Effect of Depth of Sedation in Older Patients Undergoing Hip Fracture Repair on Postoperative Delirium

Abstract

clinicaltrials.gov Identifier: NCT00590707.

Depth of sedation as an interventional target to reduce postoperative delirium: mortality and functional outcomes of the Strategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients randomised clinical trial

“…9 In short, no statistically significant difference in the incidence of postoperative in-hospital delirium was found between the groups, but a significant effect modification by level of comorbidity was observed, where lighter sedation was associated with lower in-hospital delirium incidence in patients with low preoperative comorbidity. 9 In this study, we report the following secondary pre-specified outcomes from the STRIDE trial: persistent delirium at 1 month; change in functional outcomes from preoperative baseline at 1 month and 1 yr follow-up; and mortality at 1 yr after surgery. In addition, exploratory analysis was performed to determine the independent risk factors for 1 yr mortality and return to prefracture ambulation level.…”

Hypnotic depth and postoperative death: a Bayesian perspective and an Independent Discussion of a clinical trial

“…The Original Discussion continues to place emphasis on evaluating lines of research related to comorbidity, which was felt to be an important effect modifier in the prior reporting of the primary outcome of the STRIDE trial. 4…”

“…STRIDE was originally powered for postoperative delirium (primary outcome), reported previously. 4 Although power calculations were performed for mortality (secondary outcome), the mortality incidence in each group (14%) was lower than the preliminary assumption (31.5%); in fact, the absolute risk reduction magnitude (15.5%) for which power was calculated was larger than the actual 1-yr mortality rate in either group. Accordingly, this secondary analysis was underpowered for detecting associations between sedative depth and mortality.…”

“…3 Primary outcome results (on the incidence of inhospital delirium between days 1 and 5) have been previously reported, showing no overall significant benefit with 'lighter' sedation, but a possible effect modification, based on severity of preoperative morbidity, was suggested. 4 The secondary outcomes of interest in the current study were intermediate-term mortality and return to preoperative ambulation level. It has been suggested that an independent Discussion for scientific manuscripts can be useful in objectively assessing inferential reproducibility.…”

State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018

“…For example, a recent randomised trial of EEG-driven anaesthetic management in hip fracture patients found that anaesthetic depth only impacted cognition in a relatively healthy subgroup (A Strategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients [STRIDE]). 116 Future studies should explore alternative approaches for anaesthetic management, notably the use of the EEG waveform and spectrogram in combination, and be large enough to perform subgroup analyses to explore the likelihood of more vulnerable subgroups.…”