TY - JOUR
T1 - Depth of sedation as an interventional target to reduce postoperative delirium
T2 - mortality and functional outcomes of the Strategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients randomised clinical trial
AU - Sieber, Frederick
AU - Neufeld, Karin J.
AU - Gottschalk, Allan
AU - Bigelow, George E.
AU - Oh, Esther S.
AU - Rosenberg, Paul B.
AU - Mears, Simon C.
AU - Stewart, Kerry J.
AU - Ouanes, Jean Pierre P.
AU - Jaberi, Mahmood
AU - Hasenboehler, Erik A.
AU - Wang, Nae Yuh
N1 - Publisher Copyright:
© 2019 British Journal of Anaesthesia
PY - 2019/4
Y1 - 2019/4
N2 - Background: The Strategy to Reduce the Incidence of Postoperative Delirium in the Elderly trial tested the hypothesis that limiting sedation during spinal anaesthesia decreases in-hospital postoperative delirium after hip fracture repair. This manuscript reports the secondary outcomes of this trial, including mortality and function. Methods: Two hundred patients (≥65 yr) undergoing hip fracture repair with spinal anaesthesia were randomised to heavier [modified Observer's Assessment of Alertness/Sedation score (OAA/S) 0–2] or lighter (OAA/S 3–5) sedation, and were assessed for postoperative delirium. Secondary outcomes included mortality and return to pre-fracture ambulation level at 1 yr. Kaplan–Meier analysis, multivariable Cox proportional hazard model, and logistic regression were used to evaluate intervention effects on mortality and odds of ambulation return. Results: One-year mortality was 14% in both groups (log rank P=0.96). Independent risk factors for 1-yr mortality included: Charlson comorbidity index [hazard ratio (HR)=1.23, 95% confidence interval (CI), 1.02–1.49; P=0.03], instrumental activities of daily living [HR=0.74, 95% CI, 0.60–0.91; P=0.005], BMI [HR=0.91, 95% CI 0.84–0.998; P=0.04], and delirium severity [HR=1.20, 95% CI, 1.03–1.41; P=0.02]. Ambulation returned to pre-fracture levels, worsened, or was not obtained in 64%, 30%, and 6% of 1 yr survivors, respectively. Lighter sedation did not improve odds of ambulation return at 1 yr [odds ratio (OR)=0.76, 95% CI, 0.24–2.4; P=0.63]. Independent risk factors for ambulation return included Charlson comorbidity index [OR=0.71, 95% CI, 0.53–0.97; P=0.03] and delirium [OR=0.32, 95% CI, 0.10–0.97; P=0.04]. Conclusions: This study found that in elderly patients having hip fracture surgery with spinal anaesthesia supplemented with propofol sedation, heavier intraoperative sedation was not associated with significant differences in mortality or return to pre-fracture ambulation up to 1 yr after surgery. Clinical trial registration: ClinicalTrials.gov NCT00590707.
AB - Background: The Strategy to Reduce the Incidence of Postoperative Delirium in the Elderly trial tested the hypothesis that limiting sedation during spinal anaesthesia decreases in-hospital postoperative delirium after hip fracture repair. This manuscript reports the secondary outcomes of this trial, including mortality and function. Methods: Two hundred patients (≥65 yr) undergoing hip fracture repair with spinal anaesthesia were randomised to heavier [modified Observer's Assessment of Alertness/Sedation score (OAA/S) 0–2] or lighter (OAA/S 3–5) sedation, and were assessed for postoperative delirium. Secondary outcomes included mortality and return to pre-fracture ambulation level at 1 yr. Kaplan–Meier analysis, multivariable Cox proportional hazard model, and logistic regression were used to evaluate intervention effects on mortality and odds of ambulation return. Results: One-year mortality was 14% in both groups (log rank P=0.96). Independent risk factors for 1-yr mortality included: Charlson comorbidity index [hazard ratio (HR)=1.23, 95% confidence interval (CI), 1.02–1.49; P=0.03], instrumental activities of daily living [HR=0.74, 95% CI, 0.60–0.91; P=0.005], BMI [HR=0.91, 95% CI 0.84–0.998; P=0.04], and delirium severity [HR=1.20, 95% CI, 1.03–1.41; P=0.02]. Ambulation returned to pre-fracture levels, worsened, or was not obtained in 64%, 30%, and 6% of 1 yr survivors, respectively. Lighter sedation did not improve odds of ambulation return at 1 yr [odds ratio (OR)=0.76, 95% CI, 0.24–2.4; P=0.63]. Independent risk factors for ambulation return included Charlson comorbidity index [OR=0.71, 95% CI, 0.53–0.97; P=0.03] and delirium [OR=0.32, 95% CI, 0.10–0.97; P=0.04]. Conclusions: This study found that in elderly patients having hip fracture surgery with spinal anaesthesia supplemented with propofol sedation, heavier intraoperative sedation was not associated with significant differences in mortality or return to pre-fracture ambulation up to 1 yr after surgery. Clinical trial registration: ClinicalTrials.gov NCT00590707.
KW - activities of daily living
KW - anaesthesia, spinal
KW - delirium
KW - hip fractures
KW - mortality
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UR - http://www.scopus.com/inward/citedby.url?scp=85060954146&partnerID=8YFLogxK
U2 - 10.1016/j.bja.2018.12.021
DO - 10.1016/j.bja.2018.12.021
M3 - Article
C2 - 30857604
AN - SCOPUS:85060954146
SN - 0007-0912
VL - 122
SP - 480
EP - 489
JO - British journal of anaesthesia
JF - British journal of anaesthesia
IS - 4
ER -