Multi-Component Care Bundle in Geriatric Fracture Hip for Reducing Post-Operative Delirium

Background: Delirium in elderly orthopaedic patients poses an enormous medical, social and financial burden to the healthcare system, and causes significant distress to patients and their caregivers. We examined whether a Multi-component Care Bundle (MCB) could reduce the incidence of post-operative delirium (POD) in fractured hip patients. Methods: An observational study was conducted, analyzing 154 patients (mean age +/- SD, 85 +/- 7.8, 68% women) admitted to Queen Mary Hospital with hip fracture. Half of the patients were cared for in the control group before MCB was introduced, which included installation of orientation aids, introduction of a Caregiver Empowerment Program, and incorporation of ultrasound-guided Fascia Iliaca Block (FIB) into the analgesia protocol. Results: There were fewer patients with POD in the MCB group, compared with the control group (18/76, 23.4% v 34/76, 44.2%, p = 0.006). Patients in MCB group consumed less opioid ( 4/77 v 13/77, p = 0.048), experienced less post-operative dizziness (2/77, 2.6% v 13/77, 16.9%, p = 0.003) and had a shorter median day to start walking post-operatively (day 1 [IQR 1-2] vs day 2 [IQR 2-3]; p = 0.001) than the control group. Length of stay was not affected. Conclusion: MCB effectively reduces POD, postoperative dizziness, opioid consumption, and days to start mobilization postoperatively.