Clincial Research : The effect of medication prophylaxis on the incidence of delirium in elderly patients undergoing orthopedic surgery : A meta-analysis

Abstract

Delirium is common in the post-operative period in patients who have undergone orthopedic surgery, and the elderly are especially vulnerable. It leads to increased costs, longer hospital stays and higher rates of discharge to inpatient institutions. Various medications are being utilized to prevent the development of delirium, but there are only a few small studies investigating these agents in randomized controlled trials. This meta-analysis examined whether delirium could be prevented with pharmaceutical agents. : A search was performed for randomized controlled trials from the last ten years, which used medications for delirium prophylaxis in the study population of elderly patients undergoing orthopedic surgery. A random-effects model was used to calculate odds ratios for the incidence of delirium as well as length of hospital stay, a secondary outcome. : 943 patients from four trials were included in the meta-analysis, and results did not show significance in incidence of delirium in patients who received medication compared to those who were given placebo (OR 0.52, 95[percent] CI 0.21, 1.31). Data for secondary outcome of length of hospital stay also did not show a significant difference (mean difference -1.4, 90[percent] CI -3.30, 0.51). : Prophylactic medication in elderly patients undergoing orthopedic surgery does not decrease the incidence of delirium or length of hospital stay. These results may be in part due to a high level of heterogeneity and small sample sizes. More randomized controlled trials are needed to examine delirium prophylaxis, as an effective pharmaceutical agent could lead to better outcomes for patients.