title: The effect of a pre- and postoperative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial (Oslo Orthogeriatric Trial).
abstract: BACKGROUND
  Delirium is a common complication in patients with hip fractures and is associated with an increased risk of subsequent dementia. The aim of this trial was to evaluate the effect of a pre- and postoperative orthogeriatric service on the prevention of delirium and longer-term cognitive decline.
  
  
  METHODS
  This was a single-center, prospective, randomized controlled trial in which patients with hip fracture were randomized to treatment in an acute geriatric ward or standard orthopedic ward. Inclusion and randomization took place in the Emergency Department at Oslo University hospital. The key intervention in the acute geriatric ward was Comprehensive Geriatric Assessment including daily interdisciplinary meetings. Primary outcome was cognitive function four months after surgery measured using a composite outcome incorporating the Clinical Dementia Rating Scale (CDR) and the 10 words learning and recalls tasks from the Consortium to Establish a Registry for Alzheimer's Disease battery (CERAD). Secondary outcomes were pre- and postoperative delirium, delirium severity and duration, mortality and mobility (measured by the Short Physical Performance Battery (SPPB)). Patients were assessed four and twelve months after surgery by evaluators blind to allocation.
  
  
  RESULTS
  A total of 329 patients were included. There was no significant difference in cognitive function four months after surgery between patients treated in the acute geriatric and the orthopedic wards (mean 54.7 versus 52.9, 95% confidence interval for the difference -5.9 to 9.5; P = 0.65). There was also no significant difference in delirium rates (49% versus 53%, P = 0.51) or four month mortality (17% versus 15%, P = 0.50) between the intervention and the control group. In a pre-planned sub-group analysis, participants living in their own home at baseline who were randomized to orthogeriatric care had better mobility four months after surgery compared with patients randomized to the orthopedic ward, measured with SPPB (median 6 versus 4, 95% confidence interval for the median difference 0 to 2; P = 0.04).
  
  
  CONCLUSIONS
  Pre- and postoperative orthogeriatric care given in an acute geriatric ward was not effective in reducing delirium or long-term cognitive impairment in patients with hip fracture. The intervention had, however, a positive effect on mobility in patients not admitted from nursing homes.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01009268 Registered November 5, 2009.
authors.affiliation: Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway. l.o.watne@gmail.com.
authors.forename: Leiv Otto
authors.initials: LO
authors.lastname: Watne
authors.forename: Anne Cathrine
authors.initials: AC
authors.lastname: Torbergsen
authors.forename: Simon
authors.initials: S
authors.lastname: Conroy
authors.forename: Knut
authors.initials: K
authors.lastname: Engedal
authors.forename: Frede
authors.initials: F
authors.lastname: Frihagen
authors.forename: Geir Aasmund
authors.initials: GA
authors.lastname: Hjorthaug
authors.forename: Vibeke
authors.initials: V
authors.lastname: Juliebo
authors.forename: Johan
authors.initials: J
authors.lastname: Raeder
authors.forename: Ingvild
authors.initials: I
authors.lastname: Saltvedt
authors.forename: Eva
authors.initials: E
authors.lastname: Skovlund
authors.forename: Torgeir Bruun
authors.initials: TB
authors.lastname: Wyller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition / Q000502:physiology*; D003693:Delirium / Q000150:complications / Q000517:prevention & control*; D003704:Dementia / Q000209:etiology / Q000517:prevention & control*; D004636:Emergency Service, Hospital; D005260:Female; D015577:Geriatric Assessment; D005853:Geriatrics; D006620:Hip Fractures / Q000523:psychology* / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D008297:Male; D009985:Orthopedics; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D011446:Prospective Studies; D016896:Treatment Outcome
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