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Objectives: To assess the independent effect of delirium on mortality and disability after 1 year of follow-up, in consecutive older patients with hip fracture hospitalized for surgical repair., Design: This is a prospective observational study., Setting and Participants: Patients aged older than 65 years consecutively admitted for hip fracture to the Trauma and Orthopedics Centre of a third-level hospital, between March and October 2014., Methods: Patients were evaluated by a multidisciplinary team. A comprehensive geriatric assessment was performed on admission. Delirium was assessed before and after surgical repair according to the Confusion Assessment Method. Mortality and disability status were collected at 3 months and 1 year after hospital discharge., Results: Of 411 patients with hip fracture, 387 (mean age 82 years, female 72%) were enrolled. Delirium was assessed in 50% of the enrolled population. Patients with delirium were older, frequently affected by dementia, severe prefracture disability, history of falls, and polypharmacy. One-year mortality was 19% in all populations, and higher in patients with delirium, although delirium did not show an independent association with mortality, in multivariable analysis. Conversely, delirium was identified as an independent prognostic factor of long-term disability (B-1.605, SE 0.211, P < .001)., Conclusion and Implications: This study identifies delirium as an independent long-term disability generator, regardless of associated clinical conditions and premorbid cognitive and functional status. This emphasises the importance of delirium prevention through a multidisciplinary approach and the potential role of systematic treatment of risk factors in reducing functional decline, even in subjects with preexistent disability and dementia. Moreover, these data call for research on rehabilitation interventions specifically targeted to these complex patients, with the aim of identifying approaches effective in reducing long-term disability. Conversely, a high level of clinical alertness is required in patients with delirium, as an appropriate treatment of acute diseases should reduce their high mortality risk., (Copyright © 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: To evaluate the effects of perioperative myocardial infarction in patients with hip fracture referred to multidisciplinary unit at a tertiary teaching hospital., Methods: 1030 patients with hip fracture underwent troponin measurement, electrocardiogram and echocardiogram at admission, 24 and 48 h after surgery. Exclusion criteria were age < 70 years, severe aortic stenosis, myocardial infarction <30 days, stress cardiomyopathy, renal failure, sepsis, active neoplastic disease. End-points were 30-day and 1 year mortality., Results: Troponin I levels ≥0.5 μg/l were found in 129/1030. 37 of them were excluded according to reported criteria. In the 92 patients included in the study in hospital and 1 year mortality were significantly higher than in controls (12.5% vs 3.5%, p .0012 and respectively 44% vs 16.1% at 12 months, p < .001). 18 patients underwent coronary angiography within 1 week from hip surgery. All had multivessel coronary artery disease. One patient died after angiography. At multivariate logistic analysis age (OR 1.09, 95% CI = 1.01 to 1.19, p = .044) and creatinine values (OR = 7. 55, 95% CI = 1.26 to 45.3, p = .02) were independent predictive factors of 1 year mortality whereas coronary revascularization (OR = 0.15, 95% CI = 0.03 to 0.78, p = .024) was an independent factor associated with improved survival., Conclusions: Perioperative TnI elevation is associated with a significantly increase in 30-day and 1-year mortality. Severe coronary disease may be suspected in patients with perioperative myocardial infarction after hip fracture surgery. Our study is one of the first providing data on the safety and feasibility of early (inhospital) coronary angiograpy and PCI after hip surgery. Further studies are needed to establish indication of coronary angiography in these patients., (Copyright © 2018. Published by Elsevier B.V.)