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-98score+/-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.
RCT Entities:
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.
Authors: Babar A Khan; Mohammed Zawahiri; Noll L Campbell; George C Fox; Eric J Weinstein; Arif Nazir; Mark O Farber; John D Buckley; Alasdair Maclullich; Malaz A Boustani Journal: J Hosp Med Date: 2012-06-08 Impact factor: 2.960
Authors: Theodore A Stern; Christopher M Celano; Anne F Gross; Jeff C Huffman; Oliver Freudenreich; Nicholas Kontos; Shamim H Nejad; Jennifer Repper-Delisi; B Taylor Thompson Journal: Prim Care Companion J Clin Psychiatry Date: 2010
Authors: Timothy D Girard; James C Jackson; Pratik P Pandharipande; Brenda T Pun; Jennifer L Thompson; Ayumi K Shintani; Sharon M Gordon; Angelo E Canonico; Robert S Dittus; Gordon R Bernard; E Wesley Ely Journal: Crit Care Med Date: 2010-07 Impact factor: 7.598
Authors: Jacqueline M Leung; Laura P Sands; Ningning Chen; Christopher Ames; Sigurd Berven; Kevin Bozic; Shane Burch; Dean Chou; Kenneth Covinsky; Vedat Deviren; Sakura Kinjo; Joel H Kramer; Michael Ries; Bobby Tay; Thomas Vail; Philip Weinstein; Stacey Chang; Gabriela Meckler; Stacey Newman; Tiffany Tsai; Vanessa Voss; Emily Youngblom Journal: Anesthesiology Date: 2017-10 Impact factor: 7.892
Authors: Rina P Patel; Meredith Gambrell; Theodore Speroff; Theresa A Scott; Brenda T Pun; Joyce Okahashi; Cayce Strength; Pratik Pandharipande; Timothy D Girard; Hayley Burgess; Robert S Dittus; Gordon R Bernard; E Wesley Ely Journal: Crit Care Med Date: 2009-03 Impact factor: 7.598
Authors: Charles H Brown; Andrew LaFlam; Laura Max; Julie Wyrobek; Karin J Neufeld; Khaled M Kebaish; David B Cohen; Jeremy D Walston; Charles W Hogue; Lee H Riley Journal: J Am Geriatr Soc Date: 2016-10-03 Impact factor: 5.562