C, WEITZNER D S, et al. 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J Pain Symptom Manage, 2000, 19(4): 240-8.\u003c/li\u003e\n\u003cli\u003eGUO Y, SUN T, WANG X, et al. Cognitive impairment and 1-year outcome in elderly patients with hip fracture [J]. Medical science monitor : international medical journal of experimental and clinical research, 2014, 20: 1963-8.\u003c/li\u003e\n\u003cli\u003eRUGGIERO C, BONAMASSA L, PELINI L, et al. Early postsurgical cognitive dysfunction is a risk factor for mortality among hip fracture hospitalized older persons [J]. Osteoporos Int, 2017, 28(2): 667-75.\u003c/li\u003e\n\u003cli\u003eBENEDETTI M G, GINEX V, MARIANI E, et al. Cognitive impairment is a negative short-term and long-term prognostic factor in elderly patients with hip fracture [J]. European journal of physical and rehabilitation medicine, 2015, 51(6): 815-23.\u003c/li\u003e\n\u003cli\u003eLI Z, GONG X, WANG S, et al. Cognitive impairment assessed by Mini-Mental State Examination predicts all-cause and CVD mortality in Chinese older adults: A 10-year follow-up study [J]. Front Public Health, 2022, 10: 908120.\u003c/li\u003e\n\u003cli\u003eCHAUDHRY H, DEVEREAUX P J, BHANDARI M. Cognitive dysfunction in hip fracture patients [J]. Orthop Clin North Am, 2013, 44(2): 153-62.\u003c/li\u003e\n\u003cli\u003eMUTCHIE H L, ALBRECHT J S, ORWIG D L, et al. Differential misclassification of cognitive impairment by sex among hip fracture patients [J]. J Am Geriatr Soc, 2022, 70(3): 838-45.\u003c/li\u003e\n\u003cli\u003eBEISHUIZEN S J, SCHOLTENS R M, VAN MUNSTER B C, et al. Unraveling the Relationship Between Delirium, Brain Damage, and Subsequent Cognitive Decline in a Cohort of Individuals Undergoing Surgery for Hip Fracture [J]. J Am Geriatr Soc, 2017, 65(1): 130-6.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hip fracture, Elderly, Cognitive impairment, Mortality","lastPublishedDoi":"10.21203/rs.3.rs-4216036/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4216036/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective \u003c/strong\u003eTo evaluate the association between cognitive impairment and postoperative mortality risk in patients with geriatric hip fractures.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eFrom Jan 2018 to Dec 2019, 109 older patients with hip fractures were retrospectively enrolled from the Department of Orthopedics of Beijing Fengtai Hospital. Based on their cognitive function, all patients were categorized into cognitive impairment and normal groups. Postoperative mortality risk was regarded as the primary outcome. Multivariate Cox regression analysis and survival curves were generated to explore the effect of cognitive impairment. The results A total of 103 patients were followed up with a mean follow-up time of 33 months. Twenty-seven patients (22 females, mean age 84.59 ± 6.68 years) were in the cognitive impairment group, while 76 patients (51 females, mean age 79.89 ± 7.83 years) were in the normal group. The cognitive impairment group had a significantly greater mortality rate than the normal group did (21 (77.8%) vs. 24 (31.6%), P\u0026lt;0.001). A significant association between cognitive impairment and mortality risk still remained even after adjustments for potential covariates (HR 2.5, 95% CI 1.28~4.88, P=0.007).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e Cognitive impairment was significantly associated with postoperative mortality risk in patients with geriatric hip fractures. Cognitive impairment may be an independent risk factor for death after hip fracture.\u003c/p\u003e","manuscriptTitle":"Association of cognitive impairment with postoperative mortality risk in patients with geriatric hip fractures.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-29 12:50:06","doi":"10.21203/rs.3.rs-4216036/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorAssigned","content":"","date":"2024-04-18T10:05:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-18T02:30:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Orthopaedic Surgery and Research","date":"2024-04-04T06:48:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ff8664b9-ed45-4f0a-ad57-f3f0a15acd0f","owner":[],"postedDate":"April 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-04-29T12:50:06+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-29 12:50:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4216036","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4216036","identity":"rs-4216036","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}