In-Hospital Haloperidol Use and Perioperative Changes in QTc-Duration.
OBJECTIVE
Haloperidol may prolong ECG QTc-duration but is often prescribed perioperatively to hip-fracture patients. We aimed to determine (1) how QTc-duration changes perioperatively, (2) whether low-dose haloperidol-use influences these changes, and (3) which clinical variables are associated with potentially dangerous perioperative QTc-prolongation (PD-QTc; increase >50 ms or to >500 ms).


METHODS
Prospective cohort study.


METHODS
Tertiary university teaching-hospital.


METHODS
Patients enrolled in a randomized controlled clinical trial of melatonin versus placebo on occurrence of delirium in hip-fracture patients.


METHODS
Data from ECGs made before and after hip surgery (1-3 days and/or 4-6 days post-surgery) were analyzed. QTc-duration was measured by hand, blinded for haloperidol and pre/post-surgery status. Clinical variables were measured at baseline. Mixed model analysis was used to estimate changes in QTc-duration. Risk-factors for PD-QTc were estimated by logistic regression analysis.


RESULTS
We included 89 patients (mean age 84 years, 24% male); 39 were treated with haloperidol. Patients with normal pre-surgery QTc-duration (male ≤430 ms, female ≤450 ms) had a significant increase (mean 12 ms, SD 28) in QTc-duration. A significant decrease (mean 19 ms, SD 34) occurred in patients with prolonged pre-surgery QTc-duration (male >450ms, female >470 ms). Haloperidol-use did not influence the perioperative course of the QTc-interval (p=0.351). PD-QTc (n=8) was not associated with any of the measured risk-factors.


CONCLUSIONS
QTc-duration changed differentially, increasing in patients with normal, but decreasing in patients with abnormal baseline QTc-duration. PD-QTc was not associated with haloperidol-use or other risk-factors. Low-dose oral haloperidol did not affect perioperative QTc-interval.
Nathalie van der Velde, MD, PhD, Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands, Phone: 31-20-5663066, Fax: 31-20-5669325; Email: n.vandervelde@amc.nl.
M T
MT
Blom
S
S
Jansen
A
A
de Jonghe
B C
BC
van Munster
A
A
de Boer
S E
SE
de Rooij
H L
HL
Tan
N
N
van der Velde
D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000494:pharmacology*; D015331:Cohort Studies; D003693:Delirium / Q000150:complications / Q000188:drug therapy; D004562:Electrocardiography / Q000187:drug effects*; D005260:Female; D006220:Haloperidol / Q000008:administration & dosage* / Q000494:pharmacology*; D006620:Hip Fractures / Q000150:complications / Q000601:surgery*; D006761:Hospitals; D006801:Humans; D008297:Male; D008550:Melatonin / Q000627:therapeutic use; D059035:Perioperative Period; D011446:Prospective Studies; D012307:Risk Factors; D016037:Single-Blind Method
D014150:Antipsychotic Agents; D006220:Haloperidol; D008550:Melatonin