Clinical question: Can a modified Hospital Elder Life Program (mHELP) reduce delirium and hospital LOS in older patients undergoing abdominal surgery?
Background: Development of delirium in the hospitalized patient, especially postsurgical patients, can have detrimental effects on the clinical recovery and LOS. Delirium occurs in 13%-50% of patients undergoing noncardiac surgery, and older surgical patients are at a higher risk.
Study design: Cluster randomized clinical trial.
Synopsis: There were 377 older patients (65 years of age or older) who were admitted for elective abdominal surgery (gastrectomy, pancreaticoduodenectomy, or colectomy) with an expected LOS greater than 6 days enrolled and randomly assigned to mHELP group (197 patients) or control group (180 patients). The mHELP intervention consisted of three core nursing protocols that occurred daily by a trained nurse: orienting communication, oral and nutritional assistance, and early mobilization. Delirium developed in 13 cases (6.6%) in the mHELP group and in 27 cases (15.1%) in the control group. This is a risk reduction of 56% indicating the need to treat 11.8 patients to prevent one case of delirium. The mHELP group had a 2-day hospital LOS reduction, compared with the control group. The effect of mHELP could be underestimated as crossover effects were not accounted for in the study. Data were not collected on postoperative complications which can have a significant effect on delirium occurrence.
Bottom line: The three nursing protocols of mHELP reduced rates of delirium and hospital LOS in older adults undergoing abdominal surgeries and could be a quick intervention to reduce the most common surgical complication in older patients.
Citation: Chen CC, Li HC, Liang JT, et al. Effect of a modified hospital elder life program on delirium and length of hospital stay in patients undergoing abdominal surgery. JAMA Surg. Published online May 24, 2017. doi: 10.1001/jamasurg.2017.1083.
Dr. Newsom is a hospitalist at Ochsner Health System, New Orleans.