The risk for incident delirium in older patients who underwent hip fracture repair was not significantly reduced with limited sedation levels, according to a recently published article in JAMA Surgery.
In the STRIDE study, a double-blind randomized clinical trial, researchers randomly assigned 200 patients to undergo non-elective hip fracture repair with either heavier or lighter intraoperative levels of propofol sedation. Mean patient age was 82 years. Follow-up visits were postoperative day 1 to day 5 or until patients were discharged from the hospital where a consensus panel used the Diagnostic and Statistical Manual of Mental Disorders to determine delirium. Investigators compared delirium incidence between the two intervention groups with and without categorization by the Charlson Comorbidity Index.
Results showed the overall risk for incident delirium was 36.5%; in the heavier sedation group it was 39% and in the lighter sedation group it was 34%. Investigators noted there was no statistically significant difference between the groups regarding the risk for incident delirium based on intention-to-treat analyses. Although, when grouped by Charlson Comorbidity Index, the sedation levels did impact delirium risk; both the heavier and lighter sedation levels doubled the risk for delirium in low comorbid states. The delirium risk was not impacted by sedation level if the Charlson Comorbidity Index was more than six. – by Monica Jaramillo
: The research was supported by National Institute on Aging grant R01 AG033615.