TY - JOUR
T1 - Effects of Ramelteon on the Prevention of Postoperative Delirium in Older Patients Undergoing Orthopedic Surgery
T2 - The RECOVER Randomized Controlled Trial
AU - Oh, Esther S.
AU - Leoutsakos, Jeannie Marie
AU - Rosenberg, Paul B.
AU - Pletnikova, Alexandra M.
AU - Khanuja, Harpal S.
AU - Sterling, Robert S.
AU - Oni, Julius K.
AU - Sieber, Frederick E.
AU - Fedarko, Neal S.
AU - Akhlaghi, Narjes
AU - Neufeld, Karin J.
N1 - Publisher Copyright:
© 2020 American Association for Geriatric Psychiatry
PY - 2021/1
Y1 - 2021/1
N2 - Objectives: Postoperative delirium, associated with negative consequences including longer hospital stays and worse cognitive and physical outcomes, is frequently accompanied by sleep-wake disturbance. Our objective was to evaluate the efficacy and short-term safety of ramelteon, a melatonin receptor agonist, for the prevention of postoperative delirium in older patients undergoing orthopedic surgery. Design: A quadruple-masked randomized placebo-controlled trial (Clinical Trials.gov NCT02324153) conducted from March 2017 to June 2019. Setting: Tertiary academic medical center. Participants: Patients aged 65 years or older, undergoing elective primary or revision hip or knee replacement. Intervention: Ramelteon (8 mg) or placebo Measurements: Eighty participants were randomized to an oral gel cap of ramelteon or placebo for 3 consecutive nights starting the night before surgery. Trained research staff conducted delirium assessments for 3 consecutive days starting on postoperative day (POD) 0, after recovery from anesthesia, and on to POD2. A delirium diagnosis was based upon DSM-5 criteria determined by expert panel consensus. Results: Of 80 participants, five withdrew consent (one placebo, four ramelteon) and four were excluded (four ramelteon) after randomization. Delirium incidence during the 2 days following surgery was 7% (5 of 71) with no difference between the ramelteon versus placebo: 9% (3 of 33) and 5% (2 of 38), respectively. The adjusted odds ratio for postoperative delirium as a function of assignment to the ramelteon treatment arm was 1.28 (95% confidence interval: 0.21–7.93; z-value 0.27; p-value = 0.79). Adverse events were similar between the two groups. Conclusion: In older patients undergoing elective primary or revision hip or knee replacement, ramelteon was not efficacious in preventing postoperative delirium.
AB - Objectives: Postoperative delirium, associated with negative consequences including longer hospital stays and worse cognitive and physical outcomes, is frequently accompanied by sleep-wake disturbance. Our objective was to evaluate the efficacy and short-term safety of ramelteon, a melatonin receptor agonist, for the prevention of postoperative delirium in older patients undergoing orthopedic surgery. Design: A quadruple-masked randomized placebo-controlled trial (Clinical Trials.gov NCT02324153) conducted from March 2017 to June 2019. Setting: Tertiary academic medical center. Participants: Patients aged 65 years or older, undergoing elective primary or revision hip or knee replacement. Intervention: Ramelteon (8 mg) or placebo Measurements: Eighty participants were randomized to an oral gel cap of ramelteon or placebo for 3 consecutive nights starting the night before surgery. Trained research staff conducted delirium assessments for 3 consecutive days starting on postoperative day (POD) 0, after recovery from anesthesia, and on to POD2. A delirium diagnosis was based upon DSM-5 criteria determined by expert panel consensus. Results: Of 80 participants, five withdrew consent (one placebo, four ramelteon) and four were excluded (four ramelteon) after randomization. Delirium incidence during the 2 days following surgery was 7% (5 of 71) with no difference between the ramelteon versus placebo: 9% (3 of 33) and 5% (2 of 38), respectively. The adjusted odds ratio for postoperative delirium as a function of assignment to the ramelteon treatment arm was 1.28 (95% confidence interval: 0.21–7.93; z-value 0.27; p-value = 0.79). Adverse events were similar between the two groups. Conclusion: In older patients undergoing elective primary or revision hip or knee replacement, ramelteon was not efficacious in preventing postoperative delirium.
KW - Delirium
KW - melatonin receptor agonist
KW - orthopedic surgery
KW - ramelteon
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U2 - 10.1016/j.jagp.2020.05.006
DO - 10.1016/j.jagp.2020.05.006
M3 - Article
C2 - 32532654
AN - SCOPUS:85086169544
SN - 1064-7481
VL - 29
SP - 90
EP - 100
JO - American Journal of Geriatric Psychiatry
JF - American Journal of Geriatric Psychiatry
IS - 1
ER -