Objective:

To develop and internally validate a nomogram specifically for predicting postoperative delirium (POD) in elderly patients undergoing internal fixation for intertrochanteric fractures, all of whom received a standardized preoperative low-dose intravenous dexamethasone.

Approach:

Key Findings:

• Incidence of POD was 12.5% (31/248).
• Three independent predictors identified: age (OR = 1.102), preoperative monocyte count (OR = 7.566), and postoperative transfer to ICU (OR = 2.923).
• Nomogram demonstrated good discriminative ability with an AUC of 0.803, accuracy of 0.843, sensitivity of 0.821, and specificity of 0.847.

Interpretation:

The nomogram may facilitate early identification of high-risk individuals within this patient subset and support targeted preventive strategies immediately following surgery.

Conclusion:

This model is the first perioperative nomogram incorporating three perioperative variables to predict POD in geriatric intertrochanteric fracture patients undergoing a standardized preoperative dexamethasone regimen.

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