Preventing Postoperative Delirium in Older Adults with Hip Fracture: A Randomised Controlled Trial of a Reorientation Intervention

Abstract Postoperative delirium (POD) is a common complication in geriatric patients undergoing hip fracture surgery. This study evaluated the effectiveness of a short postoperative reorientation intervention in reducing the incidence and duration of POD. In this randomised controlled trial, 62 patients aged > 75 undergoing hip fracture surgery were recruited. Preoperative cognitive assessments were conducted using the Montreal Cognitive Assessment (MOCA) and delirium screening with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Daily evaluations using CAM-ICU were performed for seven postoperative days. The intervention group received structured reorientation sessions and a five-minute news briefing daily. The trial was comprised of 62 participants (80.6% female, mean age 82 ± 6 years), with 49% having preoperative cognitive impairment associated with delirium development (p = 0.02). Incidence rates of delirium were similar in both groups: 20% vs. 25% in controls (p = 0.82). However, the duration of delirium was significantly shorter in the intervention group (4 vs. 6 days, p < 0.01). Patients in the intervention group were four times more likely to achieve delirium resolution within 7 days (relative risk (RR): 4.13, p = 0.03). The reorientation intervention significantly reduced the duration of delirium post-hip fracture surgery, but did not affect overall incidence rates.