Mayo Clinic Proceedings: Study finds decrease in postoperative delirium in elderly patients

January 18, 2010

ROCHESTER, Minn. -- A recent study, published in the January issue of Mayo Clinic Proceedings, demonstrates that in elderly patients undergoing hip fracture repair under spinal anesthesia with propofol sedation, the prevalence of delirium can be decreased by 50 percent with light sedation, compared to deep sedation.

"These data show that, for every 3.5 to 4.7 patients treated in this manner, one incident of delirium will be prevented," says Frederick Sieber, M.D., primary investigator of the study from the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine in Baltimore. "Therefore, interventions capable of reducing the occurrence of postoperative delirium would be important from a public health perspective."

Several demographic and perioperative variables are associated with postoperative delirium in elderly patients after hip fracture repair. The most important is preoperative dementia. Other risk factors for postoperative delirium include age, systemic disease and functionality. Inhalational and intravenous anesthetics, opioids, benzodiazepines and anticholinergic drugs are all known or suspected risk factors for postoperative delirium.

Although postoperative delirium usually resolves within 48 hours of onset, delirium can persist and is associated with poor functional recovery, increased length of stay in hospitals, higher costs, and greater likelihood of placement in an assisted-living facility after surgery.

In addition to decreasing the prevalence of delirium, lighter sedation in this group of elderly surgical patients was associated with a reduction in delirium that averaged almost one day for each patient in the light sedation group. The effects of lighter sedation were observed in patients with or without preoperative cognitive dysfunction.

Limiting depth of sedation during spinal anesthesia is a simple, safe and cost-effective intervention for preventing postoperative delirium in elderly patients that could be widely and readily adopted, say Dr. Sieber.
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A peer-reviewed journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 80 years and has a circulation of 130,000 nationally and internationally. Articles are available online at www.mayoclinicproceedings.com.



About Mayo Clinic

Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. Doctors from every medical specialty work together to care for patients, joined by common systems and a philosophy of "the needs of the patient come first." More than 3,700 physicians, scientists and researchers and 50,100 allied health staff work at Mayo Clinic, which has sites in Rochester, Minn., Jacksonville, Fla., and Scottsdale/Phoenix, Ariz. Collectively, the three locations treat more than half a million people each year. To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news. For information about research and education visit www.mayo.edu. MayoClinic.com (www.mayoclinic.com) is available as a resource for your health stories.

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