Objective To construct the prediction model of perioperative neurocognitive disorders (PND) in elderly patients with hip fracture surgery based on frailty and perioperative clinical data, and explore its application value.

Methods A total of 231 elderly patients with hip fractures were divided into the PND group and non-PND group according to whether they had PND. The clinical data were compared between two groups, the influencing factors of PND in elderly patients treated with hip fracture surgery were analyzed using logistic regression. Based on the influencing factors, a Nomogram prediction model for PND in elderly patients treated with hip fracture surgery was constructed. The predictive performance and clinical utility of the model were evaluated using ROC curves and DCA.

Results Among 231 elderly patients with hip fractures treated with surgery, 37 cases developed PND, with a PND incidence of 16.01%. The age (OR = 3.329, 95%CI = 1.315–8.426), number of preoperative comorbidities (R = 2.801, 95%CI = 1.197–6.554), MMSE score (OR = 0.375, 95%CI = 0.231–0.609), albumin (OR = 0.327, 95%CI = 0.185–0.577), CRP level (OR = 3.339, 95%CI = 1.357–8.216), preoperative weakness (OR = 6.104, 95%CI = 6.104–2.375), surgical approach (OR = 3.182, 95%CI = 1.259–8.042), anesthesia method (OR = 4.456, 95%CI = 1.884–10.537), intraoperative sedation depth (OR = 4.805, 95%CI = 1.921–12.018) and postoperative use of analgesia pump (OR = 3.971, 95%CI = 1.536–10.264) were the influencing factors of the occurrence of PND in elderly patients treated with hip fracture surgery. The results of ROC curve and DCA showed that the AUC of prediction model was 0.917, the predictive model has good predictive efficiency and significant positive net benefit. It had good clinical utility in predicting the risk of PND occurrence.

Conclusions The age, number of preoperative comorbidities, MMSE score, albumin, CRP level, preoperative weakness, surgical approach, anesthesia method, intraoperative sedation depth and postoperative use of analgesia pump are the influencing factors of the occurrence of PND in elderly patients treated with hip fracture surgery. Clinical measures can be developed to further improve the prognosis.