Haloperidol Prophylaxis for Elderly Hip‐Surgery Patients at Risk for Delirium: A Randomized Placebo‐Controlled Study

Sep 27, 2005Journal of the American Geriatrics Society

Haloperidol to prevent delirium in elderly hip surgery patients at risk: a controlled trial

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Abstract

The overall incidence of postoperative delirium was 15.8% among elderly hip-surgery patients.

Patients receiving haloperidol showed a lower incidence of postoperative delirium at 15.1% compared to 16.5% in the placebo group, but this difference was not statistically significant.
Haloperidol treatment resulted in a significantly lower severity of delirium, with mean scores of 14.4 for haloperidol versus 18.4 for placebo.
The duration of delirium was reduced by an average of 6.4 days in patients taking haloperidol compared to those receiving placebo.
Patients treated with haloperidol had a shorter hospital stay, averaging 17.1 days compared to 22.6 days with placebo.
No side effects related to haloperidol were reported.

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OBJECTIVES: To study the effectiveness of haloperidol prophylaxis on incidence, severity, and duration of postoperative delirium in elderly hip-surgery patients at risk for delirium.

DESIGN: Randomized, double-blind, placebo-controlled trial.

SETTING: Large medical school-affiliated general hospital in Alkmaar, The Netherlands.

PARTICIPANTS: A total of 430 hip-surgery patients aged 70 and older at risk for postoperative delirium.

INTERVENTION: Haloperidol 1.5 mg/d or placebo was started preoperatively and continued for up to 3 days postoperatively. Proactive geriatric consultation was provided for all randomized patients.

MEASUREMENTS: The primary outcome was the incidence of postoperative delirium (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and Confusion Assessment Method criteria). Secondary outcomes were the severity of delirium (Delirium Rating Scale, revised version-98 (DRS-R-98)), the duration of delirium, and the length of hospital stay.

RESULTS: The overall incidence of postoperative delirium was 15.8%. The percentage of patients with postoperative delirium in the haloperidol and placebo treatment condition was 15.1% and 16.5%, respectively (relative risk=0.91, 95% confidence interval (CI)=0.6-1.3); the mean highest DRS-R-98 score+/-standard deviation was 14.4+/-3.4 and 18.4+/-4.3, respectively (mean difference 4.0, 95% CI=2.0-5.8; P<.001); delirium duration was 5.4 versus 11.8 days, respectively (mean difference 6.4 days, 95% CI=4.0-8.0; P<.001); and the mean number of days in the hospital was 17.1+/-11.1 and 22.6+/-16.7, respectively (mean difference 5.5 days, 95% CI=1.4-2.3; P<.001). No haloperidol-related side effects were noted.

CONCLUSION: Low-dose haloperidol prophylactic treatment demonstrated no efficacy in reducing the incidence of postoperative delirium. It did have a positive effect on the severity and duration of delirium. Moreover, haloperidol reduced the number of days patients stayed in the hospital, and the therapy was well tolerated.

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Haloperidol Prophylaxis for Elderly Hip‐Surgery Patients at Risk for Delirium: A Randomized Placebo‐Controlled Study

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