Reduced perioperative sensory impairment could lower postoperative delirium incidence: a before-and-after study in older patients with hip fracture

Background
Postoperative delirium (POD) is a common complication in older patients. Multicomponent prevention reduces POD but requires substantial resources. The effect of single interventions derived from multicomponent programs remains elusive, but it is essential to assess their effect to identify which components are meaningful. This study investigates whether a single intervention from a multicomponent program may reduce the incidence of POD.

Methods
This prospective, single-center before-and-after study evaluated older surgery patients at a university hospital’s geriatric trauma center between July 2020 and November 2021. Inclusion criteria were age ≥ 70 years and a proximal femoral fracture. A control cohort (CC) left their dentures, vision, and hearing aids on the ward throughout surgery, while an intervention cohort (IC) used them until anesthesia induction and received them back when they regained consciousness. Therefore, IC obtained a transport case for hygienic storage and perioperative device management. The time of sensory aid removal was measured to ensure proper implementation. Outcomes were the incidence of POD (assessed via the 3-min Diagnostic Confusion Assessment Method at admission and twice daily for three days postoperatively), patient satisfaction, and recovery (evaluated via Quality of Recovery-9), length of hospital stay, postoperative monitoring time, Barthel-index, and 30-day mortality.

Results
248 patients were screened for eligibility. Following a dropout rate of n = 166, the cohorts were: CC n = 40 and IC n = 42. Both cohorts had similar baseline and treatment characteristics. The intervention significantly reduced the median time of sensory aid removal (CC 12h 14min, IC 12min, p < 0.001), and the incidence of POD overall (CC 65.0%, IC 40.5%, p = 0.026). The length of hospital stay and long-term recovery outcomes remained insignificant. However, postoperative monitoring time correlated with time of sensory aid removal (r_s = 0.518, p < 0.001, n = 62), and median quality of recovery improved on average (CC 12.75, IC 15.62, p < 0.001).

Conclusion
Reduced perioperative sensory impairment may reduce the incidence of POD, decrease postoperative monitoring time, and be associated with a better postoperative recovery. Therefore, multimodal preventative efforts should include reducing sensory aid removal.

Trial registration
German Clinical Trial Register (DRKS-ID DRKS00022085); 07/07/2020