TY - JOUR

T1 - Preoperative intervention to prevent delirium in patients with hip fracture - a systematic review

AU - Virsøe-Frandsen, Cathrine D.

AU - Skjold, Christine

AU - Wildgaard, Kim

AU - Moller, Ann M.

PY - 2022

Y1 - 2022

N2 - INTRODUCTION. Delirium is a syndrome characterised by disturbance of consciousness and is a common complication to hip fractures. This systematic review was conducted to investigate the effect of simple preoperative interventions for the prevention of delirium in patients with hip fractures. The aim was to establish an easily implementable and resource-sparring treatment for the initial admission phase of hip fracture patients aimed at reducing the incidence of delirium. MEHODS. Five databases were searched to identify randomised controlled trials comparing preoperative interventions other than geriatric assessment to placebo or usual care. Our primary outcome was incidence of delirium using a well-defined delirium-screening tool. Secondary outcomes included need for pharmacological treatment, duration of delirium and mortality. RESULTS. A total of 13 RCTs provided data on 2,222 patients who had been exposed to 11 different interventions. Four interventions significantly reduced of the incidence of delirium: methylprednisolone (odds ratio (OR) = 0.42; 95% confidence interval (CI): 0.17-1.00; p = 0.048), fascia iliaca block (OR = 0.39; 95% CI: 0.18-0.84; p = 0.02), hypertonic saline (OR = 0.21; 95% CI: 0.08-0.55; p = 0.001) and rivastigmine patches (OR = 0.23; 95% CI: 0.07-0.77; p = 0.013). All studies were rated as having a high risk of overall bias. CONCLUSIONS. Robust conclusions are precluded by study heterogeneity and high risk of bias in the included studies. However, this systematic review provides an indication of treatments that should be investigated further to establish any effect on delirium in the preoperative setting in hip fracture patients.

AB - INTRODUCTION. Delirium is a syndrome characterised by disturbance of consciousness and is a common complication to hip fractures. This systematic review was conducted to investigate the effect of simple preoperative interventions for the prevention of delirium in patients with hip fractures. The aim was to establish an easily implementable and resource-sparring treatment for the initial admission phase of hip fracture patients aimed at reducing the incidence of delirium. MEHODS. Five databases were searched to identify randomised controlled trials comparing preoperative interventions other than geriatric assessment to placebo or usual care. Our primary outcome was incidence of delirium using a well-defined delirium-screening tool. Secondary outcomes included need for pharmacological treatment, duration of delirium and mortality. RESULTS. A total of 13 RCTs provided data on 2,222 patients who had been exposed to 11 different interventions. Four interventions significantly reduced of the incidence of delirium: methylprednisolone (odds ratio (OR) = 0.42; 95% confidence interval (CI): 0.17-1.00; p = 0.048), fascia iliaca block (OR = 0.39; 95% CI: 0.18-0.84; p = 0.02), hypertonic saline (OR = 0.21; 95% CI: 0.08-0.55; p = 0.001) and rivastigmine patches (OR = 0.23; 95% CI: 0.07-0.77; p = 0.013). All studies were rated as having a high risk of overall bias. CONCLUSIONS. Robust conclusions are precluded by study heterogeneity and high risk of bias in the included studies. However, this systematic review provides an indication of treatments that should be investigated further to establish any effect on delirium in the preoperative setting in hip fracture patients.

KW - POSTOPERATIVE DELIRIUM

KW - GERIATRIC-PATIENTS

KW - ELDERLY-PATIENTS

KW - PAIN MANAGEMENT

KW - OLDER PATIENTS

KW - RISK-FACTORS

KW - DOUBLE-BLIND

KW - SURGERY

KW - BLOCK

KW - RIVASTIGMINE

M3 - Review

VL - 69

JO - Danish Medical Journal

JF - Danish Medical Journal

SN - 2245-1919

IS - 7

M1 - 09210679

ER -