Efficacy of Low Dose Risperidone Treatment for Postsurgical Delirium in Elderly Orthopedic Patients

Background:
Delirium is an acute and typically reversible failure of essential cognitive and attentional functions and is a growing public health concern, with an incidence of 20-50% in patients older than 65 after major surgery and 61% in patients undergoing hip fracture surgery. Numerous treatment strategies were examined with no conclusive results. The purpose of this study is to assess the efficacy of a 3-day low dose Risperidone treatment protocol, 0.5mg BID, in treating delirium in elderly hospitalized orthopedic surgery department patients.

Methods:
This study is a prospective non-randomized study involving the senior patient population, older than 65, in an Orthopedic Surgery Department between 2019 and 2020. Delirium was diagnosed by a Confusion Assessment Method (CAM) questionnaire. A 3-day 0.5mg Risperidone BID treatment protocol was initiated following diagnosis. Patient data collected included age, gender, chronic diseases, type of surgery and anesthesia and delirium characteristics.

Results:
The cohort`s average age was 84.4 years (± 8.6), and 53.2% were females. Delirium incidence was 3.7% in all patients older than 65 and 9.3% in the proximal femoral fracture group. We did not correlate electrolyte imbalance, anemia, polypharmacy and chronic diseases to delirium onset or characteristics. Following the 3-day low dose Risperidone treatment protocol, 0.5mg BID, 14.9% of the patients showed CAM score normalization after one day of treatment, and 93.6% within two days.

Conclusion:
We found our rigid 3-day low dose Risperidone treatment protocol, 0.5mg BID, efficacious in fast delirium resolution, without side effects.

Keywords:
Delirium, Risperidone, Postsurgical, Elderly, Protocol

Key Points:
Delirium in elderly orthopedic patients is challenging to treat.

No prefered protocol can be identified.

We confirmed the efficiency of 3-day low-dose Risperidone protocol.

Why Does this Paper Matter?

Effective treatment is essential as delirium is an acute reversible failure of key cognitive and attentional functions with agrowing public health concern in older patients.