Low-dose haloperidol does not prevent delirium after noncardiac thoracic surgery

Reference

Khan BA, Perkins AJ, Campbell NL, et al. Preventing postoperative delirium after major noncardiac thoracic surgery—a randomized clinical trial. J Am Geriatr Soc 2018;66(12):2289-2297.

Synopsis

These researchers randomly assigned 135 adults who were undergoing noncardiac thoracic surgery to an immediate postoperative intravenous bolus of 0.5 mg haloperidol or placebo followed by 10 more doses 3 times daily of the same. The researchers excluded patients with schizophrenia, Parkinson's disease, severe dementia, alcohol abuse, neuroleptic malignant syndrome, haloperidol allergy, a prolonged QT interval, or who were pregnant, breast feeding, or taking cholinesterase inhibitors or levodopa. Using standardized scales, trained staff unaware of treatment assignment assessed each patient for the presence of delirium and severity (if present) in the morning and in the afternoon. The authors don't describe evaluating outcomes by intention to treat, the absence of which could bias the data in favor of haloperidol. Most of the patients (62%) underwent esophagectomy. Overall, the rate of delirium in haloperidol-treated patients was similar (22%) to the rate in placebo-treated patients (28%). Among those who developed delirium, haloperidol did not delay its onset, shorten its duration, or lessen its severity. Additionally, the patients taking haloperidol did not have shorter hospitalizations or time in the intensive care unit. Among the patients undergoing esophagectomy, there were no statistically significant differences in any outcomes other than slightly shorter intensive care unit duration (2.8 vs 3.1 days).