Aging Clinical and Experimental Research

, Volume 19, Issue 3, pp 178–186

Postoperative delirium in old patients with femoral neck fracture: a randomized intervention study

Authors

    • Department of Community Medicine and Rehabilitation, Geriatric MedicineUmeå University
  • Birgitta Olofsson
    • Department of Community Medicine and Rehabilitation, Geriatric MedicineUmeå University
    • Department of Surgical and Perioperative Science, OrthopedicsUmeå University
  • Michael Stenvall
    • Department of Community Medicine and Rehabilitation, Geriatric MedicineUmeå University
  • Stig Karlsson
    • Department of Community Medicine and Rehabilitation, Geriatric MedicineUmeå University
  • Lars Nyberg
    • Department of Health SciencesLuleå University of Technology
  • Undis Englund
    • Department of Community Medicine and Rehabilitation, Geriatric MedicineUmeå University
  • Bengt Borssén
    • Department of OrthopedicsUmeå University Hospital
  • Olle Svensson
    • Department of Surgical and Perioperative Science, OrthopedicsUmeå University
  • Yngve Gustafson
    • Department of Community Medicine and Rehabilitation, Geriatric MedicineUmeå University
Original Articles

DOI: 10.1007/BF03324687

Cite this article as:
Lundström, M., Olofsson, B., Stenvall, M. et al. Aging Clin Exp Res (2007) 19: 178. doi:10.1007/BF03324687

Abstract

Background and aims: Delirium is a common postoperative complication in elderly patients which has a serious impact on outcome in terms of morbidity and costs. We examined whether a postoperative multi-factorial intervention program can reduce delirium and improve outcome in patients with femoral neck fractures. Methods: One hundred and ninety-nine patients, aged 70 years and over (mean age±SD, 82±6, 74% women), were randomly assigned to postoperative care in a specialized geriatric ward or a conventional orthopedic ward. The intervention consisted of staff education focusing on the assessment, prevention and treatment of delirium and associated complications. The staff worked as a team, applying comprehensive geriatric assessment, management and rehabilitation. Patients were assessed using the Mini Mental State Examination and the Organic Brain Syndrome Scale, and delirium was diagnosed according to DSM-IV criteria. Results: The number of days of postoperative delirium among intervention patients was fewer (5.0±7.1 days vs 10.2±13.3 days, p=0.009) compared with controls. A lower proportion of intervention patients were delirious postoperatively than controls (56/102, 54.9% vs 73/97, 75.3%, p=0.003). Eighteen percent in the intervention ward and 52% of controls were delirious after the seventh postoperative day (p<0.001). Intervention patients suffered from fewer complications, such as decubitus ulcers, urinary tract infections, nutritional complications, sleeping problems and falls, than controls. Total postoperative hospitalization was shorter in the intervention ward (28.0±17.9 days vs 38.0±40.6 days, p=0.028). Conclusions: Patients with postoperative delirium can be successfully treated, resulting in fewer days of delirium, fewer other complications, and shorter length of hospitalization.

Keywords

Deliriumfemoral neck fracturegeriatric teaminterventionRCT

Copyright information

© Springer Internal Publishing Switzerland 2007