• Kenneth A Larsen, Susan E Kelly, Theodore A Stern, Robert H Bode, Lori Lyn Price, David J Hunter, Diane Gulczynski, Benjamin E Bierbaum, Gerard A Sweeney, Karen A Hoikala, James J Cotter, and Adam W Potter.
• Beth Israel Deaconess Medical Center, New England Baptist Hospital, Boston, MA, USA.
• Psychosomatics. 2010 Sep 1;51(5):409-18.

BackgroundDelirium is a serious postoperative condition for which few pharmacologic prevention trials have been conducted.ObjectiveThe authors tested the efficacy of perioperative olanzapine administration to prevent postoperative delirium in elderly patients after joint-replacement surgery.MethodThe authors conducted a randomized, double-blind, placebo-controlled, prophylaxis trial at an orthopedic teaching hospital, enrolling 495 elderly patients age ≥65 years, who were undergoing elective knee- or hip-replacement surgery; 400 patients received either 5 mg of orally-disintegrating olanzapine or placebo just before and after surgery. The primary efficacy outcome was the incidence of (DSM-III-R) delirium.ResultsThe incidence of delirium was significantly lower in the olanzapine group than in the placebo group; this held true for both knee- and hip-replacement surgery. However, delirium lasted longer and was more severe in the olanzapine group. Advanced age, a high level of medical comorbidity, an abnormal albumin level, and having knee-replacement surgery were independent risk factors for postoperative delirium (Clinicaltrials.gov Identifier: NCT000699946).ConclusionAdministration of 10 mg of oral olanzapine perioperatively, versus placebo, was associated with a significantly lower incidence of delirium. These findings suggest that olanzapine prophylaxis of postoperative delirium may be an effective strategy.

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