title: Postoperative delirium in old patients with femoral neck fracture: a randomized intervention study.
abstract: OBJECTIVE
  Delirium is a common postoperative complication in elderly patients which has a serious impact on outcome in terms of morbidity and costs. We examined whether a postoperative multi-factorial intervention program can reduce delirium and improve outcome in patients with femoral neck fractures.
  
  
  METHODS
  One hundred and ninety-nine patients, aged 70 years and over (mean age+/-SD, 82+/-6, 74% women), were randomly assigned to postoperative care in a specialized geriatric ward or a conventional orthopedic ward. The intervention consisted of staff education focusing on the assessment, prevention and treatment of delirium and associated complications. The staff worked as a team, applying comprehensive geriatric assessment, management and rehabilitation. Patients were assessed using the Mini Mental State Examination and the Organic Brain Syndrome Scale, and delirium was diagnosed according to DSM-IV criteria.
  
  
  RESULTS
  The number of days of postoperative delirium among intervention patients was fewer (5.0+/-7.1 days vs 10.2+/-13.3 days, p=0.009) compared with controls. A lower proportion of intervention patients were delirious postoperatively than controls (56/102, 54.9% vs 73/97, 75.3%, p=0.003). Eighteen percent in the intervention ward and 52% of controls were delirious after the seventh postoperative day (p<0.001). Intervention patients suffered from fewer complications, such as decubitus ulcers, urinary tract infections, nutritional complications, sleeping problems and falls, than controls. Total postoperative hospitalization was shorter in the intervention ward (28.0+/-17.9 days vs 38.0+/-40.6 days, p=0.028).
  
  
  CONCLUSIONS
  Patients with postoperative delirium can be successfully treated, resulting in fewer days of delirium, fewer other complications, and shorter length of hospitalization.
authors.affiliation: Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 87 Umeå, Sweden. maria.lundstrom@germed.umu.se
authors.forename: Maria
authors.initials: M
authors.lastname: Lundström
authors.forename: Birgitta
authors.initials: B
authors.lastname: Olofsson
authors.forename: Michael
authors.initials: M
authors.lastname: Stenvall
authors.forename: Stig
authors.initials: S
authors.lastname: Karlsson
authors.forename: Lars
authors.initials: L
authors.lastname: Nyberg
authors.forename: Undis
authors.initials: U
authors.lastname: Englund
authors.forename: Bengt
authors.initials: B
authors.lastname: Borssén
authors.forename: Olle
authors.initials: O
authors.lastname: Svensson
authors.forename: Yngve
authors.initials: Y
authors.lastname: Gustafson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000209:etiology / Q000628:therapy*; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D013997:Time Factors