Postoperative delirium in an orthogeriatric patients: risk factors and modern approaches to prevention

Objective. Based on an analysis of the literature, to identify the main risk factors for postoperative delirium (POD) in elderly patients with femoral neck fractures undergoing hip arthroplasty and to substantiate contemporary approaches to its prevention.
Materials and methods. A systematic review of domestic and international literature published between 2015 and 2025 was conducted using PubMed, Scopus, eLibrary, and the Cochrane Library databases. The following keywords were used: hip fracture, delirium, risk factors, elderly, perioperative care, regional anesthesia, and PENG-block. Metaanalyses, systematic reviews, randomized controlled trials, and prospective cohort studies were included.
Results. The incidence of POD after hip arthroplasty for femoral neck fractures reaches 40–60 %. The following modifiable risk factors were identified: anemia, electrolyte imbalance, hypoalbuminemia, polypharmacy, prolonged preoperative fasting, intraoperative hypotension, deep anesthesia, hypothermia, severe pain syndrome, high opioid doses, and delayed mobilization. A key role in prevention is attributed to multimodal opioid-sparing analgesia with a regional component (PENG-block), which reduces opioid consumption by 50–70 % and lowers the risk of POD by 25–35 %. The use of dexmedetomidine in high-risk patients decreases the incidence of POD by 40–50 %. Implementation of comprehensive multidisciplinary protocols can reduce POD incidence by 30–40 %.
Conclusions. POD in elderly patients with femoral neck fractures undergoing hip arthroplasty is a multifactorial complication, the prevention of which should be based on correction of modifiable risk factors using regional anesthesia, dexmedetomidine, early mobilization, and a complex of non-pharmacological interventions.

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