Postoperative mental impairment in hip fracture patients - A randomized study of reorientation measures in 223 patients

Mental impairment is a common and serious complication in geriatric surgery . We studied 223 hip fracture patients. They were over 64 years of age (mea n 81), with no history of mental deterioration and acutely admitted to hosp ital from independent living conditions. They were randomized into two grou ps. One of these was subjected to reorientation measures during the periope rative phase, i.e., presurgery admission to the orthopedic ward, accompanie d home visits during the hospital stay and access to reorientation devices- they received a large clock, calendar, radio, TV-set, telephone and were en couraged to wear their own clothing. Otherwise, there were no differences i n the treatment given to the two groups. We used monitoring of cognitive fu nction with the Short Portable Mental Status Questionnaire (SPMSQ) and a fe edback program for evaluation of the treatment results. There was a low incidence of postoperative cognitive deterioration in both groups, compared with historical controls. However, no difference in mental status was noted when we compared the two groups. The conclusion is that a ttributes were less important than the psychological environment for postop erative mental deterioration. The mean total continuous hospitalization (tr ansfers between departments and hospitals included) in the reorientation gr oup was 22 (95% CI: 17-43) days, the corresponding figures for the controls were 30 (14-29) days.