The effect of a pre- and postoperative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial (Oslo Orthogeriatric Trial)
1 Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
2 University of Oslo, Institute of Clinical Medicine, Oslo, Norway
3 Department of General Internal Medicine, Oslo University Hospital, Oslo, Norway
4 Department of Cardiovascular Sciences, University of Leicester School of Medicine, Leicester, UK
5 Norwegian Centre for Ageing and Health, Vestfold Mental Health Trust, Vestfold, Norway
6 Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
7 Department of Cardiology, Oslo University Hospital, Oslo, Norway
8 Department of Anesthesiology, Oslo University Hospital, Oslo, Norway
9 Department of Geriatrics, St. Olav Hospital, University Hospital of Trondheim, Trondheim, Norway
10 Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
11 School of Pharmacy, University of Oslo, Oslo, Norway
BMC Medicine 2014, 12:63 doi:10.1186/1741-7015-12-63Published: 15 April 2014
Delirium is a common complication in patients with hip fractures and is associated with an increased risk of subsequent dementia. The aim of this trial was to evaluate the effect of a pre- and postoperative orthogeriatric service on the prevention of delirium and longer-term cognitive decline.
This was a single-center, prospective, randomized controlled trial in which patients with hip fracture were randomized to treatment in an acute geriatric ward or standard orthopedic ward. Inclusion and randomization took place in the Emergency Department at Oslo University hospital. The key intervention in the acute geriatric ward was Comprehensive Geriatric Assessment including daily interdisciplinary meetings. Primary outcome was cognitive function four months after surgery measured using a composite outcome incorporating the Clinical Dementia Rating Scale (CDR) and the 10 words learning and recalls tasks from the Consortium to Establish a Registry for Alzheimer’s Disease battery (CERAD). Secondary outcomes were pre- and postoperative delirium, delirium severity and duration, mortality and mobility (measured by the Short Physical Performance Battery (SPPB)). Patients were assessed four and twelve months after surgery by evaluators blind to allocation.
A total of 329 patients were included. There was no significant difference in cognitive function four months after surgery between patients treated in the acute geriatric and the orthopedic wards (mean 54.7 versus 52.9, 95% confidence interval for the difference -5.9 to 9.5; P = 0.65). There was also no significant difference in delirium rates (49% versus 53%, P = 0.51) or four month mortality (17% versus 15%, P = 0.50) between the intervention and the control group. In a pre-planned sub-group analysis, participants living in their own home at baseline who were randomized to orthogeriatric care had better mobility four months after surgery compared with patients randomized to the orthopedic ward, measured with SPPB (median 6 versus 4, 95% confidence interval for the median difference 0 to 2; P = 0.04).
Pre- and postoperative orthogeriatric care given in an acute geriatric ward was not effective in reducing delirium or long-term cognitive impairment in patients with hip fracture. The intervention had, however, a positive effect on mobility in patients not admitted from nursing homes.
ClinicalTrials.gov NCT01009268 Registered November 5, 2009