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· DOS Abstracts
Effect of prophylactic high-dose methylpredniso-
lone on postoperative delirium in elderly patients
undergoing hip fracture surgery; a double-blind,
randomised, placebo-controlled trial.
Christopher Clemmesen, Troels Haxholdt Lunn, Morten Tange Kristensen, Henrik
Palm, Nicolai Bang Foss
Department of Anaesthesiology, Hvidovre Hospital; Department of Anaes-
thesiology, Hvidovre Hospital; Departments of Physiotherapy & Orthopaedic
Surgery, Hv; Department of Orthopaedic Surgery, Hvidovre ; Department of
Anaesthesiology, Hvidovre Hospital
Background:
Postoperative delirium is a common complication in elderly pa-
tients after hip fracture surgery. Neuroinflammation due to stress response
might be a key element in the pathophysiological mechanisms to most postop-
erative delirium.
Purpose / Aim of Study:
If prophylactic high single dose methylprednisolone
could attenuate the stress response and thereby lower the severity of postop-
erative delirium in elderly patients after hip fracture surgery.
Materials and Methods:
A randomised, double-blind, placebo-controlled trial.
Patients were aged ≥ 65 years, admitted with hip fracture and able to give in-
formed consent. They were allocated to receive either i.v. methylprednisolone
(125 mg), or placebo as soon as possible after admission and confirmed hip
fracture. The primary outcome was severity of postoperative delirium assessed
once daily with the Confusion Assessment Method delirium severity scoring
system for the first three postoperative days.
Findings / Results:
117 patients were included in modified intention-to- treat
analyses of the primary outcome. There was no significant difference in median
cumulated CAM-S score between the methylprednisolone group (1 [IQR 0-6])
and the placebo group (2 [IQR 0-9.5]), p= 0.294. The incidence of postop-
erative delirium (defined as CAM-S > 5) was significantly lower in the methyl-
prednisolone group (10 out of 59 [16.7%]) compared with the placebo group
(19 out of 58 [31.7%] odds ratio [OR] 2.39, 95%CI 1.00 to 5.72;p=0.048).
The median cumulated postoperative fatigue score was significantly lower in
the methylprednisolone group (5 [IQR 2-6]) compared with the placebo group
(6[IQR 4-8]), p=0.008.
Conclusions:
Prophylactic high-dose methylprednisolone to elderly patients
with hip fracture might have a preventive effect on postoperative delirium and
fatigue after surgery.
No conflicts of interest reported
102.