Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study.
OBJECTIVE
To study the effectiveness of haloperidol prophylaxis on incidence, severity, and duration of postoperative delirium in elderly hip-surgery patients at risk for delirium.


METHODS
Randomized, double-blind, placebo-controlled trial.


METHODS
Large medical school-affiliated general hospital in Alkmaar, The Netherlands.


METHODS
A total of 430 hip-surgery patients aged 70 and older at risk for postoperative delirium.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Kalisvaart
Kees J
KJ
Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, The Netherlands. k.kalisvaart@mca.nl
de Jonghe
Jos F M
JF
Bogaards
Marja J
MJ
Vreeswijk
Ralph
R
Egberts
Toine C G
TC
Burger
Bart J
BJ
Eikelenboom
Piet
P
van Gool
Willem A
WA
D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003693:Delirium / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D006220:Haloperidol / Q000009:adverse effects / Q000627:therapeutic use*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D015207:Osteoarthritis, Hip / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000517:prevention & control*; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D006220:Haloperidol