Abstract:
BACKGROUND:Delirium is a serious postoperative condition for which few pharmacologic prevention trials have been conducted. OBJECTIVE:The authors tested the efficacy of perioperative olanzapine administration to prevent postoperative delirium in elderly patients after joint-replacement surgery. METHOD:The authors conducted a randomized, double-blind, placebo-controlled, prophylaxis trial at an orthopedic teaching hospital, enrolling 495 elderly patients age ≥65 years, who were undergoing elective knee- or hip-replacement surgery; 400 patients received either 5 mg of orally-disintegrating olanzapine or placebo just before and after surgery. The primary efficacy outcome was the incidence of (DSM-III-R) delirium. RESULTS:The incidence of delirium was significantly lower in the olanzapine group than in the placebo group; this held true for both knee- and hip-replacement surgery. However, delirium lasted longer and was more severe in the olanzapine group. Advanced age, a high level of medical comorbidity, an abnormal albumin level, and having knee-replacement surgery were independent risk factors for postoperative delirium (Clinicaltrials.gov Identifier: NCT000699946). CONCLUSION:Administration of 10 mg of oral olanzapine perioperatively, versus placebo, was associated with a significantly lower incidence of delirium. These findings suggest that olanzapine prophylaxis of postoperative delirium may be an effective strategy.
journal_name
Psychosomaticsjournal_title
Psychosomaticsauthors
Larsen KA,Kelly SE,Stern TA,Bode RH Jr,Price LL,Hunter DJ,Gulczynski D,Bierbaum BE,Sweeney GA,Hoikala KA,Cotter JJ,Potter AWdoi
10.1176/appi.psy.51.5.409subject
Has Abstractpub_date
2010-09-01 00:00:00pages
409-18issue
5eissn
0033-3182issn
1545-7206pii
51/5/409journal_volume
51pub_type
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