Program helps reduce risk of delirium, hospital length of stay for older patients undergoing surgery

May 24, 2017

Older patients who underwent major abdominal surgery and received an intervention that included nutritional assistance and early mobilization were less likely to experience delirium and had a shorter hospital stay, according to a study published by JAMA Surgery.

Older patients undergoing abdominal surgery commonly experience preventable delirium, which extends their hospital length of stay (LOS). Implementing effective interventions to prevent delirium and reduce LOS is a clinical priority. Guan-Hua Huang, Ph.D., of National Chiao Tung University, Hsinchu, Taiwan, and colleagues randomly assigned 377 patients (65 years of age or older) undergoing abdominal surgery for a malignant tumor to an intervention (n = 197) or usual care (n = 180).

The intervention, modified Hospital Elder Life Program (mHELP), consisted of three protocols administered daily by a nurse: orienting communication (such as inquiring about information in the context of the present day to reinforce orientation); oral (including brushing teeth) and nutritional assistance; and early mobilization. Intervention group participants received all three mHELP protocols postoperatively, in addition to usual care, as soon as they arrived in the inpatient ward and until hospital discharge.

Postoperative delirium occurred in 6.6 percent of mHELP participants vs 15.1 percent of control individuals (odds of delirium reduced by 56 percent). Intervention group participants received the mHELP for a median of 7 days, and they had a median LOS that was two days shorter (12 vs 14 days).

Several limitations of the study are noted in the article, including that data on postoperative complications were not collected, which are important risk factors for delirium and might have also been affected by mHELP and contributed to the study findings.

"The key to the effectiveness of the 3 mHELP components is their consistent and daily application, with high adherence rates. Medical centers that want to advance postoperative care for older patients might consider mHELP as a highly effective starting point for delirium prevention," the authors write.
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For more details and to read the full study, please visit the For The Media website.

(JAMA Surgery. Published online May 24, 2017.doi:10.1001/jamasurg.2017.1083)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Related material: The commentary, "Interventions to Reduce Postoperative Delirium," by Pasithorn A. Suwanabol, M.D., and Daniel B. Hinshaw, M.D., of the University of Michigan, Ann Arbor, also is available at the For The Media website.

To place an electronic embedded link to this study in your story: This link will be live at the embargo time: http://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/jamasurg.2017.1083

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