Bundles of care prevents postoperative delirium in elderly patients with hip fractures

Abstract

Objective To evaluate the effect of bundles of care on the prevention of postoperative delirium among elderly patients with hip fractures. Methods A prospective randomized case control study was conducted on 80 patients (≥65 years old) with hip fractures from March 2017 to June 2017. The patients were divided into experimental group (n=43) and control group (n=37) according to the random number table method. The experimental group received bundles of care, while the control group received routine nursing. The patients in both groups were all surgically treated, and the confusion assessment method (CAM) was applied to diagnose delirium after surgery. Gender, age, fracture type, duration from injury to operation, internal fixation type, operation time, total amount of bleeding, visual analogue scale (VAS), incidence of delirium, complications, and adverse events were compared between the two groups. Results Among the 80 patients, there were 11 males and 69 females, aged averagely 79.3 years (range, 65-95 years). No significant differences were found between experiment group and control group in terms of gender (male: 6 cases vs. 5 cases, females: 37 cases vs. 32 cases), age [(79.8±7.8)years vs. (78.7±8.9)years], cause of injury (traffic injuries: 7 cases vs. 4 cases; falling injuries: 36 cases vs. 33 cases), duration from injury to operation [(66.1±14.3)hours vs. (63.4±14.9)hours], fracture type (femoral neck: 13 cases vs. 10 cases; intertrochanteric: 26 cases vs. 24 cases; subtrochanteric: 4 cases vs. 3 cases), internal fixation type (artificial total hip: 5 cases vs. 5 cases; artificial femoral head: 8 cases vs. 5 cases; PFNA: 29 cases vs. 27 cases), operation time[(55.5±16.8)minutes vs.(51.6±17.0)minutes], total blood loss [(114.4±73.9)ml vs.(108.1±72.0) ml](P>0.05). After bundles of care intervention, the postoperative VAS [(2.2±0.8)points vs. (4.3±1.2) points], postoperative delirium incidence (9% vs. 32%), incidence of complications and adverse events (2% vs. 19%) in experimental group were significantly lower than those in control group (P<0.05). Conclusion Bundles of care can relieve the pain and effectively reduce the incidences of postoperative delirium, complications, and adverse events in elderly patients with hip fracture. Key words: Hip fractures; Delirium; Aged; Care bundle