POST OPERATIVE DELIRIUM IN ELDERLY PATIENTS UNDERGOING HIP SURGERY: DIAZEPAM VERSUS HALOPERIDOL

Post-operative delirium is transient global disorder showing reduced cognition, altered consciousness and psychomotor activity as well as deranged sleep-wake cycle.  For elderly patients undergoing hip surgery, the reported incidence varies from 16% to 62% with average rate of 35%.  Pharmacotherapy management of post-operative delirium may entail use of drugs belonging to groups like sedatives, antipsychotics, analgesics and others. The aim of this study was to assess the efficacy and safety of diazepam compared to haloperidol in post-operative delirium. A retrospective analysis of all elderly (>65 years) undergoing hip surgery in our department between 2014 to 2016 was done to identify patients developing post-operative delirium and those treated with Diazepam or  with Haloperidol were divided in separate groups.  We compared these groups for parameters like duration of postoperative hospital stay, duration of delirium, number of patients showing complications and adverse events. Total 506 patients meeting inclusion criteria were identified.  Of these, 188 patients were found to have been diagnosed with post-operative delirium. 55 patients were treated with diazepam (Group A) while 73 patients were treated with haloperidol (Group B). There was no statistically significant difference between the groups regarding post-operative hospital stay or duration of delirium. Diazepam group however showed a significantly higher complication rate (20% vs 6.84%). The incidence of side effects was similar in both the groups. Haloperidol appears to be better tolerated and safer in treatment of post-operative delirium.  Diazepam has limited role in treatment of post-operative delrium and should be used cautiously.