高齢者股関節骨折患者における周術期せん妄を軽減するための品質管理サークル介入の実施：パイロットスタディ

Delirium is a common perioperative complication among older adults undergoing surgery for hip fractures. It is associated with increased risks of recurrent fractures, prosthesis-related complications, such as loosening, breakage, or dislocation, and overall delayed recovery. The etiology of delirium is multifactorial, involving intrinsic and precipitating factors spanning physiological, psychological, and environmental domains. Quality control circle (QCC) activities, defined as collaborative, problem-solving initiatives led by teams with shared or complementary responsibilities, are designed to promote continuous improvements in healthcare quality.

The aim of this pilot study is to evaluate the effectiveness of QCC-based interventions in reducing the incidence of perioperative delirium among older adults with hip fractures.

A double-blinded pilot study was conducted involving 90 older adults diagnosed with hip fractures between April 2022 and September 2023. Participants were assigned to either a control group (n = 46), receiving standard delirium management, or an intervention group (n = 44), which received additional QCC-based care strategies. Interventions included early mobilization, optimization of sleep duration and quality, cognitive and orientation support, and targeted delirium education for both patients and caregivers. Outcomes compared between groups included the incidence and duration of perioperative delirium, night-time sleep duration, and sleep quality index.

The incidence of perioperative delirium was lower in the intervention group (9.0%) compared to the control group (17.4%). The duration of delirium episodes was significantly shorter in the intervention group (p < 0.001). In addition, the intervention group demonstrated significantly longer nocturnal sleep durations (p < 0.001) and higher sleep quality index scores (p < 0.001) compared to the control group.

The integration of QCC-based interventions was associated with a reduced incidence and duration of perioperative delirium in older adults with hip fractures. Improvements in sleep quality and night-time sleep duration were observed, indicating that QCC activities may contribute to enhanced postoperative recovery in this population. However, these findings should be interpreted with caution given the relatively small sample size and single-center design.