Evidence map›Paper›PMID 30857604›Full record

Trial reportBritish journal of anaesthesia2019

Depth of sedation as an interventional target to reduce postoperative delirium: mortality and functional outcomes of the Strategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients randomised clinical trial.

Frederick Sieber, Karin J Neufeld, Allan Gottschalk, George E Bigelow, Esther S Oh, Paul B Rosenberg, Simon C Mears, Kerry J Stewart, Jean-Pierre P Ouanes, Mahmood Jaberi and 2 more

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in British journal of anaesthesia, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00590707 (A Strategy to Reduce the Incidence of Post-Operative Delirium in Elderly Patients), which is not on this map. Cited by 33 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
33citing papers in PubMed, 7 pooled it
6.4field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00590707 nacompletednot on this map

A Strategy to Reduce the Incidence of Post-Operative Delirium in Elderly Patients

TypeinterventionalSponsorJohns Hopkins UniversityRan2005 to 2017Enrolled200ConditionsHip Fractures, DeliriumArmsDeeper sedation, Moderate sedation
3 · Its place in the literature

Who cites it

33 citing papers in PubMed, 7 syntheses or guidelines pooled it, 72 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. [Effects of Dexmedetomidine on the Recovery Quality of Donors Undergoing Pure Laparoscopic Donor Hepatectomy].Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition · 2024
    Trial
  9. Trial
  10. Trial
  11. Trial
  12. Trial
  13. Trial
  14. Trial
  15. Article
  16. Article
  17. Article
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors at 6 institutions in 1 country.

Frederick SieberDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA. Electronic address: fsieber1@jhmi.edu.
Karin J NeufeldDepartment of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Allan GottschalkDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA; Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA.
George E BigelowBehavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, BPRU, JV Brady Behavioral Biology Research Center, Baltimore, MD, USA.
Esther S OhDivision of Geriatric Medicine and Gerontology, Psychiatry and Behavioral Sciences and Neuropathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Paul B RosenbergDepartment of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Simon C MearsDepartment of Orthopedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Kerry J StewartDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Jean-Pierre P OuanesDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
Mahmood JaberiDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
Erik A HasenboehlerAdult and Trauma Surgery, Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
Nae-Yuh WangDepartments of Medicine, Johns Hopkins University, Baltimore, MD, USA; Biostatistics, Johns Hopkins University, Baltimore, MD, USA; Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
Johns Hopkins University · USJohns Hopkins Bayview Medical Center · USJohns Hopkins Hospital · USJohns Hopkins Medicine · USBehavioral Pharma (United States) · USUniversity of Arkansas for Medical Sciences · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe Strategy to Reduce the Incidence of Postoperative Delirium in the Elderly trial tested the hypothesis that limiting sedation during spinal anaesthesia decreases in-hospital postoperative delirium after hip fracture repair. This manuscript reports the secondary outcomes of this trial, including mortality and function.

methodsTwo hundred patients (≥65 yr) undergoing hip fracture repair with spinal anaesthesia were randomised to heavier [modified Observer's Assessment of Alertness/Sedation score (OAA/S) 0-2] or lighter (OAA/S 3-5) sedation, and were assessed for postoperative delirium. Secondary outcomes included mortality and return to pre-fracture ambulation level at 1 yr. Kaplan-Meier analysis, multivariable Cox proportional hazard model, and logistic regression were used to evaluate intervention effects on mortality and odds of ambulation return.

resultsOne-year mortality was 14% in both groups (log rank P=0.96). Independent risk factors for 1-yr mortality included: Charlson comorbidity index [hazard ratio (HR)=1.23, 95% confidence interval (CI), 1.02-1.49; P=0.03], instrumental activities of daily living [HR=0.74, 95% CI, 0.60-0.91; P=0.005], BMI [HR=0.91, 95% CI 0.84-0.998; P=0.04], and delirium severity [HR=1.20, 95% CI, 1.03-1.41; P=0.02]. Ambulation returned to pre-fracture levels, worsened, or was not obtained in 64%, 30%, and 6% of 1 yr survivors, respectively. Lighter sedation did not improve odds of ambulation return at 1 yr [odds ratio (OR)=0.76, 95% CI, 0.24-2.4; P=0.63]. Independent risk factors for ambulation return included Charlson comorbidity index [OR=0.71, 95% CI, 0.53-0.97; P=0.03] and delirium [OR=0.32, 95% CI, 0.10-0.97; P=0.04].

conclusionsThis study found that in elderly patients having hip fracture surgery with spinal anaesthesia supplemented with propofol sedation, heavier intraoperative sedation was not associated with significant differences in mortality or return to pre-fracture ambulation up to 1 yr after surgery. CLINICAL

trial registrationClinicalTrials.gov NCT00590707.

Indexed as

Activities of Daily LivingAgedAged, 80 and overAnesthesia, SpinalDeep SedationDose-Response Relationship, DrugEmergence DeliriumFemaleHand StrengthHip FracturesHumansHypnotics and SedativesKaplan-Meier EstimateMaleMarylandPostoperative ComplicationsHypnotics and SedativesPropofolactivities of daily livinganaesthesia, spinaldeliriumhip fracturesmortality

Identifiers

PMID30857604
PMCPMC6435903
OpenAlexW2911959488

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.