Delirium Reduced With Intravenous Acetaminophen in Geriatric Hip Fracture Patients

Abstract

Introduction: Postoperative delirium is associated with opioid use in the elderly and is a common complication of geriatric hip fractures, with reported incidences from 16% to 70%. Intravenous (IV) acetaminophen is a safe and efficacious medication in elderly patients and has been shown to reduce use of opioids after hip fracture. At our institution, IV acetaminophen was implemented for the first 24 hours postoperatively as part of a multimodal pain control regimen for geriatric hip fracture patients. Methods: A retrospective review of 123 hip fragility fracture patients older than 60 years from January 2016 to December 2016 was performed. Delirium was identified using a validated chart–based review tool. The rate of delirium, as well as length of stay, pain scores, opioid administration, need for one-to-one supervision, and readmissions were analyzed. Results: Sixty-five patients (52.8%) received IV acetaminophen during this period. No notable differences were found in baseline characteristics between groups. Ten of 65 patients receiving IV acetaminophen postoperatively experienced delirium compared with 19 of 58 who did not receive the medication (15.4% versus 32.8%, P = 0.024). The IV acetaminophen group also required fewer doses of IV opioids on postoperative day 1 (0.37 versus 1.19 doses, P = 0.008), were less likely to require one-to-one supervision (9.2% versus 24.1%, P = 0.025), and had shorter lengths of hospital stay (6.37 versus 8.47 days, P = 0.037). Readmission rates and discharge dispositions did not vary with significance between the two groups. Conclusion: The inclusion of IV acetaminophen as part of a multimodal pain regimen led to fewer episodes of delirium in this study. The reduced use of opioids immediately after surgery may have been a large factor in this outcome. Lower delirium rates may reduce the utilization of inpatient resources for direct patient supervision and provide for shorter hospital stays.

Factors associated with post-operative delirium in hip fracture patients: what should we care

“…Studies [ 28 , 29 ] have shown that elderly patients with hip fractures ≥ 73 years of age are 1.83 times more likely to develop delirium after surgery than those aged < 73 years. Studies [ 30 , 31 ] have shown that age is attributable to preoperative malnutrition in elderly patients with medullary fractures, and it is one of the main risk factors of delirium in elderly patients, which is consistent with the results of this study.…”

The Influencing Factors of Postoperative Delirium in Elderly Hip Fracture Patients: What Should Treatment Focus On

“…Studies [28,29] have shown that elderly patients with hip fractures ≥73 years of age are 1.83 times more likely to develop delirium after surgery than those aged <73 years. At the same time, studies [30,31] have shown that age is attributable to preoperative malnutrition in elderly patients with medullary fractures, and it is one of the main risk factors of delirium in elderly patients, which is consistent with the results of this study.…”

Noteworthy Literature From 2019 for Cardiothoracic Critical Care

“…13 Across surgical disciplines, studies have shown that multimodal analgesia, along with decreased opiate usage, may be associated with lower rates of POD. 14,15 Dexmedetomidine, an α-2 agonist with sedative and analgesic properties, has demonstrated an opioid-sparing effect in cardiac surgery patients 16 and has shown promise in reducing delirium in this patient population when used instead of propofol. 10 Acetaminophen may be particularly effective in reducing opioid requirements.…”

“…Overall, this study is consistent with a growing body of evidence indicating that nonopioid analgesia may contribute to decreased rates of POD across surgical specialties. 14,15 Further research is needed to confirm the specific utility of acetaminophen in reducing POD risk in cardiac surgery patients, as demonstrated in the DEXACET trial.…”