Published online Jun 19, 2026. doi: 10.5498/wjp.v16.i6.116925
Revised: January 26, 2026
Accepted: March 2, 2026
Published online: June 19, 2026
Processing time: 142 Days and 1.2 Hours
Postoperative delirium (POD) is characterized as a major complication for the geriatric population, and is associated with worsening of the individual and an increase in healthcare costs. The association between POD and the presence of preoperative depression and cognitive status remains unknown.
To analyze whether preoperative cognitive status and depression would associate with POD and to what extent in the aged population with hip fractures.
A cohort study of patients aged ≥ 65 with hip fractures who underwent surgical intervention at this institution from October 2022 to October 2025 was performed. The 15-item Geriatric Depression Scale was used for assessing depression, and The Mini-Mental State Examination for cognitive status as well. POD was diagnosed using the Confusion Assessment Method within the first 7 postoperative days. Multivariate logistic regression analysis was performed to identify the independent risk factors for POD.
Of 150 patients, 46 (30.7%) developed POD. Patients with preoperative depression (15-item Geriatric Depression Scale ≥ 5) had a significantly higher incidence of POD than non-depressed patients (45.8% vs 22.1%, P = 0.003). Similarly, patients with cognitive impairment (Mini-Mental State Examination score < 24) had a higher incidence of POD than those with normal cognition (52.0% vs 18.5%, P < 0.001). Multivariable analysis revealed that preoperative depression [odds ratio (OR) = 2.84, 95%CI: 1.26-6.41, P = 0.012], cognitive impairment (OR = 3.92, 95%CI: 1.71-8.98, P = 0.001), age ≥ 80 years (OR = 2.47, 95%CI: 1.09-5.59, P = 0.030), and American Society of Anesthesiologists classification ≥ III (OR = 2.63, 95%CI: 1.18-5.87, P = 0.018) were independent predictors of POD.
Preoperative depression and cognitive impairment are independent risk factors for POD in elderly patients with hip fractures. Preoperative screening for these factors can guide preventive interventions in high-risk patients.
Core Tip: Cognitive dysfunction and preoperative depression were recognized as independent variables and were evaluated for the incidence of postoperative delirium in hip fracture surgery patients in the geriatric population. We have shown a considerable increase in the incidence of postoperative delirium with the combination of dementia and depression in this population via established techniques including the 15-item Geriatric Depression Scale, the Mini-Mental State Examination, and the Confusion Assessment Method. Higher American Society of Anesthesiologists scores and older age only increase the incidence. The incorporation of these screening mechanisms in the preoperative settings is expected to help construction of specific preoperative plans for patients at higher risk.