Diagnostic accuracy of the 3-minute diagnostic interview for confusion assessment method-defined delirium in delirium detection: a systematic review and meta-analysis

Outcomes of a delirium prevention program after major abdominal emergency surgery: An interventional study

BACKGROUND

Postoperative delirium is a common complication after emergency surgery. Delirium is associated with increased morbidity and mortality. Clinical approach varies and pharmacological treatment is ineffective. We aimed to investigate if a structured non-pharmacological multidisciplinary intervention could reduce postoperative delirium.

METHODS

An interventional study including all patients aged 65 years or older undergoing major abdominal emergency surgery in an 8 month period. The intervention consisted of improved screening, staff, patient, and family education, ward modifications and nurse-led daily motor and sensory stimulation. Data was obtained from medical records. Results were compared to an unmatched historic cohort. Primary outcome was occurrence of delirium, secondary outcomes were mortality, postoperative complications, and length of stay.

RESULTS

312 patients were included, 81 in the study group and 231 in the control group. Delirium occurred in 6.2% of the interventional group compared to 15.2% in the historic cohort (p = 0.038). In a multivariate regression analysis, the rate of delirium was significantly reduced in the interventional group; OR 0.185 95% CI (0.04-0.81), p = 0.026. The 90 day mortality was 14.8% in the interventional group and 8.7% in the historic cohort (p = 0.116). The rate of overall medical complications was significantly lower in the study group (37% vs. 63%, p < 0.001). Median length of stay was 6 days in both groups.

CONCLUSIONS

A structured cluster intervention may prevent the occurrence of postoperative delirium. The intervention did not reduce mortality or length of stay, but the need for supplementary nursing staff was eliminated.

Effect of hospital elder life program on the incidence of delirium: A systematic review and meta-analysis of clinical trials

OBJECTIVE

This meta-analysis aims to investigate the effect of the Hospital Elder Life Program (HELP) on the incidence of delirium, delirium scores, length of hospital stay, and incidence of falls.

METHODS

Four databases (PubMed, Embase, Cochrane Library, and Web of Science) were searched from inception until January 18, 2024. The search specifically targeted randomized controlled trials (RCTs). Two independent researchers conducted literature screening, quality assessment, and data extraction. The meta-analysis was performed using Review Manager 5.4.1 and Stata 15.1 software.

RESULTS

The final analysis included a total of 9 RCTs with 2583 patients. The findings from the meta-analysis indicated that HELP was found to considerably reduce the incidence of delirium and the length of hospital stay when compared to the control group. Nevertheless, no statistically significant differences were observed between the two groups in terms of delirium scores and fall rates.

CONCLUSION

In this meta-analysis, HELP can effectively reduce the incidence of delirium and lead to a shorter hospital stay.