Outcomes of a Geriatric Liaison Intervention to Prevent the Development of Postoperative Delirium in Frail Elderly Cancer Patients: Report on a Multicentre, Randomized, Controlled Trial

Abstract

BackgroundDelirium is a serious and common postoperative complication, especially in frail elderly patients. The aim of this study was to evaluate the effect of a geriatric liaison intervention in comparison with standard care on the incidence of postoperative delirium in frail elderly cancer patients treated with an elective surgical procedure for a solid tumour.MethodsPatients over 65 years of age who were undergoing elective surgery for a solid tumour were recruited to a multicentre, prospective, randomized, controlled trial. The patients were randomized to standard treatment versus a geriatric liaison intervention. The intervention consisted of a preoperative geriatric consultation, an individual treatment plan targeted at risk factors for delirium, daily visits by a geriatric nurse during the hospital stay and advice on managing any problems encountered. The primary outcome was the incidence of postoperative delirium. The secondary outcome measures were the severity of delirium, length of hospital stay, complications, mortality, care dependency, quality of life, return to an independent preoperative living situation and additional care at home.ResultsIn total, the data of 260 patients were analysed. Delirium occurred in 31 patients (11.9%), and there was no significant difference between the incidence of delirium in the intervention group and the usual-care group (9.4% vs. 14.3%, OR: 0.63, 95% CI: 0.29–1.35).ConclusionsWithin this study, a geriatric liaison intervention based on frailty for the prevention of postoperative delirium in frail elderly cancer patients undergoing elective surgery for a solid tumour has not proven to be effective.Trial RegistrationNederlands Trial Register Trial ID NTR 823

Predicting postoperative delirium after vascular surgical procedures

“…A recent study in frail elderly cancer patients undergoing surgery for a solid tumor reported an incidence of only 11.9%. 28 Two other large studies found similar low percentages of 9% and 8%, respectively. 14,29 Second, we included patients undergoing various vascular surgery procedures.…”

The effects of a tailored intensive care unit delirium prevention protocol: A randomized controlled trial

“…Likewise, a reduced incidence and the severity of delirium was observed after the application of a randomized controlled intervention, led by an expert in geriatrics, which involved access to oxygen, maintenance of fluid electrolyte balance, pain management, and promotion of exercise in post-surgery elderly patients (Marcantonio et al, 2001). In contrast to these studies, other investigators have reported that applying a delirium-prevention protocol had no significant effects on patient outcomes (Cole et al, 2002;Hempenius et al, 2013;Jeffs et al, 2013;Lee et al, 2007). In this study, a decrease in 7-day mortality was observed; this decrease was probably because the researchers considered the first 2-3 days after ICU admission as the peak for delirium.…”

Understanding cognition in older patients with cancer

“…Hempenius et al conducted a randomized controlled trial of a geriatric liaison intervention to prevent postoperative delirium after elective surgery for a solid tumor. 92 Again, there was no difference in the incidence of delirium between the intervention and usual care groups. Concerns have been raised about the potency of the interventions in both of these studies.…”