Preventing Postoperative Delirium After Major Noncardiac Thoracic Surgery—A Randomized Clinical Trial

Babar Khan, Anthony J. Perkins, Noll L. Campbell, Sujuan Gao, Sikandar H. Khan, Sophia Wang, Mikita Fuchita, Daniel J. Weber, Ben L. Zarzaur, Malaz Boustani, Kenneth Kesler

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: To assess the efficacy of haloperidol in reducing postoperative delirium in individuals undergoing thoracic surgery. Design: Randomized double-blind placebo-controlled trial. Setting: Surgical intensive care unit (ICU) of tertiary care center. Participants: Individuals undergoing thoracic surgery (N=135). Intervention: Low-dose intravenous haloperidol (0.5 mg three times daily for a total of 11 doses) administered postoperatively. Measurements: The primary outcome was delirium incidence during hospitalization. Secondary outcomes were time to delirium, delirium duration, delirium severity, and ICU and hospital length of stay. Delirium was assessed using the Confusion Assessment Method for the ICU and delirium severity using the Delirium Rating Scale-Revised. Results: Sixty-eight participants were randomized to receive haloperidol and 67 placebo. No significant differences were observed between those receiving haloperidol and those receiving placebo in incident delirium (n=15 (22.1%) vs n=19 (28.4%); p =.43), time to delirium (p =.43), delirium duration (median 1 day, interquartile range (IQR) 1-2 days vs median 1 day, IQR 1-2 days; p =.71), delirium severity, ICU length of stay (median 2.2 days, IQR 1–3.3 days vs median 2.3 days, IQR 1-4 days; p =.29), or hospital length of stay (median 10 days, IQR 8–11.5 days vs median 10 days, IQR 8-12 days; p =.41). In the esophagectomy subgroup (n = 84), the haloperidol group was less likely to experience incident delirium (n=10 (23.8%) vs n=17 (40.5%); p =.16). There were no differences in time to delirium (p =.14), delirium duration (median 1 day, IQR 1-2 days vs median 1 day, IQR 1-2 days; p =.71), delirium severity, or hospital length of stay (median 11 days, IQR 10-12 days vs median days 11, IQR 10-15 days; p =.26). ICU length of stay was significantly shorter in the haloperidol group (median 2.8 days, IQR 1.1–3.8 days vs median 3.1 days, IQR 2.1–5.1 days; p =.03). Safety events were comparable between the groups. Conclusion: Low-dose postoperative haloperidol did not reduce delirium in individuals undergoing thoracic surgery but may be efficacious in those undergoing esophagectomy. J Am Geriatr Soc 66:2289–2297, 2018.

Original languageEnglish (US)
Pages (from-to)2289-2297
Number of pages9
JournalJournal of the American Geriatrics Society
Volume66
Issue number12
DOIs
StatePublished - Dec 1 2018

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Delirium
Thorax
Randomized Controlled Trials
Haloperidol
Length of Stay
Intensive Care Units
Thoracic Surgery
Esophagectomy
Placebos
Confusion
Critical Care

Keywords

  • cognition
  • delirium
  • esophagectomy
  • haloperidol
  • ICU

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Preventing Postoperative Delirium After Major Noncardiac Thoracic Surgery—A Randomized Clinical Trial. / Khan, Babar; Perkins, Anthony J.; Campbell, Noll L.; Gao, Sujuan; Khan, Sikandar H.; Wang, Sophia; Fuchita, Mikita; Weber, Daniel J.; Zarzaur, Ben L.; Boustani, Malaz; Kesler, Kenneth.

In: Journal of the American Geriatrics Society, Vol. 66, No. 12, 01.12.2018, p. 2289-2297.

Research output: Contribution to journalArticle

Khan, Babar ; Perkins, Anthony J. ; Campbell, Noll L. ; Gao, Sujuan ; Khan, Sikandar H. ; Wang, Sophia ; Fuchita, Mikita ; Weber, Daniel J. ; Zarzaur, Ben L. ; Boustani, Malaz ; Kesler, Kenneth. / Preventing Postoperative Delirium After Major Noncardiac Thoracic Surgery—A Randomized Clinical Trial. In: Journal of the American Geriatrics Society. 2018 ; Vol. 66, No. 12. pp. 2289-2297.
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abstract = "Objectives: To assess the efficacy of haloperidol in reducing postoperative delirium in individuals undergoing thoracic surgery. Design: Randomized double-blind placebo-controlled trial. Setting: Surgical intensive care unit (ICU) of tertiary care center. Participants: Individuals undergoing thoracic surgery (N=135). Intervention: Low-dose intravenous haloperidol (0.5 mg three times daily for a total of 11 doses) administered postoperatively. Measurements: The primary outcome was delirium incidence during hospitalization. Secondary outcomes were time to delirium, delirium duration, delirium severity, and ICU and hospital length of stay. Delirium was assessed using the Confusion Assessment Method for the ICU and delirium severity using the Delirium Rating Scale-Revised. Results: Sixty-eight participants were randomized to receive haloperidol and 67 placebo. No significant differences were observed between those receiving haloperidol and those receiving placebo in incident delirium (n=15 (22.1{\%}) vs n=19 (28.4{\%}); p =.43), time to delirium (p =.43), delirium duration (median 1 day, interquartile range (IQR) 1-2 days vs median 1 day, IQR 1-2 days; p =.71), delirium severity, ICU length of stay (median 2.2 days, IQR 1–3.3 days vs median 2.3 days, IQR 1-4 days; p =.29), or hospital length of stay (median 10 days, IQR 8–11.5 days vs median 10 days, IQR 8-12 days; p =.41). In the esophagectomy subgroup (n = 84), the haloperidol group was less likely to experience incident delirium (n=10 (23.8{\%}) vs n=17 (40.5{\%}); p =.16). There were no differences in time to delirium (p =.14), delirium duration (median 1 day, IQR 1-2 days vs median 1 day, IQR 1-2 days; p =.71), delirium severity, or hospital length of stay (median 11 days, IQR 10-12 days vs median days 11, IQR 10-15 days; p =.26). ICU length of stay was significantly shorter in the haloperidol group (median 2.8 days, IQR 1.1–3.8 days vs median 3.1 days, IQR 2.1–5.1 days; p =.03). Safety events were comparable between the groups. Conclusion: Low-dose postoperative haloperidol did not reduce delirium in individuals undergoing thoracic surgery but may be efficacious in those undergoing esophagectomy. J Am Geriatr Soc 66:2289–2297, 2018.",
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author = "Babar Khan and Perkins, {Anthony J.} and Campbell, {Noll L.} and Sujuan Gao and Khan, {Sikandar H.} and Sophia Wang and Mikita Fuchita and Weber, {Daniel J.} and Zarzaur, {Ben L.} and Malaz Boustani and Kenneth Kesler",
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T1 - Preventing Postoperative Delirium After Major Noncardiac Thoracic Surgery—A Randomized Clinical Trial

AU - Khan, Babar

AU - Perkins, Anthony J.

AU - Campbell, Noll L.

AU - Gao, Sujuan

AU - Khan, Sikandar H.

AU - Wang, Sophia

AU - Fuchita, Mikita

AU - Weber, Daniel J.

AU - Zarzaur, Ben L.

AU - Boustani, Malaz

AU - Kesler, Kenneth

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N2 - Objectives: To assess the efficacy of haloperidol in reducing postoperative delirium in individuals undergoing thoracic surgery. Design: Randomized double-blind placebo-controlled trial. Setting: Surgical intensive care unit (ICU) of tertiary care center. Participants: Individuals undergoing thoracic surgery (N=135). Intervention: Low-dose intravenous haloperidol (0.5 mg three times daily for a total of 11 doses) administered postoperatively. Measurements: The primary outcome was delirium incidence during hospitalization. Secondary outcomes were time to delirium, delirium duration, delirium severity, and ICU and hospital length of stay. Delirium was assessed using the Confusion Assessment Method for the ICU and delirium severity using the Delirium Rating Scale-Revised. Results: Sixty-eight participants were randomized to receive haloperidol and 67 placebo. No significant differences were observed between those receiving haloperidol and those receiving placebo in incident delirium (n=15 (22.1%) vs n=19 (28.4%); p =.43), time to delirium (p =.43), delirium duration (median 1 day, interquartile range (IQR) 1-2 days vs median 1 day, IQR 1-2 days; p =.71), delirium severity, ICU length of stay (median 2.2 days, IQR 1–3.3 days vs median 2.3 days, IQR 1-4 days; p =.29), or hospital length of stay (median 10 days, IQR 8–11.5 days vs median 10 days, IQR 8-12 days; p =.41). In the esophagectomy subgroup (n = 84), the haloperidol group was less likely to experience incident delirium (n=10 (23.8%) vs n=17 (40.5%); p =.16). There were no differences in time to delirium (p =.14), delirium duration (median 1 day, IQR 1-2 days vs median 1 day, IQR 1-2 days; p =.71), delirium severity, or hospital length of stay (median 11 days, IQR 10-12 days vs median days 11, IQR 10-15 days; p =.26). ICU length of stay was significantly shorter in the haloperidol group (median 2.8 days, IQR 1.1–3.8 days vs median 3.1 days, IQR 2.1–5.1 days; p =.03). Safety events were comparable between the groups. Conclusion: Low-dose postoperative haloperidol did not reduce delirium in individuals undergoing thoracic surgery but may be efficacious in those undergoing esophagectomy. J Am Geriatr Soc 66:2289–2297, 2018.

AB - Objectives: To assess the efficacy of haloperidol in reducing postoperative delirium in individuals undergoing thoracic surgery. Design: Randomized double-blind placebo-controlled trial. Setting: Surgical intensive care unit (ICU) of tertiary care center. Participants: Individuals undergoing thoracic surgery (N=135). Intervention: Low-dose intravenous haloperidol (0.5 mg three times daily for a total of 11 doses) administered postoperatively. Measurements: The primary outcome was delirium incidence during hospitalization. Secondary outcomes were time to delirium, delirium duration, delirium severity, and ICU and hospital length of stay. Delirium was assessed using the Confusion Assessment Method for the ICU and delirium severity using the Delirium Rating Scale-Revised. Results: Sixty-eight participants were randomized to receive haloperidol and 67 placebo. No significant differences were observed between those receiving haloperidol and those receiving placebo in incident delirium (n=15 (22.1%) vs n=19 (28.4%); p =.43), time to delirium (p =.43), delirium duration (median 1 day, interquartile range (IQR) 1-2 days vs median 1 day, IQR 1-2 days; p =.71), delirium severity, ICU length of stay (median 2.2 days, IQR 1–3.3 days vs median 2.3 days, IQR 1-4 days; p =.29), or hospital length of stay (median 10 days, IQR 8–11.5 days vs median 10 days, IQR 8-12 days; p =.41). In the esophagectomy subgroup (n = 84), the haloperidol group was less likely to experience incident delirium (n=10 (23.8%) vs n=17 (40.5%); p =.16). There were no differences in time to delirium (p =.14), delirium duration (median 1 day, IQR 1-2 days vs median 1 day, IQR 1-2 days; p =.71), delirium severity, or hospital length of stay (median 11 days, IQR 10-12 days vs median days 11, IQR 10-15 days; p =.26). ICU length of stay was significantly shorter in the haloperidol group (median 2.8 days, IQR 1.1–3.8 days vs median 3.1 days, IQR 2.1–5.1 days; p =.03). Safety events were comparable between the groups. Conclusion: Low-dose postoperative haloperidol did not reduce delirium in individuals undergoing thoracic surgery but may be efficacious in those undergoing esophagectomy. J Am Geriatr Soc 66:2289–2297, 2018.

KW - cognition

KW - delirium

KW - esophagectomy

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KW - ICU

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