Preoperative pharmacological intervention with potential of reducing delirium in patients with hip fractures

Delirium is a common complication to hip fractures and many cases develop preoperatively. The aetiology is often multifactorial and includes physiological stress, hypovolemia, hypotension, pain, and opioid treatment. Virsøe-Frandsen et al conducted a systematic review to investigate the effect of simple preoperative interventions for the prevention of delirium in patients with hip fractures with the aim to implement resource-sparring treatments for the initial admission phase. The study identified four treatments with a potential to reduce preoperative delirium: methylprednisolone, fascia iliaca block, hypertonic saline and rivastigmine patches. As the studies had a high risk of bias, the authors conclude that these treatments should be investigated further in the preoperative setting in hip fracture patients, either in combination or as single interventions.