Family involvement cuts postoperative delirium risk

  • Wang YY & al.
  • JAMA Intern Med
  • 21 Oct 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • A tailored hospital elder life programme that involves family (t-HELP) reduced the risk for postoperative delirium in older adults by 86%.

Why this matters

  • Postoperative delirium is associated with declines in cognitive function.

Key results

  • Incidence of postoperative delirium: 2.6% with intervention vs 19.4% with usual care (relative risk, 0.14; 95% CI, 0.05-0.38).
  • Only 5.9 patients needed to be treated to prevent 1 case of postoperative delirium.
  • At discharge, vs usual care, intervention yielded:
    • Less decline in activities of daily living (median, −5 vs −20; P<.001>
    • Less decline in instrumental activities of daily living (median, −2 vs −4; P<.001>
    • Lower incidence of decline in cognitive function on Short Portable Mental Status Questionnaire (level 1, 0.8% vs 7.0%; P=.009).
  • Mean length of stay shorter with intervention (12.15 vs 16.41 days; P<.001>

Study design

  • Chinese cluster–randomised controlled trial on 6 surgical floors.
  • 281 patients randomly assigned to nursing units providing intervention or usual care.
  • Intervention: 7 days, with family involvement in 3 universal protocols (orientation, therapeutic activities, early mobilisation)+8 targeted protocols tailored to delirium-related risk factors.
  • Main outcome: postoperative delirium (Confusion Assessment Method).
  • Funding: National Key Research and Development Program of the Ministry of Science and Technology of China; others.

Limitations

  • Possible compromise of blinding.
  • Unknown generalisability.
  • Long-term benefits not assessed.