Background: Although various physical risk factors for delirium have been identified, the effect of psychological aspects is currently unknown. This study aimed to examine psychological risk factors for postoperative delirium and to identify hidden subgroups of delirium in clinical and psychological feature space. Methods: Among 200 patients with hip fracture, 78 elderly patients were prospectively evaluated for clinical and psychological assessments before surgery. As delirium was assessed from the next day to the 7th day after surgery, postoperative delirium was found in 40 patients, but not in 38 patients. Univariate and multivariate logistic regression analyses were used to explore risk factors for postoperative delirium. Phenotypic subgroups of delirium were assessed using Topological Data Analysis, in which the significant risk factors were used for evaluating filter and distance metrics. Results: Mini-Mental State Examination, neuroticism, conscientiousness, and regional anesthesia were identified as a predictive risk factor for postoperative delirium. The filter metric showed significant negative correlations with nutrition-related factors such as total protein and albumin. When filter metric and Euclidean distances were entered, delirious patients were bifurcated as a function of personality traits and anesthesia method in the patient-patient network. Conclusions: A personality trait of neuroticism and conscientiousness may predispose elderly patients to postoperative delirium and this influence may be amplified by regional anesthesia. This study verifies the contribution of psychological risk factors to delirium and provides new insight for complex etiologies of delirium by mapping various clinical variables in the topological space.
Bibliographical noteFunding Information:
The authors thank In Jung Son, M.D., M.S., Ho Jun Choi, M.D., Min Suk Ko, M.D., Jun Yeol Lim, M.D., Sang Yok Seok, M.D., and Jun Young Kim, M.D. for helping to collect data, the nursing staffs of emergency center and orthopedic unit for supporting to enroll patients, and Han Na Yoo, Ph.D. for helping statistical analysis. This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI16C0132). The funding source has not contributed to the performance of the study or preparation of this article.
© 2016 The Author(s).
All Science Journal Classification (ASJC) codes
- Psychiatry and Mental health