Program Helps Reduce Risk of Delirium, Hospital Length of Stay for Older Surgical Patients

Older patients who underwent major abdominal surgery and received an intervention that included nutritional assistance and early mobilisation were less likely to experience delirium and had a shorter hospital stay, according to a study published by JAMA Surgery.

Older patients undergoing abdominal surgery commonly experience preventable delirium, which extends their hospital length of stay (LOS). Implementing effective interventions to prevent delirium and reduce LOS is a clinical priority.

For the current study, Guan-Hua Huang, PhD, National Chiao Tung University, Hsinchu, Taiwan, and colleagues randomised 377 patients aged 65 years and older who were undergoing abdominal surgery for a malignant tumour to an intervention (n = 197) or usual care (n = 180).

The intervention — modified Hospital Elder Life Program (mHELP) — consisted of 3 protocols administered daily by a nurse: orienting communication (such as inquiring about information in the context of the present day to reinforce orientation); oral (including brushing teeth) and nutritional assistance; and early mobilisation.

The intervention group received all 3 mHELP protocols postoperatively, in addition to usual care, as soon as they arrived in the inpatient ward and until hospital discharge.

Postoperative delirium occurred in 6.6 5of mHELP participants versus 15.1% of control patients (odds of delirium reduced by 56%).

Intervention group participants received the mHELP for a median of 7 days, and they had a median LOS that was 2 days shorter than the control group (12 vs 14 days).

Several limitations of the study are noted in the article, including that data on postoperative complications were not collected, which are important risk factors for delirium and might have also been affected by mHELP and contributed to the study findings.

“The key to the effectiveness of the 3 mHELP components is their consistent and daily application, with high adherence rates,” the authors wrote. “Medical centers that want to advance postoperative care for older patients might consider mHELP as a highly effective starting point for delirium prevention.”